Kevin Lewis

August 21, 2017

The Economic Functioning of Online Drugs Markets
V. Bhaskar, Robin Linacre & Stephen Machin
Journal of Economic Behavior & Organization, forthcoming

The economic functioning of online drug markets using data scraped from online platforms is studied. Analysis of over 1.5 million online drugs sales shows online drugs markets tend to function without the significant moral hazard problems that, a priori, one might think would plague them. Only a small proportion of online drugs deals receive bad ratings from buyers, and online markets suffer less from problems of adulteration and low quality that are a common feature of street sales of illegal drugs. Furthermore, as with legal online markets, the market penalizes bad ratings, which subsequently lead to significant sales reductions and to market exit. The impact of the well-known seizure by law enforcement of the original Silk Road and the shutdown of Silk Road 2.0 are also studied, together with the exit scam of the market leader at the time, Evolution. There is no evidence that these exits deterred buyers or sellers from online drugs trading, as new platforms rapidly replaced those taken down, with the online market for drugs continuing to grow.

Recreational marijuana legalization and college student use: Early evidence
Austin Miller, Robert Rosenman & Benjamin Cowan
SSM - Population Health, December 2017, Pages 649-657

We analyze marijuana use by college undergraduates before and after legalization of recreational marijuana. Using survey data from the National College Health Assessment, we show that students at Washington State University experienced a significant increase in marijuana use after legalization. This increase is larger than would be predicted by national trends. The change is strongest among females, Black students, and Hispanic students. The increase for underage students is as much as for legal-age students. We find no corresponding changes in the consumption of tobacco, alcohol, or other drugs.

Improved memory for information learnt before alcohol use in social drinkers tested in a naturalistic setting
Molly Carlyle et al.
Scientific Reports, July 2017

Alcohol is known to facilitate memory if given after learning information in the laboratory; we aimed to investigate whether this effect can be found when alcohol is consumed in a naturalistic setting. Eighty-eight social drinkers were randomly allocated to either an alcohol self-dosing or a sober condition. The study assessed both retrograde facilitation and alcohol induced memory impairment using two independent tasks. In the retrograde task, participants learnt information in their own homes, and then consumed alcohol ad libitum. Participants then undertook an anterograde memory task of alcohol impairment when intoxicated. Both memory tasks were completed again the following day. Mean amount of alcohol consumed was 82.59 grams over the evening. For the retrograde task, as predicted, both conditions exhibited similar performance on the memory task immediately following learning (before intoxication) yet performance was better when tested the morning after encoding in the alcohol condition only. The anterograde task did not reveal significant differences in memory performance post-drinking. Units of alcohol drunk were positively correlated with the amount of retrograde facilitation the following morning. These findings demonstrate the retrograde facilitation effect in a naturalistic setting, and found it to be related to the self-administered grams of alcohol.

Examining the Protective Effect of Ethnic Identity on Drug Attitudes and Use Among a Diverse Youth Population
Tamika Zapolski et al.
Journal of Youth and Adolescence, August 2017, Pages 1702–1715

Ethnic identity is an important buffer against drug use among minority youth. However, limited work has examined pathways through which ethnic identity mitigates risk. School-aged youth (N = 34,708; 52 % female) of diverse backgrounds (i.e., African American (n = 5333), Asian (n = 392), Hispanic (n = 662), Multiracial (n = 2129), Native American (n = 474), and White (n = 25718) in grades 4–12 provided data on ethnic identity, drug attitudes, and drug use. After controlling for gender and grade, higher ethnic identity was associated with lower past month drug use for African American, Hispanic, and Multiracial youth. Conversely, high ethnic identity was associated with increased risk for White youth. An indirect pathway between ethnic identity, drug attitudes, and drug use was also found for African American, Hispanic, and Asian youth. Among White youth the path model was also significant, but in the opposite direction. These findings confirm the importance of ethnic identity for most minority youth. Further research is needed to better understand the association between ethnic identity and drug use for Multiracial and Hispanic youth, best ways to facilitate healthy ethnic identity development for minority youth, and how to moderate the risk of identity development for White youth.

Variation in receipt of pharmacotherapy for alcohol use disorders across racial/ethnic groups: A national study in the U.S. Veterans Health Administration
Emily Williams et al.
Drug and Alcohol Dependence, September 2017, Pages 527-533

Objective: Pharmacologic treatment is recommended for alcohol use disorders (AUD), but most patients do not receive it. Although racial/ethnic minorities have greater AUD consequences than whites, whether AUD medication receipt varies across race/ethnicity is unknown. We evaluate this in a national sample.

Methods: Electronic health records data were extracted for all black, Hispanic, and/or white patients who received care at the U.S. Veterans Health Administration (VA) during Fiscal Year 2012 and had a documented AUD diagnosis. Mixed effects regression models, with a random effect for facility, determined the likelihood of receiving AUD pharmacotherapy (acamprosate, disulfiram, topirimate or oral or injectable naltrexone ≤180 days after AUD diagnosis) for black and Hispanic patients relative to white patients. Models were unadjusted and then adjusted for patient- and facility-level factors.

Results: 297,506 patients had AUD; 26.4% were black patients, 7.1% were Hispanic patients and 66.5% were white patients; 5.1% received AUD medications. Before adjustment, black patients were less likely than white [Odds Ratio (OR) 0.77; 95% Confidence Interval (CI) 0.75 −0.82; (p < 0.001)], while Hispanic patients were more likely than white (OR 1.09; 95% CI 1.01–1.16) to receive AUD medications. After adjustment, black patients remained less likely than white to receive AUD medications (OR 0.68; 95% CI 0.65–0.71; p < 0.0001); no difference between Hispanic and white patients was observed (OR 0.94; 95% CI 0.87–1.00; p = 0.07).

Conclusions: In this national study of patients with AUD, blacks were less likely to receive AUD medications than whites. Future research is needed to identify why these disparities exist.

The Unintended Effects of Providing Risk Information About Drinking and Driving
Mark Johnson & Catalina Kopetz
Health Psychology, forthcoming

Method: In a hypothetical drinking and driving scenario, 3 studies investigated participants’ self-reported likelihood of drinking and driving as a function of (a) accessibility of information regarding risk associated with drinking and driving, (b) motivation to drive, and (c) need for cognitive closure (NFC).

Results: Across the 3 studies, participants self-reported a higher likelihood of driving when exposed to high-risk information (vs. low-risk information) if they were high in NFC. Risk information did decrease self-reported likelihood of driving among low-NFC participants (Studies 1–3). Furthermore, this effect was exacerbated when the relevant motivation (to get home conveniently) was high (Study 3).

When and how does normative feedback reduce intentions to drink irresponsibly? An experimental investigation
Joanne Smith, Winnifred Louis & Charles Abraham
Addiction Research & Theory, forthcoming

Objectives: To test the effects of exposure to a campaign to discourage drinking alcohol drinks down in one gulp (‘bolting’).

Method: Laboratory experiments assessed the effects of exposure to (1) the campaign (Pilot Study; N = 48), (2) the campaign combined with an injunctive norm message of explicit peer disapproval of bolting (Study 1; N = 78), and (3) the campaign and a descriptive norm message of low prevalence of bolting (Study 2; N = 96) on both normative perceptions of bolting and bolting intentions.

Results: The Pilot Study showed that the campaign had no effect on norm perceptions or bolting intentions. In Study 1, the campaign was associated with higher, not lower, intentions to bolt drinks, an effect exacerbated by the injunctive norm information. Bootstrapping analyzes of the indirect effects showed that participants perceived that bolting was more common when exposed to the campaign combined with the injunctive norm, and these negative descriptive norm perceptions were associated with stronger bolting intentions. In contrast, Study 2 showed that addition of the descriptive norm (i.e. low prevalence information) enhanced the effectiveness of the campaign.

Geographic Variation in Opioid and Heroin Involved Drug Poisoning Mortality Rates
Christopher Ruhm
American Journal of Preventive Medicine, forthcoming

Introduction: An important barrier to formulating effective policies to address the rapid rise in U.S. fatal overdoses is that the specific drugs involved are frequently not identified on death certificates. This analysis supplies improved estimates of state opioid and heroin involved drug fatality rates in 2014, and changes from 2008 to 2014.

Methods: Reported mortality rates were calculated directly from death certificates and compared to corrected rates that imputed drug involvement when no drug was specified. The analysis took place during 2016–2017.

Results: Nationally, corrected opioid and heroin involved mortality rates were 24% and 22% greater than reported rates. The differences varied across states, with particularly large effects in Pennsylvania, Indiana, and Louisiana. Growth in corrected opioid mortality rates, from 2008 to 2014, were virtually the same as reported increases (2.5 deaths per 100,000 people) whereas changes in corrected heroin death rates exceeded reported increases (2.7 vs 2.3 per 100,000). Without corrections, opioid mortality rate changes were considerably understated in Pennsylvania, Indiana, New Jersey, and Arizona, but dramatically overestimated in South Carolina, New Mexico, Ohio, Connecticut, Florida, and Kentucky. Increases in heroin death rates were understated in most states, and by large amounts in Pennsylvania, Indiana, New Jersey, Louisiana, and Alabama.

The Taxation of Recreational Marijuana: Evidence from Washington State
Benjamin Hansen, Keaton Miller & Caroline Weber
NBER Working Paper, July 2017

The median United States voter supports the legalization of marijuana, at least in part due to a desire to increase state tax revenues. However, states with legal markets have implemented wildly different regulatory schemes with tax rates ranging from 3.75 to 37 percent, indicating that policy makers have a range of beliefs about industry responses to taxes and regulation. We examine a policy reform in Washington: a switch from a 25 percent gross receipts tax collected at every step in the supply chain to a sole 37 percent excise tax at retail. Using novel, comprehensive administrative data, we assess responses to the reform throughout the supply and consumption chain. We find the previous tax regime provided strong incentives for vertical integration. Tax invariance did not hold, with some types of firms benefiting much more than predicted. Consumers bear 44 percent of the additional retail tax burden. Finally, we find evidence that consumer demand for marijuana is price-inelastic in the short-run, but becomes price-elastic within a few weeks of a price increase.

Not in My Backyard? Not so Fast. The Effect of Marijuana Legalization on Neighborhood Crime
Jeffrey Brinkman & David Mok-Lamme
Federal Reserve Working Paper, July 2017

This paper studies the effects of marijuana legalization on neighborhood crime using unique geospatial data from Denver, Colorado. We construct a highly local panel data set that includes changes in the location of marijuana dispensaries and changes in neighborhood crime. To account for endogenous retail dispensary locations, we use a novel identification strategy that exploits exogenous changes in demand across different locations. The change in geographic demand arises from the increased importance of access to external markets caused by a change in state and local policy. The results imply that retail dispensaries lead to reduced crime in the neighborhoods where they are located. Reductions in crime are highly localized, with no evidence of benefits for adjacent neighborhoods. The spatial extent of these effects are consistent with a policing or security response, and analysis of detailed crime categories provides indirect evidence that the reduction in crime arises from a disruption of illicit markets.

Crash Fatality Rates After Recreational Marijuana Legalization in Washington and Colorado
Jayson Aydelotte et al.
American Journal of Public Health, August 2017, Pages 1329-1331

Methods: We used the US Fatality Analysis Reporting System to determine the annual numbers of motor vehicle crash fatalities between 2009 and 2015 in Washington, Colorado, and 8 control states. We compared year-over-year changes in motor vehicle crash fatality rates (per billion vehicle miles traveled) before and after recreational marijuana legalization with a difference-in-differences approach that controlled for underlying time trends and state-specific population, economic, and traffic characteristics.

Results: Pre–recreational marijuana legalization annual changes in motor vehicle crash fatality rates for Washington and Colorado were similar to those for the control states. Post–recreational marijuana legalization changes in motor vehicle crash fatality rates for Washington and Colorado also did not significantly differ from those for the control states (adjusted difference-in-differences coefficient = +0.2 fatalities/billion vehicle miles traveled; 95% confidence interval = −0.4, +0.9).

Alcohol Intake and Cognitively Healthy Longevity in Community-Dwelling Adults: The Rancho Bernardo Study
Erin Richard et al.
Journal of Alzheimer's Disease, Summer 2017, Pages 803-814

To better understand the association of alcohol intake with cognitively healthy longevity (CHL), we explored the association between amount and frequency of alcohol intake and CHL among 1,344 older community-dwelling adults. Alcohol intake was assessed by questionnaire in 1984–1987. Cognitive function was assessed in approximate four-year intervals between 1988 and 2009. Multinomial logistic regression, adjusting for multiple lifestyle and health factors, was used to examine the association between alcohol consumption and CHL (living to age 85 without cognitive impairment), survival to age 85 with cognitive impairment (MMSE score >1.5 standard deviations below expectation for age, sex, and education), or death before age 85. Most participants (88%) reported some current alcohol intake; 49% reported a moderate amount of alcohol intake, and 48% reported drinking near-daily. Relative to nondrinkers, moderate and heavy drinkers (up to 3 drinks/day for women and for men 65 years and older, up to 4 drinks/day for men under 65 years) had significantly higher adjusted odds of survival to age 85 without cognitive impairment (p’s < 0.05). Near-daily drinkers had 2-3 fold higher adjusted odds of CHL versus living to at least age 85 with cognitive impairment (odds ratio (OR) = 2.06; 95% confidence interval (CI): 1.21, 3.49) or death before 85 (OR = 3.24; 95% CI: 1.92, 5.46). Although excessive drinking has negative health consequences, these results suggest that regular, moderate drinking may play a role in cognitively healthy longevity.

Cigarette Smoking and Risk of Early Natural Menopause
Brian Whitcomb et al.
American Journal of Epidemiology, forthcoming

Menopause before age 45 affects roughly 5%–10% of women and is associated with higher risk of adverse health conditions. Smoking may increase early menopause risk; however, evidence is inconsistent, and data regarding smoking amount, duration, cessation and patterns over time and risk are scant. We used data from the Nurses’ Health Study II of 116,429 nurses from 1989 through 2011 and Cox proportional hazards models to estimate hazard ratios (HR) adjusting for confounders. Compared to never-smokers, current smokers had a HR of 1.90 (95% CI: 1.71, 2.11); former smokers had a HR of 1.10 (95% CI: 1.00, 1.21). Increased risks were observed among women reporting current smoking with a HR = 1.72 (95% CI: 1.36, 2.18) for 11–15 pack-years; HR = 1.72 (95% CI: 1.38, 2.14) for 16–20 pack-years; and HR = 2.42 (95% CI: 2.11, 2.77) for >20 pack-years. Elevated risk was observed in former smokers reporting 11–15 (HR = 1.29, 95% CI: 1.07–1.55), 16–20 (HR = 1.42, 95% CI: 1.13, 1.79) or >20 pack-years (HR = 1.54, 95% CI: 1.23, 1.93). Women who smoked ≤10 cigarettes/day but quit by age 25 had comparable risk to never-smokers (HR = 1.03, 95% CI: 0.91, 1.17). A dose-response relation between smoking and early natural menopause risk, and reduced risk among quitters, may provide insights into the mechanisms of cigarette smoking on reproductive health.

Creativity on tap? Effects of alcohol intoxication on creative cognition
Mathias Benedek et al.
Consciousness and Cognition, forthcoming

Anecdotal reports link alcohol intoxication to creativity, while cognitive research highlights the crucial role of cognitive control for creative thought. This study examined the effects of mild alcohol intoxication on creative cognition in a placebo-controlled design. Participants completed executive and creative cognition tasks before and after consuming either alcoholic beer (BAC of 0.03) or non-alcoholic beer (placebo). Alcohol impaired executive control, but improved performance in the Remote Associates Test, and did not affect divergent thinking ability. The findings indicate that certain aspects of creative cognition benefit from mild attenuations of cognitive control, and contribute to the growing evidence that higher cognitive control is not always associated with better cognitive performance.

Treatment use, sources of payment, and financial barriers to treatment among individuals with opioid use disorder following the national implementation of the ACA
Ryan McKenna
Drug and Alcohol Dependence, October 2017, Pages 87-92

Methods: Data on individuals ages 18-64 with OUD come from the 2008-2014 National Survey on Drug Use and Health (N = 4,100). Multivariable logistic regression analyses were performed to estimate the trends of health care insurance, treatment and barriers to care across the stages of ACA implementation: pre-ACA (2008-2009), partial-ACA (2010-2013), and national implementation (2014). All models were adjusted for predisposing, enabling, and need factors.

Results: In both adjusted and unadjusted comparisons, national implementation of the ACA was associated with significant improvements in outcome measures for those with OUD. Multivariable analyses indicate that, after national implementation, those with OUD were significantly less likely to be uninsured and were less likely to report financial barriers as a reason for not receiving substance use treatment, relative to the pre-ACA period. Individuals were also more likely to receive substance use treatment and were more likely to report that insurance paid for treatment after national implementation of the ACA relative to the pre-ACA period. These results persisted when national implementation was compared relative to partial-implementation.

Addressing the Opioid Epidemic: Is There a Role for Physician Education?
Molly Schnell & Janet Currie
NBER Working Paper, August 2017

Using data on all opioid prescriptions written by physicians from 2006 to 2014, we uncover a striking relationship between opioid prescribing and medical school rank. Even within the same specialty and county of practice, physicians who completed their initial training at top medical schools write significantly fewer opioid prescriptions annually than physicians from lower ranked schools. Additional evidence suggests that some of this gradient represents a causal effect of education rather than patient selection across physicians or physician selection across medical schools. Altering physician education may therefore be a useful policy tool in fighting the current epidemic.

Increased alcohol use after Hurricane Ike: The roles of perceived social cohesion and social control
Chenyi Ma & Tony Smith
Social Science & Medicine, forthcoming

Hurricane Ike, the third costliest hurricane in US history, made landfall in the Galveston Bay Area in September, 2008. Existing literature postulates that maladaptive behavior such as increased alcohol use is often exhibited by disaster survivors in coping with both disaster-related traumatic events and post-disaster stressful events. In addition, it has also been postulated that survivors’ perceptions of social cohesion and social control can potentially serve to moderate such behavior. The purpose of this paper is to study such hypotheses for Hurricane Ike. In particular, we investigate the following four hypotheses: (H1) There is an increase of alcohol use by survivors of Hurricane Ike in the Galveston Bay Area; (H2) There are positive associations between both Ike-related trauma and post-Ike stress events and the increase in alcohol use; (H3) There are negative associations between both perceived social cohesion and social control and the increase in alcohol use following Ike; and finally that (H4) perceived social cohesion and social control serve to moderate the associations between both Ike-related trauma and post-Ike stress events and increased alcohol use after Ike. Using public use survey-weighted data from the Galveston Bay Recovery Study (GBRS) of Ike survivors (N = 658), we tested these hypotheses using logistic regressions controlling for other key socioeconomic variables. Our results confirm H1 and H2. Hypotheses H3 and H4 are partially confirmed with respect to social control, but show that (i) there is a positive association between perceived social cohesion and the increase in alcohol use following Ike, and that (ii) while perceived social cohesion and social control do moderate the association between post-Ike stress events and increased alcohol use, they have no effect on the association between Ike-related trauma and increased alcohol use.

The effect of payday lending restrictions on liquor sales
Harold Cuffe & Christopher Gibbs
Journal of Banking & Finance, forthcoming

We exploit a change in lending laws to estimate the causal effect of restricting access to payday loans on liquor sales. Leveraging lender- and liquor store-level data, we find that the changes reduce sales, with the largest decreases at stores located nearest to payday lenders. By focusing on states with state-run liquor monopolies, we account for endogenous supply-side variables that are typically unobserved. Further analysis of consumer-level data indicates that the lending restrictions reduce alcohol expenditures without affecting total household spending. This is consistent with a distinct relationship between payday lending access and alcohol purchases, and suggests that present biased motivations underlie some loan use. The finding is significant because it shows that payday loan access is associated with unproductive borrowing, and directly links payday loan access to public health issues.

Association of elevated ambient temperature with death from cocaine overdose
Nathalie Auger et al.
Drug and Alcohol Dependence, September 2017, Pages 101-105

Methods: We carried out a case-crossover study of all deaths from cocaine or other drug overdose between the months of May and September, from 2000 through 2013 in Quebec, Canada. We used conditional logistic regression to estimate odds ratios (OR) and 95% confidence intervals (CI) for the association between maximum outdoor temperature and death from cocaine or other drug overdose. The main outcome measure was death from cocaine overdose as a function of maximum temperature the day of death and the days immediately preceding death.

Results: There were 316 deaths from cocaine overdose and 446 from other drug overdoses during the study. Elevated temperature the preceding week was associated with the likelihood of death from cocaine but not other drug overdose. Compared with 20 °C, a maximum weekly temperature of 30 °C was associated with an OR of 2.07 for death from cocaine overdose (95% CI 1.15–3.73), but an OR of 1.03 for other drug overdoses (95% CI 0.60–1.75). Associations for cocaine overdose were present with maximum daily temperature the day of and each of the three days preceding death.

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