Being used
Twin epidemics: The surging rise of methamphetamine use in chronic opioid users
Matthew Ellis, Zachary Kasper & Theodore Cicero
Drug and Alcohol Dependence, December 2018, Pages 14-20
Methods: Patients (N = 13,521) entering drug treatment programs across the United States completed an anonymous survey of drug use patterns from 2011-2017. A subset of these patients (N = 300) was also interviewed to add context and expand on the structured survey.
Results: Past month use of methamphetamine significantly increased among treatment-seeking opioid users (+82.6%, p < .001), from 18.8% in 2011 to 34.2% in 2017. The Western region had the greatest increase in past month methamphetamine use (+202.4%, p < 0.001) and the highest prevalence rate in 2017 (63.0%). Significant increases (p < .001) in methamphetamine use were seen among males (+81.8%), females (+97.8%), whites (+100.6%), urban residents (+123.0%) and rural residents (+93.7%).
Conclusions: Our studies show that there has been a marked increase in the past month use of methamphetamine in individuals with a primary indication of opioid use disorder. Qualitative data indicated that methamphetamine served as an opioid substitute, provided a synergistic high, and balanced out the effects of opioids so one could function “normally”. Our data suggest that, at least to some extent, efforts limiting access to prescription opioids may be associated with an increase in the use of methamphetamine.
Identifying Unreported Opioid Deaths Through Toxicology Data and Vital Records Linkage: Case Study in Marion County, Indiana, 2011–2016
Evan Lowder et al.
American Journal of Public Health, December 2018, Pages 1682-1687
Methods: We matched toxicology data to vital records for all accidental poisoning deaths (n = 1238) in Marion County, Indiana, from January 2011 to December 2016. From vital records, we coded cases as opioid involved, specified other substance, or unspecified. We extracted toxicology data on opioid substances for unspecified cases, and we have reported corrected estimates of opioid-involved deaths after accounting for toxicology findings.
Results: Over a 6-year period, 57.7% of accidental overdose deaths were unspecified and 34.2% involved opioids. Toxicology data showed that 86.8% of unspecified cases tested positive for an opioid. Inclusion of toxicology results more than doubled the proportion of opioid-involved deaths, from 34.2% to 86.0%.
Unemployment Insurance and Cigarette Smoking
Wei Fu & Feng Liu
Journal of Health Economics, forthcoming
Abstract:
We provide evidence for the causal relationship between unemployment insurance (UI) and individuals’ smoking behavior using the 1995–2011 Current Population Survey-Tobacco Use Supplement data. Our identification relies on the exploitation of the exogenous variations of the maximum UI weekly benefits across states and over years. Instead of focusing on all unemployed people, we concentrate on those who are eligible for UI benefits. We find that when the maximum UI weekly benefit level increases by $100, smoking cessation increases by approximately 2.9 percentage points among the UI-eligible unemployed. The results are robust to various model specifications. We also explore the mechanism and find suggestive evidence that the increase in the maximum UI weekly benefit leads to a decrease in the probability of over-work of the respective spouse. Moreover, the unemployed who are less educated are more responsive to the increasing UI benefits.
De-unionization and Drug Death Rates
Robert DeFina & Lance Hannon
Social Currents, forthcoming
Abstract:
Drug death rates in the United States have risen dramatically in recent years, sparking urgent discussions about causes. Most of these discussions have centered on supply-side issues, such as doctors overprescribing pain killers. However, there is increasing recognition of the need to go beyond proximate causes and to consider larger social forces that bear on the demand for pain-relieving drugs. Informed by sociological research linking labor unions to community health, we empirically examined the relationship between union density and drug death rates for the years 1999 to 2016. We found that states experiencing greater declines in unionization also tended to experience greater increases in drug deaths. Estimates from our fixed-effects models suggested that a one standard deviation decrease in union density was associated with a 42 percent increase in drug death rates over the period. Although the incorporation of a variety of statistical controls reduced this association, it remained negative and significant. Beyond variation in the availability of substances to misuse, our findings underscore the importance of considering institutional decline and broader social conditions as deeply relevant for contemporary drug death trends.
Displacement in the Criminal Labor Market: Evidence from Drug Legalizations
Heyu Xiong
Northwestern University Working Paper, October 2018
Abstract:
It is widely hypothesized that legalization disrupts illicit markets and displaces illegal suppliers, but the consequences for those who are displaced remain poorly understood. In this paper, I use comprehensive administrative data from three states that legalized marijuana covering all individuals released from prison in the years immediately before and after the policy change to estimate the effect of legalization on the subsequent criminality of convicted dealers. I find that marijuana legalization increased the 9-month recidivism rate of marijuana offenders by 6 percentage points relative to a baseline rate of 10 percent. The increased recidivism is largely driven by a substitution to the trafficking of other drugs, which is consistent with a Becker-style model where individuals develop human capital specific to the drug industry. To learn about potential mechanism behind these results, I use detailed drug transaction price data to estimate the effect of legalization on average prices and price dispersion, and I find suggestive evidence that both the average level and residual variance decline following legalization, which is consistent with legalization eroding rents earned in the illicit marijuana market. Lastly, I explore the generalizability of my findings in a distinct legalization experiment from history: the end of National Prohibition. I replicate the main insights at an organizational level and show that, in response to the repeal of Prohibition, the Italian-American Mafia shifted personnel from bootlegging to narcotics. Overall, the results in this paper suggest that an unintended consequence of drug legalization is a re-allocation of drug criminals to other illicit activity.
She Looks like She’d Be an Animal in Bed: Dehumanization of Drinking Women in Social Contexts
Abigail Riemer et al.
Sex Roles, forthcoming
Abstract:
The purpose of the present research was to examine the perceptions of women who drink in social contexts through the lens of dehumanization (Haslam 2006). Across three experiments, we manipulated the presence of alcohol by depicting a woman at a bar with a bottle of beer or a bottle of water and measured dehumanization. As hypothesized, women were dehumanized more in the alcohol condition than in the water condition by men (Experiments 1–3) and women (Experiments 2 and 3). Notably, the presence of alcohol compared to water had no impact on dehumanization of men (Experiment 2). Also, as hypothesized, perceived intoxication emerged as a significant mediator of the link between alcohol condition and dehumanization in Experiments 1 and 2, and alcohol quantity predicted greater dehumanization in Experiment 3. Extending the present work to prior work in this area, Experiment 3 also examined the links among alcohol, perceived sexual availability, and dehumanization, revealing that perceived sexual availability mediated the link between alcohol and dehumanization. Implications for theories of dehumanization, alcohol, and social perception as well as practical implications of these findings are discussed.
Effects of state education requirements for substance use prevention
Christopher Carpenter et al.
Health Economics, forthcoming
Abstract:
We provide the first evidence on the effects of state laws requiring students to receive education about alcohol, tobacco, and other drugs using data on over a million youths from the 1976–2010 Monitoring the Future study. In difference‐in‐differences and event‐study models, we find robust evidence that these laws significantly reduced recent alcohol and marijuana use among high school seniors by 1.6–2.8 percentage points, or about 8–10% of the overall decline over this period. Our results suggest that information interventions can reduce youth substance use.
Initiation of new psychotropic prescriptions without a psychiatric diagnosis among US adults: Rates, correlates, and national trends from 2006 to 2015
Taeho Greg Rhee & Robert Rosenheck
Health Services Research, forthcoming
Data source: Data were gathered from the 2006‐2015 National Ambulatory Medical Care Survey (NAMCS), a nationally representative sample of office‐based U.S. outpatient care. The sample was limited to adults aged 18 or older who received a new psychotropic drug prescription (n = 8618 unweighted).
Study Design: Using a repeated cross‐sectional design with survey sampling techniques, we estimated prescription initiation rates and national trends. Multivariable‐adjusted logistic regression analysis was used to identify correlates independently associated with initiation of new psychotropic prescriptions without a psychiatric diagnosis.
Principal findings: Altogether, at 60.4% of visits at which a new psychotropic prescription was initiated, no psychiatric diagnosis was recorded for the visit. Overall, the rate increased from 59.1% in 2006‐2007 to 67.7% in 2008‐2009 and then decreased to 52.0% in 2014‐2015. Visits to psychiatrists were associated with very low odds of having no psychiatric diagnosis when compared to primary care visits (OR = 0.02; 95% CI, 0.01‐0.04). Visits to non‐psychiatric specialists showed 6.90 times greater odds of not having a psychiatric diagnosis when compared to primary care visits (95% CI, 5.38‐8.86).
Assessment of Exposure to High-Performing Schools and Risk of Adolescent Substance Use: A Natural Experiment
Rebecca Dudovitz et al.
JAMA Pediatrics, forthcoming
Design, Setting, and Participants: This natural experiment used admission lotteries, which mimic random assignment, to estimate the association of school environments and adolescent health. A survey of 1270 students who applied to at least 1 of 5 high-performing public charter schools in low-income minority communities in Los Angeles, California. Schools had an academic performance ranked in the top tertile of Los Angeles County public high schools, applicants outnumbered available seats by at least 50, and an admissions lottery was used. Participants included lottery winners (intervention group [n = 694]) and lottery losers (control group [n = 576]) from the end of 8th grade and beginning of 9th grade through the end of 11th grade. Intention-to-treat (ITT) and instrumental variable techniques estimated the association of winning the lottery and attending high-performing schools with health behaviors and whether the association varied by sex. Data were collected from March 11, 2013, through February 22, 2017, and analyzed from October 1, 2017, through July 1, 2018.
Results: Among the 1270 participating students (52.6% female; mean [SD] age at enrollment, 14.3 [0.5] years), ITT analysis showed that the intervention group reported less marijuana misuse than the control group (mean marijuana misuse score, 0.46 vs 0.71), as well as fewer substance-using peers (9.6% vs 12.7%), more time studying (mean, 2.63 vs 2.49 hours), less truancy (84.3% vs 77.3% with no truancy), greater teacher support for college (mean scores, 7.20 vs 7.02), more orderly schools (mean order score, 7.06 vs 6.83), and less school mobility (21.4% vs 28.4%) (all P < .05). Stratified analyses suggest that among boys, intervention participants had significantly lower marijuana use (mean misuse score, 0.43 vs 0.88; difference, −0.45; 95% CI, −0.78 to −0.13) and alcohol misuse (mean misuse score, 0.52 vs 0.97; difference, −0.44; 95% CI, −0.80 to −0.09) scores compared with control participants, whereas no significant health outcomes were noted for girls.
How Does Alcohol Consumption Affect Perceptions of One’s Own and a Drinking Partner’s Ability to Consent to Sexual Activity?
Michelle Drouin et al.
Journal of Sex Research, forthcoming
Abstract:
In this naturalistic study, our aim was to examine the extent to which alcohol consumption affected perceptions of one’s own and one’s friend’s ability to consent to sexual activity. We surveyed 160 adult bargoers in pairs about their own and their friends’ alcohol consumption, intoxication symptoms, and ability to consent to sexual activity. On average, participants reported consuming 4.97 drinks, rated themselves at the legal limit for driving, reported one intoxication symptom, and had a blood alcohol concentration (BAC) just over .08. However, few thought they or their friend had diminished cognitive function. Accordingly, most indicated that they could consent to sex (93%) and their friend could consent to sex (87%). Number of drinks people reported consuming, self-reported intoxication levels and symptoms, and BACs were significantly correlated; however, none of these measures was significantly related to individuals’ perceptions of their own or their friends’ ability to consent to sexual activity. Finally, those in man–man pairs were significantly more likely than those in woman–woman pairs to indicate they would allow their friend to have sex if approached by an interested party. These findings have potential implications for prevention programming and for legal cases involving individuals who engage in sexual activity while intoxicated.
Sex, Drugs, and Baby Booms: Can Behavior Overcome Biology?
Michele Baggio, Alberto Chong & David Simon
NBER Working Paper, November 2018
Abstract:
We study the behavioral changes due to marijuana consumption on fertility and its key mechanisms, as opposed to physiological changes. We can employ several large proprietary data sets, including the 1997 National Longitudinal Survey of Youth, Nielsen Retail Scanner database, as well as the Vital Statistics Natality files and apply a differences-in-differences approach by exploiting the timing of the introduction of medical marijuana laws among states. We first replicate the earlier literature by showing that marijuana use increases after the passage of medical marijuana laws. Our novel results reveal that birth rates increased after the passage of a law corresponding to increased frequency of sexual intercourse, decreased purchase of condoms and suggestive evidence on decreased condom use during sex. More sex and less contraceptive use may be attributed to behavioral responses such as increased attention to the immediate hedonic effects of sexual contact, delayed discounting and ignoring costs associated with risky sex. These findings are consistent with a large observational literature linking marijuana use with increased sexual activity and multiple partners. Our findings are robust to a broad set of tests.
One Month of Cannabis Abstinence in Adolescents and Young Adults Is Associated With Improved Memory
Randi Melissa Schuster et al.
Journal of Clinical Psychiatry, November/December 2018
Methods: Eighty-eight adolescents and young adults (aged 16–25 years) who used cannabis regularly were recruited from the community and a local high school between July 2015 and December 2016. Participants were randomly assigned to 4 weeks of cannabis abstinence, verified by decreasing 11-nor-9-carboxy-∆9-tetrahydrocannabinol urine concentration (MJ-Abst; n = 62), or a monitoring control condition with no abstinence requirement (MJ-Mon; n = 26). Attention and memory were assessed at baseline and weekly for 4 weeks with the Cambridge Neuropsychological Test Automated Battery.
Results: Among MJ-Abst participants, 55 (88.7%) met a priori criteria for biochemically confirmed 30-day continuous abstinence. There was an effect of abstinence on verbal memory (P = .002) that was consistent across 4 weeks of abstinence, with no time-by-abstinence interaction, and was driven by improved verbal learning in the first week of abstinence. MJ-Abst participants had better memory overall and at weeks 1, 2, 3 than MJ-Mon participants, and only MJ-Abst participants improved in memory from baseline to week 1. There was no effect of abstinence on attention: both groups improved similarly, consistent with a practice effect.