Dulling the pain
Abby Alpert, David Powell & Rosalie Liccardo Pacula
NBER Working Paper, January 2017
Abstract:
Overdose deaths from prescription opioid pain relievers nearly quadrupled between 1999 and 2010, making this the worst drug overdose epidemic in U.S. history. In response, numerous supply-side interventions have aimed to limit access to opioids. However, these supply disruptions may have the unintended consequence of increasing the use of substitute drugs, including heroin. We study the consequences of one of the largest supply disruptions to date to abusable opioids – the introduction of an abuse-deterrent version of OxyContin in 2010. Our analysis exploits across state variation in exposure to the OxyContin reformulation. Using data from the National Survey on Drug Use and Health (NSDUH), we show that states with higher pre-2010 rates of OxyContin misuse experienced larger reductions in OxyContin misuse, permitting us to isolate consumer substitution responses. We estimate large differential increases in heroin deaths immediately after reformulation in states with the highest initial rates of OxyContin misuse. We find less evidence of differential reductions in overall opioid-related deaths, potentially due to substitution towards other opioids, including more harmful synthetic opioids such as fentanyl. Our results imply that a substantial share of the dramatic increase in heroin deaths since 2010 can be attributed to the reformulation of OxyContin.
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A Block-Level Analysis of Medical Marijuana Dispensaries and Crime in the City of Los Angeles
Christopher Contreras
Justice Quarterly, forthcoming
Abstract:
The liberalization of marijuana laws may have implications for neighborhood crime insofar as the distribution of marijuana through a dispensary system may provide additional opportunities for criminal behavior to take place. This project fills an important gap in the scant literature on medical marijuana dispensaries and neighborhood crime rates by integrating perspectives from environmental criminology and social organization theories in investigating the dispensary-crime nexus through interaction models and flexibly assessing dispensaries’ relationship to crime at different spatial scales. This study found the placement of a medical marijuana dispensary in the previous year to be associated with crime rate change, in both the block and the surrounding area, over and above predictor variables drawn from social organization theory. And, this study’s interaction models suggest that marijuana dispensaries may increase crime rates on socially organized blocks, with such blocks potentially experiencing a slight perturbation in their ecological continuity from a dispensary’s establishment.
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Contact High: The External Effects of Retail Marijuana Establishments on House Prices
James Neil Conklin, Moussa Diop & Herman Li
University of Georgia Working Paper, December 2016
Abstract:
Using publicly available data from the city of Denver and the state of Colorado, this study examines the effects of retail conversions (conversions from medical marijuana to retail marijuana stores) on neighboring house values in Denver, Colorado for the years 2013 and 2014. The time period was chosen to reflect a time before (2013) and after (2014) retail marijuana sales became legal in Colorado. Using a difference-in-differences approach, we compare houses that were in close proximity to a conversion (within 0.1 miles) to those that are farther away from a conversion. We find that after the law went into effect, single family residences close to a retail conversion increased in value by approximately 9% relative to houses that are located slightly farther away. We perform a battery of robustness checks and falsification tests to provide additional support for this finding. To our knowledge this is the first study to examine at a micro-level the highly localized effect of retail marijuana establishments on house prices and hope that it can contribute to the debate on retail marijuana laws.
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“Zombie” Outbreak Caused by the Synthetic Cannabinoid AMB-FUBINACA in New York
Axel Adams et al.
New England Journal of Medicine, forthcoming
Background: New psychoactive substances constitute a growing and dynamic class of abused drugs in the United States. On July 12, 2016, a synthetic cannabinoid caused mass intoxication of 33 persons in one New York City neighborhood, in an event described in the popular press as a “zombie” outbreak because of the appearance of the intoxicated persons.
Methods: We obtained and tested serum, whole blood, and urine samples from 8 patients among the 18 who were transported to local hospitals; we also tested a sample of the herbal “incense” product “AK-47 24 Karat Gold,” which was implicated in the outbreak. Samples were analyzed by means of liquid chromatography–quadrupole time-of-flight mass spectrometry.
Results: The synthetic cannabinoid methyl 2-(1-(4-fluorobenzyl)-1H-indazole-3-carboxamido)-3-methylbutanoate (AMB-FUBINACA, also known as MMB-FUBINACA or FUB-AMB) was identified in AK-47 24 Karat Gold at a mean (±SD) concentration of 16.0±3.9 mg per gram. The de-esterified acid metabolite was found in the serum or whole blood of all eight patients, with concentrations ranging from 77 to 636 ng per milliliter.
Conclusions: The potency of the synthetic cannabinoid identified in these analyses is consistent with strong depressant effects that account for the “zombielike” behavior reported in this mass intoxication. AMB-FUBINACA is an example of the emerging class of “ultrapotent” synthetic cannabinoids and poses a public health concern. Collaboration among clinical laboratory staff, health professionals, and law enforcement agencies facilitated the timely identification of the compound and allowed health authorities to take appropriate action.
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US Traffic Fatalities, 1985–2014, and Their Relationship to Medical Marijuana Laws
Julian Santaella-Tenorio et al.
American Journal of Public Health, February 2017, Pages 336-342
Methods: Using data from the 1985–2014 Fatality Analysis Reporting System, we examined the association between MMLs and traffic fatalities in multilevel regression models while controlling for contemporaneous secular trends. We examined this association separately for each state enacting MMLs. We also evaluated the association between marijuana dispensaries and traffic fatalities.
Results: On average, MML states had lower traffic fatality rates than non-MML states. Medical marijuana laws were associated with immediate reductions in traffic fatalities in those aged 15 to 24 and 25 to 44 years, and with additional yearly gradual reductions in those aged 25 to 44 years. However, state-specific results showed that only 7 states experienced post-MML reductions. Dispensaries were also associated with traffic fatality reductions in those aged 25 to 44 years.
Conclusions: Both MMLs and dispensaries were associated with reductions in traffic fatalities, especially among those aged 25 to 44 years. State-specific analysis showed heterogeneity of the MML–traffic fatalities association, suggesting moderation by other local factors. These findings could influence policy decisions on the enactment or repealing of MMLs and how they are implemented.
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Identifying Sibling Influence on Teenage Substance Use
Joseph Altonji, Sarah Cattan & Iain Ware
Journal of Human Resources, forthcoming
Abstract:
We assess the extent to which the large sibling correlations in substance use are causal. Our primary approach is based on a joint dynamic model of the behavior of older and younger siblings that allows for family specific effects, individual specific heterogeneity, and state dependence. We use the model to simulate the dynamic response of substance use to the behavior of the older sibling. Overall, we find that substance use is affected by the example of older siblings, but only a small fraction of the sibling correlation is causal.
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Benjamin Han et al.
Drug and Alcohol Dependence, January 2017, Pages 198–207
Methods: We examined alcohol use among adults age ≥50 in the National Survey on Drug Use and Health (NSDUH) from 2005 to 2014. Trends of self-reported past-month binge alcohol use and AUD were estimated. Logistic regression models were used to examine correlates of binge alcohol use and AUD.
Results: The prevalence of both past-month binge alcohol use and AUD increased significantly among adults age ≥50 from 2005/2006 to 2013/2014, with a relative increase of 19.2% for binge drinking (linear trend p < 0.001) and a 23.3% relative increase for AUD (linear trend p = 0.035). While males had a higher prevalence of binge alcohol use and AUD compared to females, there were significant increases in both among females. In adjusted models of aggregated data, being Hispanic, male, and a smoker or illicit drug user were associated with binge alcohol use, while being male, a smoker, an illicit drug user, or reporting past-year depression or mental health treatment were associated with AUD.
Conclusions: Alcohol use among older adults is increasing in the US, including past-month binge alcohol use and AUD with increasing trends among females. Providers and policymakers need to be aware of these changes to address the increase of older adults with unhealthy drinking.
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Maria Testa & Michael Cleveland
Journal of Studies on Alcohol and Drugs, January 2017, Pages 5-13
Objective: The current longitudinal study was designed to consider the time-varying effects of men’s heavy episodic drinking (HED) and drinking setting attendance on college sexual assault perpetration.
Method: Freshman men (N = 992) were recruited in their first semester and completed online measures at the end of their first five semesters. Using multilevel models, we examined whether men with higher frequency HED (or party or bar attendance) were more likely to perpetrate sexual assault (between-person, Level 2 effect) and whether sexual assault perpetration was more likely in semesters in which HED (or party or bar attendance) was higher than each individual’s average (within-person, Level 1 effect).
Results: The between-person effect of HED on sexual assault was not significant after accounting for the between-person effects of antisocial behavior, impersonal sex orientation, and low self-control. The within-person effect of HED on sexual assault perpetration was not significant. However, models substituting frequency of party attendance or bar attendance revealed both between- and within-person effects. The odds of sexual assault were increased for men with higher bar and party attendance than the sample as a whole, and in semesters in which party or bar attendance was higher than their own average. Supplemental analyses suggested that these drinking setting effects were explained by hookups, with sexual assault perpetration more likely in semesters in which the number of hookups exceeded one’s own average.
Conclusions: Findings point toward the importance of drinking contexts, rather than drinking per se, as predictors of college men’s sexual assault perpetration.
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Natalie Castellanos-Ryan et al.
Development and Psychopathology, forthcoming
Abstract:
The main objective of this prospective longitudinal study was to investigate bidirectional associations between adolescent cannabis use (CU) and neurocognitive performance in a community sample of 294 young men from ages 13 to 20 years. The results showed that in early adolescence, and prior to initiation to CU, poor short-term and working memory, but high verbal IQ, were associated with earlier age of onset of CU. In turn, age of CU onset and CU frequency across adolescence were associated with (a) specific neurocognitive decline in verbal IQ and executive function tasks tapping trial and error learning and reward processing by early adulthood and (b) lower rates of high-school graduation. The association between CU onset and change in neurocognitive function, however, was found to be accounted for by CU frequency. Whereas the link between CU frequency across adolescence and change in verbal IQ was explained (mediated) by high school graduation, the link between CU frequency and tasks tapping trial and error learning were independent from high school graduation, concurrent cannabis and other substance use, adolescent alcohol use, and externalizing behaviors. Findings support prevention efforts aimed at delaying onset and reducing frequency of CU.
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Alcohol-Impaired Driving and Perceived Risks of Legal Consequences
Frank Sloan, Sabrina McCutchan & Lindsey Eldred
Alcoholism, forthcoming
Methods: Using survey data collected from individual drivers, police, and defense attorneys specializing in DWI in 8 U.S. cities, we investigated whether risk perceptions about legal consequences for alcohol-impaired driving, both the risk of being stopped if driving while alcohol-impaired and receiving specific penalties following a DWI, deter alcohol-impaired driving. First, we analyzed how different drivers' risk perceptions about being pulled over and facing criminal sanctions related to their self-reported alcohol-impaired driving in the year following the interview at which risk perceptions were elicited. Second, using data from an experimental module in which individual's risk perceptions were randomly updated by the interview, we analyzed how each driver's beliefs about his or her own future alcohol-impaired driving responded to randomly generated increases in the apprehension probability and sanction magnitude.
Results: Higher probabilities as estimated by the individuals of being pulled over corresponded to less alcohol-impaired driving in both analyses. Conversely, there was no statistical relationship between perceptions of criminal sanctions for DWI and alcohol-impaired driving with 1 exception — a small significant negative relationship between duration of jail time following a DWI conviction and alcohol-impaired driving.
Conclusions: Perceptions regarding the threat of being apprehended for alcohol-impaired driving were related to actual self-reported driving, while perceived sanctions following a DWI conviction for DWI generally were unrelated to either actual self-reported alcohol-impaired driving or the person's estimate of probability that he or she would drive while alcohol-impaired in the following year. Increasing certainty of apprehension by increasing police staffing and/or conducting sobriety checks is a more effective strategy for reducing alcohol-impaired driving than legislating increased penalties for DWI.
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Jessica Cook et al.
Journal of Abnormal Psychology, forthcoming
Abstract:
This research sought to determine whether smoking influences affect by means other than withdrawal reduction. Little previous evidence suggests such an effect. We surmised that such an effect would be especially apparent in posttraumatic stress disorder (PTSD) and major depressive disorder (MDD), 2 disorders that are frequently comorbid with smoking and that involve dysregulated affect. Participants were U.S. veterans who were regular smokers (N = 159): 52 with PTSD (58% with comorbid MDD), 51 with MDD, and 56 controls with no psychiatric disorder. During 3 positive and 3 negative mood induction trials (scheduled over 2 sessions), nonwithdrawn participants smoked either a nicotine-containing cigarette (NIC+), a nicotine-free cigarette (NIC−), or held a pen. Positive and negative affect were each measured before and after mood induction. Results showed a significant 2-way interaction of Smoking Condition × Time on negative affect during the negative mood induction (F(6, 576) = 2.41, p = .03) in those with PTSD and controls. In these groups, both NIC+ and NIC−, relative to pen, produced lower negative affect ratings after the negative mood induction. There was also a 2-way interaction of Smoking Condition × Time on positive affect response to the positive mood induction among those with PTSD and controls (F(6, 564) = 3.17, p = .005) and among MDD and controls (F(6, 564) = 2.27, p = .036). Among all smokers, NIC+ enhanced the magnitude and duration of positive affect more than did NIC−. Results revealed affect modulation outside the context of withdrawal relief; such effects may motivate smoking among those with psychiatric diagnoses, and among smokers in general.
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Christopher Salas-Wright et al.
Drug and Alcohol Dependence, February 2017, Pages 97–106
Method: Findings are based on repeated, cross-sectional data collected from late middle-aged (ages 50-64) and older adults (ages 65 and older) surveyed as part of the National Survey on Drug Use and Health between 2002 and 2014.
Results: The prevalence of past-year marijuana use among late middle-aged adults increased significantly from a low of 2.95% in 2003 to a high of 9.08% in 2014. Similarly, the prevalence of marijuana use increased significantly among older adults from a low of 0.15% in 2003 to a high of 2.04% in 2014. Notably, the upward trends in marijuana use remained significant even when accounting for sociodemographic, substance use, behavioral, and health-related factors. We also found that decreases in marijuana-specific protective factors were associated with the observed trend changes in marijuana use among late middle-aged and older adults, and observed a weakening of the association between late-middle aged marijuana use and risk propensity, other illicit drug use, and criminal justice system involvement over the course of the study.
Conclusions: Findings from the present study provide robust evidence indicating that marijuana use among older Americans has increased markedly in recent years, with the most evident changes observed between 2008 and 2014.
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Parent–Offspring Resemblance for Drinking Behaviors in a Longitudinal Twin Sample
Gretchen Saunders et al.
Journal of Studies on Alcohol and Drugs, January 2016, Pages 49–58
Objective: The purpose of the current study was to evaluate parent–offspring resemblance for alcohol consumption and dependence symptoms, including sex-specific effects, and how these patterns change across adolescence and early adulthood.
Method: Three cohorts of twins were assessed longitudinally at five time points between ages 14 and 29 years, with parents directly assessed at intake, using structured interviews. Twin offspring and parents from the population-based Minnesota Twin Family Study were included for a total sample size of 3,762 offspring (52% female) and their parents. Alcohol use was measured using an index based on drinking quantity, frequency, maximum drinks, and number of intoxications. Alcohol dependence symptom counts were also used.
Results: Parent–offspring correlations for alcohol consumption increased from age 14 (r = .12) to age 17 (r = .25), remained stable from ages 17 through 24, and then decreased slightly by age 29 (r = .19). Familial resemblance for symptoms of alcohol dependence peaked at age 17 (r = .18) then decreased through age 29 (r = .11). Parent–offspring correlations of both measures did not vary significantly by sex of offspring or sex of parent.
Conclusions: Overall, parent–offspring resemblance for alcohol use and problems is relatively stable after early adulthood, with resemblance for alcohol use at higher magnitudes across offspring development. Evidence for differential resemblance based on sex of offspring or parents was lacking.
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Compliance Inspections of Tobacco Retailers and Youth Smoking
Rahi Abouk & Scott Adams
American Journal of Health Economics, forthcoming
Abstract:
Since 2010, the Food and Drug Administration has contracted with states to perform random checks of tobacco retailers to identify illegal sales to youths. We test whether the inspections affect youth access and smoking for boys and girls. Using the 2010-13 Monitoring the Future survey and data on the number and location of inspections in the first several years of the program, we find the checks have been successful at limiting access to cigarettes in small retail establishments. As for reducing smoking, we observe reductions only among girls. Boys continue to smoke with about the same incidence and intensity as before the inspections. The likely reason for this is that girls are generally more successful at purchasing illicit products at retail establishments while underage. Therefore, enforcing the minimum legal age laws for purchasing tobacco products likely curtails the access of girls to the illegal product.