Kevin Lewis

March 05, 2020

Trends in Drug Use among Electronic Dance Music Party Attendees in New York City, 2016-2019
Joseph Palamar & Katherine Keyes
Drug and Alcohol Dependence, forthcoming

Methods: Each summer from 2016 through 2019, we used time-space sampling to survey a cross-section of adults entering EDM parties at randomly selected nightclubs and at dance festivals in New York City. Ns ranged from 504 (2019) to 1,087 (2016). We estimated log-linear trends in past-year use of 16 different synthetic drugs or drug classes.

Results: Between 2016 and 2019, estimated past-year prevalence of use of ketamine increased from 5.9% to 15.3% (a 157.6% relative increase; P = .007), LSD use increased from 9.9% to 16.6% (a 67.7% relative increase, P < .001), powder cocaine use increased from 17.3% to 35.2% (a 103.5% relative increase, P < .001), and GHB use increased from 1.0% to 4.2% (a 311.8% relative increase; P = .002). Past-year use of >3 drugs increased from 12.7% to 20.5% (a 61.4% relative increase; P = .013); however, estimated past-year use of unknown powders decreased from 2.0% to 1.1% (a relative 44.7% decrease; P = .038) and ecstasy/MDMA/Molly use was stable across years (at 25.0-28.5%; P = .687).

The Effects of E-Cigarette Taxes on E-Cigarette Prices and Tobacco Product Sales: Evidence from Retail Panel Data
Chad Cotti et al.
NBER Working Paper, January 2020


We explore the effect of e-cigarette taxes enacted in eight states and two large counties on e-cigarette prices, e-cigarette sales, and sales of other tobacco products. We use the Nielsen Retail Scanner data from 2011 to 2017, comprising approximately 35,000 retailers nationally. We calculate a Herfindahl–Hirschman Index of 0.251 for e-cigarette retail purchases, indicating high market concentration, and a tax-to-price pass-through of 1.6. We then calculate an e-cigarette own-price elasticity of -2.6 and a positive cross-price elasticity of demand between e-cigarettes and traditional cigarettes of 1.1, suggesting that e-cigarettes and traditional cigarettes are economic substitutes. We simulate that for every one standard e-cigarette pod (a device that contains liquid nicotine in e-cigarettes) of 0.7 ml no longer purchased as a result of an e-cigarette tax, the same tax increases traditional cigarettes purchased by 6.2 extra packs.

The Real Effect of Smoking Bans: Evidence from Corporate Innovation
Huasheng Gao et al.
Journal of Financial and Quantitative Analysis, March 2020, Pages 387-427


We identify a positive causal effect of healthy working environments on corporate innovation, using the staggered passage of U.S. state-level laws that ban smoking in workplaces. We find a significant increase in patents and patent citations for firms headquartered in states that have adopted such laws relative to firms headquartered in states without such laws. The increase is more pronounced for firms in states with stronger enforcement of such laws and in states with weaker preexisting tobacco controls. We present suggestive evidence that smoke-free laws affect innovation by improving inventor health and productivity and by attracting more productive inventors.

A Study of the Effects of Legalization of Recreational Marijuana on Consumption of Cigarettes
Ashutosh Bhave & B.P.S. Murthi
University of Texas Working Paper, November 2019


The impact of legalization of marijuana for recreational use in Colorado has been studied to assess its effect on crime rates, hospitalizations, traffic accidents, incarceration rates and other related aspects. However, one connection that has not been studied is the effect of legalization of marijuana use on cigarette consumption, which is a source of significant healthcare expenditure. The US spends $170 billion per year on healthcare expenditures related to tobacco use. In this study, we assess the impact of legalization of recreational marijuana in Colorado on cigarette sales using retail scanner data from A.C. Nielsen. We use multiple methods - difference-in-difference (DID) model as well as synthetic control methodology - to show that marijuana and cigarettes are complements and legalizing recreational marijuana is associated with an increase in cigarette consumption by about 4-7%. We check the robustness of our results using different dependent variables, placebo dates of intervention in the DID model, and placebo counties in the synthetic control method. In addition, we control for tobacco industry’s response to legalization such as price changes in cigarettes, and effects of increase in tourism due to legalization. Overall, we show that legalization of marijuana for recreational use may have significant spillover to increase in tobacco use that could lead to increased health care costs in future. Surprisingly this connection to smoking has not been articulated in the arguments to support legalization and several states are attempting to pass laws for the legalization of marijuana for recreational use. We advise caution in passing such laws since we estimate the nationwide health care costs associated with such an increase in tobacco consumption will be about $10 billion and may equal or exceed the touted monetary benefits of marijuana legalization in many states. So our message for lawmakers in other states attempting to legalize use of marijuana for recreational purposes to examine the effects of such co-dependence carefully.

Intended and Unintended Effects of Banning Menthol Cigarettes
Christopher Carpenter & Hai Nguyen
NBER Working Paper, February 2020


Bans on menthol cigarettes have been recommended by the World Health Organization, adopted throughout the European Union, and proposed by the United States Food and Drug Administration (FDA), primarily due to concerns that menthol cigarettes enable youth smoking. Yet there is almost no direct evidence on their effects using real-world policy variation. We provide the first comprehensive evaluation of this policy by studying Canada where seven provinces banned menthol cigarettes prior to a nationwide menthol ban in 2018. Using provincial sales data, we show that menthol cigarette sales fell to zero immediately after menthol bans, with no meaningful effect on non-menthol sales. Survey data confirm that provincial menthol bans significantly reduced menthol cigarette smoking among both youths and adults. We also find strong evidence of substitution, however: provincial menthol bans significantly increased non-menthol cigarette smoking among youths, resulting in no overall net change in youth smoking rates. We also document evidence of evasion: provincial menthol bans shifted smokers’ cigarette purchases away from grocery stores and gas stations to First Nations reserves (where the menthol bans do not bind). Our results demonstrate the importance of accounting for substitution and evasion responses in the design of stricter tobacco regulations.

Hospital Use Declines After Implementation Of Virginia Medicaid’s Addiction And Recovery Treatment Services
Andrew Barnes et al.
Health Affairs, February 2020, Pages 238-246


Medicaid programs responded to the opioid crisis by expanding treatment coverage and reforming delivery systems. We assessed whether Virginia’s Addiction and Recovery Treatment Services (ARTS) program, implemented in April 2017, influenced emergency department and inpatient use. Using claims for January 2016–June 2018 and difference-in-differences models, we compared beneficiaries with opioid use disorder before and after ARTS implementation to beneficiaries with no substance use disorder. After program implementation, the likelihood of having an emergency department visit in a quarter declined by 9.4 percentage points (a 21.1 percent relative decrease) among beneficiaries with opioid use disorder, compared to 0.9 percentage points among beneficiaries with no substance use disorder. Similarly, the likelihood of having an inpatient hospitalization declined among beneficiaries with opioid use disorder. In contrast to other states, Virginia has a new Medicaid expansion population whose beneficiaries enter a delivery system in which reforms of the addiction treatment system are well under way.

Uncovering the Hidden Antibiotic Potential of Cannabis
Maya Farha et al.
ACS Infectious Diseases, forthcoming


The spread of antimicrobial resistance continues to be a priority health concern worldwide, necessitating the exploration of alternative therapies. Cannabis sativa has long been known to contain antibacterial cannabinoids, but their potential to address antibiotic resistance has only been superficially investigated. Here, we show that cannabinoids exhibit antibacterial activity against methicillin-resistant Staphylococcus aureus (MRSA), inhibit its ability to form biofilms, and eradicate preformed biofilms and stationary phase cells persistent to antibiotics. We show that the mechanism of action of cannabigerol is through targeting the cytoplasmic membrane of Gram-positive bacteria and demonstrate in vivo efficacy of cannabigerol in a murine systemic infection model caused by MRSA. We also show that cannabinoids are effective against Gram-negative organisms whose outer membrane is permeabilized, where cannabigerol acts on the inner membrane. Finally, we demonstrate that cannabinoids work in combination with polymyxin B against multidrug resistant Gram-negative pathogens, revealing the broad-spectrum therapeutic potential for cannabinoids.

Trends in Alcohol-Related Mortality by Educational Attainment in the U.S., 2000–2017
Yana Vierboom
Population Research and Policy Review, February 2020, Pages 77–97


Alcohol-related mortality rates in the U.S. have risen since 2000, though how trends vary across socio-economic status is unclear. This analysis combines data from vital statistics and the National Health Interview Survey (NHIS) to estimate alcohol-related mortality rates at four levels of educational attainment (less than high school, high school/GED, some college/associate’s degree, 4-year degree, or more) over the period 2000–2017. The analysis includes a comprehensive set of 48 alcohol-related causes of death, including causes which are indirectly influenced by alcohol use. I consider period and cohort patterns in inequality using the relative index of inequality (RII). Results indicate that alcohol-related mortality rates increased over the study period, at all levels of educational attainment. Relative increases were larger for females than males at nearly all ages and levels of educational attainment, and were largest among 45–59-year-old women. Male and female members of the 1950–1959 birth cohort exhibited elevated rates of alcohol-related mortality relative to neighboring cohorts. Despite widespread increases in alcohol-related mortality, educational inequalities present at the beginning of the analysis persisted and exceeded those in all-cause mortality. Disparities were typically greatest among younger adults aged 30–44, though inequality in this age group declined over time. Inequality increased among females aged 60–74, as well as among males aged 45–74. While interventions targeting these groups may reduce educational disparities, care should also be taken to stem the increasing prevalence of alcohol-related deaths at all levels of educational attainment.

Do Firms Get High? The Impact of Marijuana Legalization on Firm Performance, Corporate Innovation, and Entrepreneurial Activity
Jue Wang, Shagun Pant & Tong Yao
University of Iowa Working Paper, June 2019


We find that state-level marijuana legalization has a positive financial impact on firms, likely by affecting firms’ human capital. Firms headquartered in marijuana-legalizing states receive higher market valuations, earn higher abnormal stock returns, improve employee productivity, and increase innovation. Exploiting firm level inventor data, we directly test the human capital channel and find that post legalization, firms retain inventors that become more productive and recruit more innovative talents from out of state. We also find that marijuana-legalizing states experience an increase in the number of new startups and venture capital investments.

Cigarette Taxes and Teen Marijuana Use
Mark Anderson, Kyutaro Matsuzawa & Joseph Sabia
NBER Working Paper, February 2020


The spillover effect of cigarette taxes on youth marijuana use has been the subject of intense public debate. Opponents of cigarette taxes warn that tax hikes will cause youths to substitute toward marijuana. On the other hand, public health experts often claim that because tobacco is a “gateway” drug, higher cigarette taxes will deter youth marijuana use. Using data from the National and State Youth Risk Behavior Surveys (YRBS) for the period 1991-2017, we explore the relationship between state excise taxes on cigarettes and teen marijuana use. In general, our results fail to support either of the above hypotheses. Rather, we find little evidence to suggest that teen marijuana use is sensitive to changes in the state cigarette tax. This null result holds for the sample period where cigarette taxes are observed to have the largest effect on teen cigarette use and across a number of demographic groups in the data. Finally, we find preliminary evidence that the recent adoption of state e-cigarette taxes is associated with a reduction in youth marijuana use.

Florida’s Opioid Crackdown and Drug, Motor Vehicle Crash, and Suicide Mortality: A Bayesian Interrupted Time-Series Analysis
Kenneth Feder et al.
American Journal of Epidemiology, forthcoming


In 2011, Florida established a Prescription Drug Monitoring Program and adopted new regulations for independent pain-management clinics. This paper examines the association of those reforms with drug overdose deaths and other injury fatalities. Florida’s post-reform monthly mortality rates – for drug-involved deaths, motor vehicle crashes, and suicides by means other than poisoning – were compared to a counterfactual estimate of what those rates would have been absent reform. The counterfactual was estimated using a Bayesian structural time-series model based on mortality trends in similar states. By December 2013, drug overdose deaths were down -17% (95% CI, -21% to -12%), motor vehicle crash deaths were down -9% (-14%, to -4%), and suicide deaths were unchanged compared to what would be expected in the absence of reform. Florida’s opioid psrescribing reform substantially reduced drug overdose deaths. Reforms may also have reduced motor vehicle crash deaths but were not associated with a change in suicides; more research is needed to understand these patterns. Bayesian structural time-series modeling is a promising new approach to interrupted time-series studies.

Must-Access Prescription Drug Monitoring Programs and the Opioid Overdose Epidemic: The Unintended Consequences
Bokyung Kim
University of Texas Working Paper, January 2020


Although supply-side drug policies that limit access to legal opioids have reduced prescription opioid abuse, growing evidence shows that these policies have had the unintended consequence of increasing use of illegal opioids, including heroin. I add to this literature by studying the consequences of must-access prescription drug monitoring programs (PDMPs), which legally require providers to access a state-level database with a patient's prescription history before prescribing controlled substances under certain circumstances. Using a difference-in-differences specification, I find strong evidence that must-access PDMPs have increased heroin death rates. My estimates indicate that two years after implementation, must-access PDMPs were associated with 1.12 more heroin deaths per 100,000 in a half-year period, relative to control states. Moreover, I find that prescription opioid death rates declined following implementation. My results suggest that even if must-access PDMPs reduce prescription opioid deaths, the decrease is offset by a large increase in illegal opioid deaths.

Opioid Prescription Rates and Asset Prices — Assessment of Causal Effects
Steven Wei Ho & Jiahao Jiang
Columbia University Working Paper, December 2019


We explore the link between county-level opioid prescription rates and asset prices, specifically, stock returns of firms headquartered in that county, as well as real estate prices. In order to establish the causal effects of opioid prescription rates on firm stock returns, we first apply an instrumental variable (IV) regression approach and use the number of clandestine drug laboratories in a county to be the instrumental variable. The results provide robust evidence that county-level opioid prescription rates have a negative causal effect on the equity returns of firms headquartered in that county. Furthermore, we analyze the effect of Medical Board of California's 2014 regulatory revision aimed at reducing controlled substance overdose due to prescriptions and implement a difference-in-differences (DiD) estimation. The DiD estimation results show that this policy change has a positive dynamic effect on Californian firms' equity returns. We also find that the opioid prescription reduction assistance program provided by California Health Care Foundation (CHCF) to certain counties in California helps to raise the median prices of existing single-family homes in those counties by $28,678 on average.

Marijuana Decriminalization, Medical Marijuana Laws, and Fatal Traffic Crashes in US Cities, 2010–2017
Amanda Cook, Gregory Leung & Rhet Smith
American Journal of Public Health, March 2020, Pages 363-369

Methods: Using a census of fatal traffic crashes from the 2010 to 2017 Fatality Analysis Reporting System, we examined MMLs and cannabis decriminalization on fatal crashes by age and sex of driver. We used a Poisson difference-in-differences approach, exploiting temporal and geographic variation in marijuana decriminalization laws.

Results: Cities experienced a 13% increase in fatal crashes involving 15- to 24-year-old male drivers following decriminalization (incidence rate ratio = 1.125; 95% confidence interval = 1.014, 1.249). This effect was immediate and strongest on weekend nights. We found no effect on female drivers or older males. Conversely, we found that MMLs were associated with fewer fatal crashes for both males and females, which was most pronounced in 15- to 24-year-old drivers.

Cannabis increases susceptibility to false memory
Lilian Kloft et al.
Proceedings of the National Academy of Sciences, 3 March 2020, Pages 4585-4589


With the growing global acceptance of cannabis and its widespread use by eyewitnesses and suspects in legal cases, understanding the popular drug’s ramifications for memory is a pressing need. In a double-blind, randomized, placebo-controlled trial, we examined the acute and delayed effects of Δ9-tetrahydrocannabinol (THC) intoxication on susceptibility to false memory in 64 healthy volunteers. Memory was tested immediately (encoding and retrieval under drug influence) and 1 wk later (retrieval sober). We used three different methods (associative word lists and two misinformation tasks using virtual reality). Across all methods, we found evidence for enhanced false-memory effects in intoxicated participants. Specifically, intoxicated participants showed higher false recognition in the associative word-list task both at immediate and delayed test than controls. This yes bias became increasingly strong with decreasing levels of association between studied and test items. In a misinformation task, intoxicated participants were more susceptible to false-memory creation using a virtual-reality eyewitness scenario and virtual-reality perpetrator scenario. False-memory effects were mostly restricted to the acute-intoxication phase. Cannabis seems to increase false-memory proneness, with decreasing strength of association between an event and a test item, as assessed by different false-memory paradigms. Our findings have implications for how and when the police should interview suspects and eyewitnesses.

Can beauty be-er ignored? A preregistered implicit examination of the beer goggles effect
Rebecca Monk et al.
Psychology of Addictive Behaviors, forthcoming


The beer goggles effect refers to heightened perceptions of attractiveness resulting from intoxication. However, research in this area has produced mixed findings and has largely been reliant on self-report measures of perceived attractiveness. This study aimed to utilize an implicit measure to assess the beer goggles phenomenon in a preregistered study. One hundred twenty-nine heterosexual U.K. university students were recruited (74 female, Mage = 24.12 years, SDage = 9.09 years) in real-life drinking environments (classified post hoc as sober or lightly intoxicated based on Blood Alcohol Concentration [BAC]) to conduct a spatial cuing paradigm that measured the effect of distracting stimuli on task performance. Participants were asked to determine the orientation of a letter while ignoring any incidentally presented (un)attractive facial stimuli. Sober participants appeared to find attractive faces equally distracting, regardless of whether they were being cued to look toward or away from the face — a traditional attractiveness bias. Intoxicated participants, on the other hand, appeared to find attractive and unattractive faces equally distracting. Findings highlight the possibility that the beer goggles phenomenon results from a leveling of the playing field whereby attentional biases toward attractive faces are dampened as a result of light intoxication.

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