Hazy
Christopher Salas-Wright et al.
Drug and Alcohol Dependence, December 2016, Pages 5–10
Method: Findings are based on repeated, cross-sectional data collected annually from adolescents (ages 12–17; n = 230,452) and young adults (ages 18–21; n = 120,588) surveyed as part of the National Survey on Drug Use and Health between 2002 and 2014. For each of the birth years between 1986 and 1996, we combined a series of nationally representative cross-sections to provide multi-year data strings designed to approximate nationally representative cohorts.
Results: Compared to youth born in the mid-to-late 1980s, youth born in the mid-1990s reported significantly higher levels of marijuana disapproval during the early adolescent years (Age 14: 1988 = 64.7%, 1994 = 70.4%) but lower levels of disapproval during the young adult years (Age 19: 1988 = 32.0%, 1994 = 25.0%; Age 20: 1988 = 27.9%, 1994 = 19.7%). Moreover, the prevalence of marijuana use among youth born in 1994 was significantly lower — compared to youth born in 1988 — at age 14 (1988: 11.39%, 1994: 8.19%) and significantly higher at age 18 (1988: 29.67%, 1994: 34.83%). This pattern held even when adjusting for potential confounding by demographic changes in the population across the study period.
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Substance Abuse Treatment Centers and Local Crime
Samuel Bondurant, Jason Lindo & Isaac Swensen
NBER Working Paper, September 2016
Abstract:
In this paper we estimate the effects of expanding access to substance-abuse treatment on local crime. We do so using an identification strategy that leverages variation driven by substance-abuse-treatment facility openings and closings measured at the county level. The results indicate that substance-abuse-treatment facilities reduce both violent and financially motivated crimes in an area, and that the effects are particularly pronounced for relatively serious crimes. The effects on homicides are documented across three sources of homicide data.
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State Medical Marijuana Laws and the Prevalence of Opioids Detected Among Fatally Injured Drivers
June Kim et al.
American Journal of Public Health, November 2016, Pages 2032-2037
Objectives: To assess the association between medical marijuana laws (MMLs) and the odds of a positive opioid test, an indicator for prior use.
Methods: We analyzed 1999–2013 Fatality Analysis Reporting System (FARS) data from 18 states that tested for alcohol and other drugs in at least 80% of drivers who died within 1 hour of crashing (n = 68 394). Within-state and between-state comparisons assessed opioid positivity among drivers crashing in states with an operational MML (i.e., allowances for home cultivation or active dispensaries) versus drivers crashing in states before a future MML was operational.
Results: State-specific estimates indicated a reduction in opioid positivity for most states after implementation of an operational MML, although none of these estimates were significant. When we combined states, we observed no significant overall association (odds ratio [OR] = 0.79; 95% confidence interval [CI] = 0.61, 1.03). However, age-stratified analyses indicated a significant reduction in opioid positivity for drivers aged 21 to 40 years (OR = 0.50; 95% CI = 0.37, 0.67; interaction P < .001).
Conclusions: Operational MMLs are associated with reductions in opioid positivity among 21- to 40-year-old fatally injured drivers and may reduce opioid use and overdose.
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Lauren Hersch Nicholas & Johanna Catherine Maclean
NBER Working Paper, September 2016
Abstract:
We study the effect of state medical marijuana laws (MMLs) on labor supply and health outcomes among older adults; the demographic group with the highest rates of many chronic conditions for which marijuana may be an effective treatment. Using 1992 - 2012 Health and Retirement Study data to estimate differences-in-differences models, we find that MML implementation leads to increases in labor supply among older adults along with improvement in health for older men and mixed health effects for women. These effects should be considered as policymakers determine how best to regulate access to medical marijuana.
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Moderate alcohol consumption after a mental stressor attenuates the stress response
I.C. Schrieks et al.
Alcohol, forthcoming
Abstract:
Alcohol is often consumed to reduce tension and improve mood when exposed to stressful situations. Previous studies showed that moderate alcohol consumption may reduce stress when alcohol is consumed prior to a stressor, but data on the effect of alcohol consumption after a mental stressor is limited. Therefore, our objective was to study whether moderate alcohol consumption immediately after a mental stressor attenuates the stress response. Twenty-four healthy men (age 21–40 y, BMI 18–27 kg/m2) participated in a placebo-controlled trial. They randomly consumed 2 cans (660 mL, ∼26 g alcohol) of beer or alcohol-free beer immediately after a mental stressor (Stroop task and Trier Social Stress Test). Physiological and immunological stress response was measured by monitoring heart rate and repeated measures of the hypothalamic-pituitary-adrenal axis (HPA-axis), white blood cells and a set of cytokines. After a mental stressor, cortisol and adrenocorticotropic hormone (ACTH) concentrations were 100% and 176% more reduced at 60 min (P = 0.012 and P = 0.001, respectively) and 92% and 60% more reduced at 90 min (P < 0.001 and P = 0.056, respectively) after beer consumption as compared to alcohol-free beer consumption. Heart rate and dehydroepiandrosterone (DHEA) were not influenced by alcohol consumption. Plasma IL-8 concentrations remained lower during the stress recovery period after beer consumption than after alcohol-free beer consumption (P < 0.001). In conclusion, consumption of a moderate dose of alcohol after a mental stressor may facilitate stress response recovery as reflected by decreasing plasma ACTH and cortisol.
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Treatment utilization among persons with opioid use disorder in the United States
Li-Tzy Wu, He Zhu & Marvin Swartz
Drug and Alcohol Dependence, forthcoming
Background: The United States is experiencing an opioid overdose epidemic. Treatment use data from diverse racial/ethnic groups with opioid use disorder (OUD) are needed to inform treatment expansion efforts.
Methods: We examined demographic characteristics and behavioral health of persons aged ≥12 years that met criteria for past-year OUD (n = 6,125) in the 2005–2013 National Surveys on Drug Use and Health (N = 503,101). We determined the prevalence and correlates of past-year use of alcohol/drug use treatment and opioid-specific treatment to inform efforts for improving OUD treatment.
Results: Among persons with OUD, 81.93% had prescription (Rx) OUD only, 9.75% had heroin use disorder (HUD) only, and 8.32% had Rx OUD + HUD. Persons with Rx OUD + HUD tended to be white, adults aged 18-49, males, or uninsured. The majority (80.09%) of persons with OUD had another substance use disorder (SUD), and major depressive episode (MDE) was common (28.74%). Of persons with OUD, 26.19% used any alcohol or drug use treatment, and 19.44% used opioid-specific treatment. Adolescents, the uninsured, blacks, native-Hawaiians/Pacific-Islanders/Asian-Americans, persons with Rx OUD only, and persons without MDE or SUD particularly underutilized opioid-specific treatment. Among alcohol/drug use treatment users, self-help group and outpatient rehabilitation treatment were commonly used services.
Conclusions: Most people with OUD report no use of OUD treatment. Multifaceted interventions, including efforts to access insurance coverage, are required to change attitudes and knowledge towards addiction treatment in order to develop a supportive culture and infrastructure to enable treatment-seeking. Outreach efforts could target adolescents, minority groups, and the uninsured to improve access to treatment.
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Michael Daly et al.
Health Psychology, November 2016, Pages 1254-1263
Methods: 21,132 participants were drawn from 2 nationally representative cohort studies; the 1970 British Cohort Study (BCS) and the 1958 National Child Development Study (NCDS). Child self-control was teacher-rated at age 10 in the BCS and at ages 7 and 11 in the NCDS. Participants reported their smoking status and number of cigarettes smoked per day at 5 time-points in the BCS (ages 26–42) and 6 time-points in the NCDS (ages 23–55). Both studies controlled for socioeconomic background, cognitive ability, psychological distress, gender, and parental smoking; the NCDS also controlled for an extended set of background characteristics.
Results: Early self-control made a substantial graded contribution to (not) smoking throughout life. In adjusted regression models, a 1-SD increase in self-control predicted a 6.9 percentage point lower probability of smoking in the BCS, and this was replicated in the NCDS (5.2 point reduced risk). Adolescent smoking explained over half of the association between self-control and adult smoking. Childhood self-control was positively related to smoking cessation and negatively related to smoking initiation, relapse to smoking, and the number of cigarettes smoked in adulthood.
Conclusions: This study provides strong evidence that low childhood self-control predicts an increased risk of smoking throughout adulthood and points to adolescent smoking as a key pathway through which this may occur.
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Silvia Martins et al.
Drug and Alcohol Dependence, December 2016, Pages 26–32
Background: Little is known on how perceived availability of marijuana is associated with medical marijuana laws. We examined the relationship between medical marijuana laws (MML) and the prevalence of past-month marijuana use, with perceived availability of marijuana.
Methods: Data were from respondents included in the National Survey of Drug Use and Health restricted use data portal 2004-2013. Multilevel logistic regression of individual- level data was used to test differences between MML and non-MML states and changes in prevalence of past-month marijuana use and perceived availability from before to after passage of MML among adolescents, young adults and older adults controlling for demographics.
Results: Among adults 26+, past-month prevalence of marijuana use increased from 5.87% to 7.15% after MML passage (Adjusted Odds Ratio (AOR): 1.24 [1.16-1.31]), but no change in prevalence of use was found for 12-17 or 18-25 year-olds. Perceived availability of marijuana increased after MML were enacted among those 26+ but not in younger groups. Among all age groups, prevalence of marijuana use and perception of it being easily available was higher in states that would eventually pass MML by 2013 compared to those that had not. Perceived availability was significantly associated with increased risk of past-month marijuana use in all age groups.
Conclusion: Evidence suggests perceived availability as a driver of change in use of marijuana due to MML. To date, this has only occurred in adults 26+ and different scenarios that could explain this change need to be further explored.
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Andrew Plunk et al.
Drug and Alcohol Dependence, forthcoming
Background: There is concern that medical marijuana laws (MMLs) could negatively affect adolescents. To better understand these policies, we assess how adolescent exposure to MMLs is related to educational attainment.
Methods: Data from the 2000 Census and 2001–2014 American Community Surveys were restricted to individuals who were of high school age (14–18) between 1990 and 2012 (n = 5,483,715). MML exposure was coded as: (i) a dichotomous “any MML” indicator, and (ii) number of years of high school age exposure. We used logistic regression to model whether MMLs affected: (a) completing high school by age 19; (b) beginning college, irrespective of completion; and (c) obtaining any degree after beginning college. A similar dataset based on the Youth Risk Behavior Survey (YRBS) was also constructed for confirmatory analyses assessing marijuana use.
Results: MMLs were associated with a 0.40 percentage point increase in the probability of not earning a high school diploma or GED after completing the 12th grade (from 3.99% to 4.39%). High school MML exposure was also associated with a 1.84 and 0.85 percentage point increase in the probability of college non-enrollment and degree non-completion, respectively (from 31.12% to 32.96% and 45.30% to 46.15%, respectively). Years of MML exposure exhibited a consistent dose response relationship for all outcomes. MMLs were also associated with 0.85 percentage point increase in daily marijuana use among 12th graders (up from 1.26%).
Conclusions: Medical marijuana law exposure between age 14 to 18 likely has a delayed effect on use and education that persists over time.
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Legal Access to Alcohol and Criminality
Benjamin Hansen & Glen Waddell
NBER Working Paper, August 2016
Abstract:
Previous research has found strong evidence that legal access to alcohol is associated with sizable increases in criminality. We revisit this relationship using the census of judicial records on criminal charges filed in Oregon Courts, the ability to separately track crimes involving firearms, and to track individuals over time. We find that crime increases at age 21, with increases mostly due to assaults lacking in premeditation, and alcohol-related nuisance crimes. We find no evident increases in rape or robbery. Among those with no prior criminal records, increases in crime are 50 percent larger; still larger for the most socially costly crimes of assault and drunk driving. This suggests that deterring criminality through increased punishments would likely prove difficult.
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Vivian Ho et al.
Medical Care Research and Review, forthcoming
Abstract:
Multiple studies claim that public place smoking bans are associated with reductions in smoking-related hospitalization rates. No national study using complete hospitalization counts by area that accounts for contemporaneous controls including state cigarette taxes has been conducted. We examine the association between county-level smoking-related hospitalization rates and comprehensive smoking bans in 28 states from 2001 to 2008. Differences-in-differences analysis measures changes in hospitalization rates before versus after introducing bans in bars, restaurants, and workplaces, controlling for cigarette taxes, adjusting for local health and provider characteristics. Smoking bans were not associated with acute myocardial infarction or heart failure hospitalizations, but lowered pneumonia hospitalization rates for persons ages 60 to 74 years. Higher cigarette taxes were associated with lower heart failure hospitalizations for all ages and fewer pneumonia hospitalizations for adults aged 60 to 74. Previous studies may have overestimated the relation between smoking bans and hospitalizations and underestimated the effects of cigarette taxes.
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Loni Philip Tabb, Lance Ballester & Tony Grubesic
Spatial and Spatio-temporal Epidemiology, forthcoming
Abstract:
Alcohol-related violence is a well-documented public health concern, where various individual and community-level factors contribute to this relationship. The purpose of this study is to examine the impact of a significant policy change at the local level, which privatized liquor sales and distribution. Specifically, we explored the relationship between alcohol and violence in Seattle, WA, 2010–2013, via hierarchical spatio-temporal disease mapping models. To measure and map this complex spatio-temporal relationship at the census block group level (n=567), we examined a variety of models using integrated nested Laplace approximations and used the deviance information criterion to gauge model complexity and fit. For each additional off-premises and on-premises alcohol outlet in a given census block group, we found a significant increase of 8% and 5% for aggravated assaults and 6% and 5% for non-aggravated assaults, respectively. Lastly, our maps showed variation in the estimated relative risks across the city of Seattle.
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Jemima Frimpong, Karen Shiu-Yee & Thomas D'Aunno
Health Services Research, forthcoming
Study Design: We used generalized linear regression models to examine associations between directors’ characteristics and methadone dose, adjusting for program and patient factors.
Principal Findings: The proportion of OAT programs with an African American director declined over time, from 29 percent in 1995 to 16 percent in 2011. The median percentage of patients in each program receiving <60 mg/day declined significantly, from 48.5 percent in 1995 to 29 percent in 2005 and 23 percent in 2011. Programs with an African American director were significantly more likely to provide low methadone doses than other programs. This association was even stronger in programs with an African American director who served populations with higher percentages of African American patients.
Conclusions: Demographic characteristics of OAT program directors (e.g., their race) may play a key role in explaining variations in methadone dosage across programs and patients. Further research should investigate the causal pathways through which directors’ characteristics affect treatment practices. This may lead to new, multifaceted managerial interventions to improve patient outcomes.
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Stevan Geoffrey Severtson et al.
Drug and Alcohol Dependence, November 2016, Pages 219–229
Background: The development of abuse deterrent formulations is one strategy for reducing prescription opioid misuse and abuse. A putative abuse deterrent formulation of oxycodone extended release (OxyContin®) was introduced in 2010. Early reports demonstrated reduced abuse and diversion, however, an analysis of social media found 32 feasible methods to circumvent the abuse deterrent mechanism. We measured trends of diversion, abuse and street price of OxyContin to assess the durability of the initial reduction in abuse.
Methods: Data from the Poison Center Program, Drug Diversion Program, Opioid Treatment Program, Survey of Key Informant Patients Program and StreetRx program of the Researched Abuse, Diversion, and Addiction-Related Surveillance (RADARS®) System were used. The average quarterly rates of abuse and diversion for OxyContin were compared from before reformulation to the rate in second quarter 2015. Rates were adjusted for population using US Census data and drug availability.
Results: OxyContin abuse and diversion declined significantly each quarter after reformulation and persisted for 5 years. The rate of abuse of other opioid analgesics increased initially and then decreased, but to lesser extent than OxyContin. Abuse through both oral and non-oral routes of self-administration declined following the reformulation. The geometric mean difference in the street price of reformulated OxyContin was 36% lower than the reformulated product in the year after reformulation.
Discussion: Despite methods to circumvent the abuse deterrent mechanism, abuse and diversion of OxyContin decreased promptly following the introduction of a crush- and solubility- resistant formulation and continued to decrease over the subsequent 5 years.
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Andrew Roberts et al.
Health Affairs, October 2016, Pages 1884-1892
Abstract:
Controlled substance lock-in programs are garnering increased attention from payers and policy makers seeking to combat the epidemic of opioid misuse. These programs require high-risk patients to visit a single prescriber and pharmacy for coverage of controlled substance medication services. Despite high prevalence of the programs in Medicaid, we know little about their effects on patients’ behavior and outcomes aside from reducing controlled substance–related claims. Our study was the first rigorous investigation of lock-in programs’ effects on out-of-pocket controlled substance prescription fills, which circumvent the programs’ restrictions and mitigate their potential public health benefits. We linked claims data and prescription drug monitoring program data for the period 2009–12 for 1,647 enrollees in North Carolina Medicaid’s lock-in program and found that enrollment was associated with a roughly fourfold increase in the likelihood and frequency of out-of-pocket controlled substance prescription fills. This finding illuminates weaknesses of lock-in programs and highlights the need for further scrutiny of the appropriate role, optimal design, and potential unintended consequences of the programs as tools to prevent opioid abuse.