I want a new drug
The Effect of Legalizing Retail Marijuana on Housing Values: Evidence from Colorado
Cheng Cheng, Walter Mayer & Yanling Mayer
Economic Inquiry, forthcoming
Abstract:
Does legalizing retail marijuana generate more benefits than costs? This paper provides a first step toward addressing that question by measuring the benefits and costs that are capitalized into housing values. We exploit the time-series and cross-sectional variations in the adoption of Colorado's municipality retail marijuana laws (RMLs) and examine the effect on housing values with a difference-in-differences strategy. Our estimates show that the legalization leads to an average 6% increase in housing values, indicating that the capitalized benefits outweigh the costs. In addition, we find suggestive evidence that this relatively large housing value appreciation is likely due to RMLs inducing strong housing demand while having no discernible effect on housing supply. Finally, we show that the effect of RMLs is heterogeneous across locations and property types.
Deaths of Despair or Drug Problems?
Christopher Ruhm
NBER Working Paper, January 2018
Abstract:
The United States is in the midst of a fatal drug epidemic. This study uses data from the Multiple Cause of Death Files to examine the extent to which increases in county-level drug mortality rates from 1999-2015 are due to “deaths of despair”, measured here by deterioration in medium-run economic conditions, or if they instead are more likely to reflect changes in the “drug environment” in ways that present differential risks to population subgroups. A primary finding is that counties experiencing relative economic decline did experience higher growth in drug mortality than those with more robust growth, but the relationship is weak and mostly explained by confounding factors. In the preferred estimates, changes in economic conditions account for less than one-tenth of the rise in drug and opioid-involved mortality rates. The contribution of economic factors is even less when accounting for plausible selection on unobservables, with even a small amount of remaining confounding factors being sufficient to entirely eliminate the relationship. These results suggest that the “deaths of despair” framing, while provocative, is unlikely to explain the main sources of the fatal drug epidemic and that efforts to improve economic conditions in distressed locations, while desirable for other reasons, are not likely to yield significant reductions in drug mortality. Conversely, the risk of drug deaths varies systematically over time across population subgroups in ways that are consistent with an important role for the public health environment related to the availability and cost of drugs. Put succinctly, the fatal overdose epidemic is likely to primarily reflect drug problems rather than deaths of despair.
Discontinuity-induced nostalgia improves the odds of a self-reported quit attempt among people living with addiction
Michael Wohl et al.
Journal of Experimental Social Psychology, March 2018, Pages 83-94
Abstract:
Most people in need of behavior change do not take action. Moreover, it has proven difficult to motivate people to engage in behavior change. In two longitudinal experiments, among people living with addiction, we tested a heretofore unexamined route to motivating behavior change—heightening a person's sense that their addictive behavior has fundamentally changed the self (i.e., the addiction has created self-discontinuity). We hypothesized that self-discontinuity would motivate self-reported behavior change by inducing nostalgic reverie for the pre-addicted self. We also hypothesized that this mediational model would be moderated by addiction severity. In both Experiment 1 (N = 180 gamblers) and Experiment 2 (N = 202 drinkers), participants were exposed to a self-discontinuity manipulation and completed a nostalgia measure. One month later, participants were asked whether they had attempted to quit in the past 30 days. As hypothesized, discontinuity-induced nostalgia predicted self-reported attempts to quit, but only when addiction severity was high (i.e., disordered gamblers, problem drinkers). A moderated-serial mediation conducted with the aggregate of data from Experiments 1 and 2 showed that, when addictive behavior severity was high (but not when it was low), self-discontinuity increased the odds of a self-reported change attempt via nostalgia and ensuing readiness to change. The findings suggest that discontinuity-induced nostalgia may be a viability means to facilitate behavior change among people living with addiction.
Investigating the effects of medical marijuana laws on educational attainment
Yajuan Li & Marco Palma
Economics Letters, March 2018, Pages 43-45
Abstract:
From 1996 to 2013, a total of 19 states and Washington, D.C. adopted medical marijuana laws (MML). Early adolescent marijuana use correlates with several problems later in life, including job-related skill acquisition, illegal substance abuse, and educational attainment. This paper examines the negative externalities of MML on educational attainment by applying a difference-in-differences research design. The results show that MML decrease high school graduation rates by 0.36 percentage points, indicating that nearly 13,000 students will not graduate as a result of the MML implementation.
Opioid Prescription Rates And Child Removals: Evidence From Florida
Troy Quast, Eric Storch & Svetlana Yampolskaya
Health Affairs, January 2018, Pages 134-139
Abstract:
A critical aspect of the opioid epidemic is its effect on the ability of opioid-dependent parents to care for their children. In this article we investigate the association between the rate of removals of children from their homes and the opioid prescription rate in Florida counties during 2012–15. We performed a panel data analysis of opioid prescriptions that also controlled for the prescription rates of benzodiazepines and stimulants and for other risk factors for child removal. We found that a one-standard-deviation increase in the opioid prescription rate was associated with a 32 percent increase in the removal rate for parental neglect. When we obtained subset samples by percentage of white residents, the estimated relationships were approximately twice as large in the counties with the highest concentration of whites than in the counties with the lowest. Policy makers should consider the opioid epidemic’s effects on child welfare when determining the appropriate public health response.
The Effect of Alcohol Access on Sexually Transmitted Diseases: Evidence From The Minimum Legal Drinking Age
Vijetha Koppa
American Journal of Health Economics, forthcoming
Abstract:
This paper evaluates the effect of alcohol use on the spread of sexually transmitted diseases (STDs) by exploiting the discrete change in legal access to alcohol at the Minimum Legal Drinking Age (MLDA) of 21 years. With administrative data from California, I implement a regression discontinuity model to compare the number of gonorrhea cases in men – an infection with a short incubation period of two weeks or less – contracted just before and after the 21st birthday. Results show no evidence of an increase in STDs in the overall population, or within racial and county subgroups with the highest infection rates. These results suggest that the relationship between alcohol and STDs, which is conventionally believed to be causal, is more likely to be driven by unobserved heterogeneity, at least among the college-age population.
Co-Opt or Coexist? A Study of Medical Cannabis Dispensaries’ Identity-Based Responses to Recreational-Use Legalization in Colorado and Washington
Greta Hsu, Özgecan Koçak & Balázs Kovács
Organization Science, forthcoming
Abstract:
When recreational cannabis dispensaries first entered the U.S. market in 2014, how did incumbent medical cannabis dispensaries react? Did they emphasize their distinct identity as medical providers, distancing themselves from recreational dispensaries and those consumers who consume cannabis recreationally? Or did they downplay their medical orientation to compete directly for potential resources? In this study, we propose that how incumbent organizations position their identities in response to increasing competition from an emerging rival form depends on key audiences’ acceptance of the new form. Using data on the evolving cannabis markets in the states of Colorado and Washington during the year following the initial emergence of the recreational category, we find a sharpening of identity among medical dispensaries in communities with low voter support for recreational-use legalization. Medical dispensaries accentuated the medical orientation of their identities as recreational dispensaries increasingly set up operations and as buyers inclined more toward recreational use. In contrast, we find a blurring of medical/recreational identity in communities where voters demonstrated support for recreational-use legalization in the state-level ballot. Overall, the theoretical framework we advance integrates cultural and strategic approaches by explicitly considering conflict in different audiences’ beliefs about the legitimacy of products and its implications for market producers seeking to connect with and appeal to current/potential consumers.
The Rapid Escalation of Fentanyl in Illicit Drug Evidence in Allegheny County, Pennsylvania, 2010-2016
Kathleen Creppage et al.
Public Health Reports, forthcoming
Abstract:
Opioid overdose deaths in the United States quadrupled from 1999 (n = 8050 deaths) to 2015 (n = 33 091 deaths), and the number of deaths associated with synthetic opioids, such as fentanyl, increased from 3105 deaths in 2013 to nearly 20 000 deaths in 2016. Given this rapid increase, timely surveillance for drugs in circulation is crucial. However, current surveillance systems used to track drug overdoses do not detect new drugs in circulation quickly. We studied the change in the presence of fentanyl in “stamp bag” drug evidence in Allegheny County, Pennsylvania, from 2010 through 2016. Stamp bags are small wax packets with individual stamps that contain mixtures of drugs, most commonly heroin, that law enforcement officers seize and retain as legal evidence. The proportion of stamp bags determined to contain fentanyl or a fentanyl analog was 2.1% in 2014 and rose sharply to 17.1% in 2016. Monitoring the chemical makeup of drug evidence items could help public health authorities identify drug use trends in their jurisdictions.
Affordable Care Act Impact on Medicaid Coverage of Smoking-Cessation Treatments
Sara McMenamin, Sara Yoeun & Helen Halpin
American Journal of Preventive Medicine, forthcoming
Introduction: Four sections of the Affordable Care Act address the expansion of Medicaid coverage for recommended smoking-cessation treatments for: (1) pregnant women (Section 4107), (2) all enrollees through a financial incentive (1% Federal Medical Assistance Percentage increase) to offer comprehensive coverage (Section 4106), (3) all enrollees through Medicaid formulary requirements (Section 2502), and (4) Medicaid expansion enrollees (Section 2001). The purpose of this study is to document changes in Medicaid coverage for smoking-cessation treatments since the passage of the Affordable Care Act and to assess how implementation has differentially affected Medicaid coverage policies for: pregnant women, enrollees in traditional Medicaid, and Medicaid expansion enrollees.
Methods: From January through June 2017, data were collected and analyzed from 51 Medicaid programs (50 states plus the District of Columbia) through a web-based survey and review of benefits documents to assess coverage policies for smoking-cessation treatments.
Results: Forty-seven Medicaid programs have increased coverage for smoking-cessation treatments post-implementation of the Affordable Care Act by adopting one or more of the four smoking-cessation treatment provisions. Coverage for pregnant women increased in 37 states, coverage for newly eligible expansion enrollees increased in 32 states, and 15 states added coverage and/or removed copayments in order to apply for a 1% increase in the Federal Medical Assistance Percentage. Coverage for all recommended pharmacotherapy and group and individual counseling increased from seven states in 2009 to 28 states in 2017.
Conclusions: The Affordable Care Act was successful in improving and expanding state Medicaid coverage of effective smoking-cessation treatments. Many programs are not fully compliant with the law, and additional guidance and clarification from the Centers for Medicare and Medicaid Services may be needed.
Genetic and Environmental Overlap Between Substance Use and Delinquency in Adolescence: An Analysis by Same-Sex Twins
Danielle Boisvert et al.
Youth Violence and Juvenile Justice, forthcoming
Abstract:
During adolescence, many teens begin to experiment with substances and engage in delinquent behavior. The current study seeks to examine whether and to what extent genetic and environmental factors contribute to the association between substance use (i.e., marijuana and alcohol) and different forms of delinquent offending (i.e., violent and nonviolent) across males and females. Analyses were based on same-sex twins (N = 1,072) from the sibling subsample of the National Longitudinal Study of Adolescent to Adult Health (Add Health). The results revealed moderate to large genetic overlap between substance use and delinquent behavior for males. Much of the covariation between alcohol use and offending behavior for females was attributable to common environmental factors, while common genetic factors explained a large portion of the overlap between marijuana use and offending in males and females. The implications of these findings for sex differences in prevention and intervention efforts are discussed from a biosocial perspective.
Beneficial effects of low alcohol exposure, but adverse effects of high alcohol intake on glymphatic function
Iben Lundgaard et al.
Scientific Reports, February 2018
Abstract:
Prolonged intake of excessive amounts of ethanol is known to have adverse effects on the central nervous system (CNS). Here we investigated the effects of acute and chronic ethanol exposure and withdrawal from chronic ethanol exposure on glymphatic function, which is a brain-wide metabolite clearance system connected to the peripheral lymphatic system. Acute and chronic exposure to 1.5 g/kg (binge level) ethanol dramatically suppressed glymphatic function in awake mice. Chronic exposure to 1.5 g/kg ethanol increased GFAP expression and induced mislocation of the astrocyte-specific water channel aquaporin 4 (AQP4), but decreased the levels of several cytokines. Surprisingly, glymphatic function increased in mice treated with 0.5 g/kg (low dose) ethanol following acute exposure, as well as after one month of chronic exposure. Low doses of chronic ethanol intake were associated with a significant decrease in GFAP expression, with little change in the cytokine profile compared with the saline group. These observations suggest that ethanol has a J-shaped effect on the glymphatic system whereby low doses of ethanol increase glymphatic function. Conversely, chronic 1.5 g/kg ethanol intake induced reactive gliosis and perturbed glymphatic function, which possibly may contribute to the higher risk of dementia observed in heavy drinkers.
Where Movements Matter: Examining Unintended Consequences of the Pain Management Movement in Medical, Criminal Justice, and Public Health Fields
Elizabeth Chiarello
Law & Policy, January 2018, Pages 79–109
Abstract:
Social movement scholars have rarely considered professional fields as sites of social movement consequences and have overlooked how social movement consequences traverse field boundaries. This research examines where movements matter by examining unintended consequences across professional fields. Drawing on a case study of the pain management movement, this study asks (1) under what conditions do movements targeting a focal professional field create consequences in adjacent fields; (2) what factors affect how adeptly the adjacent field responds; and (3) how do social movement impacts on adjacent fields affect the focal field? Findings demonstrate how the success of the pain management movement in medicine helped to fuel the opioid epidemic, which detrimentally affected the adjacent fields of criminal justice and public health. These adjacent fields' strategies for curbing spillover, in turn, created a new set of consequences for medicine. Their responses depended on material and moral resources and authority structures that differed significantly across the two adjacent fields. This article concludes with a discussion of factors that may facilitate or deter cross-field contagion effects and offers suggestions for future research.
Tobacco papers and tobacco industry ties in regulatory toxicology and pharmacology
Clayton Velicer, Gideon St. Helen & Stanton Glantz
Journal of Public Health Policy, February 2018, Pages 34–48
Abstract:
We examined the relationship between the tobacco industry and the journal Regulatory Toxicology and Pharmacology (RTP) using the Truth Tobacco Industry Documents Library and internet sources. We determined the funding relationships, and categorised the conclusions of all 52 RTP papers on tobacco or nicotine between January 2013 and June 2015, as “positive”, “negative” or “neutral” for the tobacco industry. RTP’s editor, 57% (4/7) of associate editors and 37% (14/38) of editorial board members had worked or consulted for tobacco companies. Almost all (96%, 50/52) of the papers had authors with tobacco industry ties. Seventy-six percent (38/50) of these papers drew conclusions positive for industry; none drew negative conclusions. The two papers by authors not related to the tobacco industry reached conclusions negative to the industry (p < .001). These results call into question the confidence that members of the scientific community and tobacco product regulators worldwide can have in the conclusions of papers published in RTP.
E-cigarettes and Adult Smoking
Henry Saffer et al.
NBER Working Paper, January 2018
Abstract:
Over the past few years adult use of e-cigs has been increasing while adult smoking has been declining. It is important to determine if there is a causal effect of e-cig use on smoking because of the known health hazards associated with smoking. An important concern with most prior studies of e-cigs and smoking is that endogeneity between e-cig use and cigarette use is ignored. One contribution of this paper is to instrument e-cig use in order to avoid this endogeneity problem. The data employed to estimate the empirical models come from the 2014-2015 Tobacco Use Supplements (TUS). The data employed in this study rely on the combined July 2014, January 2015 and May 2015 waves of the TUS. The results show that e-cig use increases the probability of a quit attempt, the probability of a quit failure and the number of quit failures. E-cig use is also found to reduce smoking by failed quitters and non-attempters. Past studies have shown that successful quitting may follow after a few years of e-cig use but the TUS is limited to a one year retrospective window, which may be too short to observe the causal effect of e-cigs on successful quit attempts. Although there is no evidence in the TUS regressions that e-cigs use affects the probability of a successful quit, the results for attempts, failures and reduction of smoking suggest that e-cigs create a path toward cessation.
Association of Noncigarette Tobacco Product Use With Future Cigarette Smoking Among Youth in the Population Assessment of Tobacco and Health (PATH) Study, 2013-2015
Shannon Lea Watkins, Stanton Glantz & Benjamin Chaffee
JAMA Pediatrics, February 2018, Pages 181-187
Design, Setting, and Participants: In this prospective cohort study of the Population Assessment of Tobacco and Health (PATH) waves 1 (September 12, 2013, to December 14, 2014) and 2 (October 23, 2014, to October 30, 2015), a nationally representative sample of youths who never smoked a conventional cigarette at baseline and completed wave 2 follow-up (N = 10 384) was studied. PATH retention at follow-up was 87.9%.
Results: The present analysis was based on the 10 384 PATH youth respondents who reported never having smoked a cigarette in wave 1 and whose cigarette ever or past 30-day use was reported in wave 2 (mean [SD] age, 14.3 [1.7] years; age range, 12-17 years; 5087 [49.1%] female; 4829 [52.5%] white). At 1-year follow-up, 469 (4.6%) of all baseline never-smoking youths had tried a cigarette and 219 (2.1%) had smoked a cigarette within the past 30 days. Cigarette ever use at follow-up was higher among youths who had ever used e-cigarettes (78 [19.1%]), hookah (60 [18.3%]), noncigarette combustible tobacco (45 [19.2%]), or smokeless tobacco (29 [18.8%]) at baseline. After adjusting for sociodemographic, environmental, and behavioral smoking risk factors and for baseline ever use of other tobacco products, the odds of past 30-day cigarette use at follow-up were approximately twice as high among baseline ever users of e-cigarettes (odds ratio [OR], 1.87; 95% CI, 1.15-3.05), hookah (OR, 1.92; 95% CI, 1.17-3.17), noncigarette combustible tobacco (OR, 1.78; 95% CI, 1.00-3.19), and smokeless tobacco (OR, 2.07; 95% CI, 1.10-3.87). Youths who had tried more than 1 type of tobacco product at baseline had 3.81 (95% CI, 2.22-6.54) greater adjusted odds of past 30-day cigarette smoking at follow-up than did baseline never tobacco users.
Conclusions and Relevance: Any use of e-cigarettes, hookah, noncigarette combustible tobacco, or smokeless tobacco was independently associated with cigarette smoking 1 year later. Use of more than 1 product increased the odds of progressing to cigarette use.
Does E-Cigarette Advertising Encourage Adult Smokers to Quit?
Dhaval Dave et al.
NBER Working Paper, February 2018
Abstract:
Only recently introduced into the U.S. market, e-cigarettes have been aggressively promoted, and use is increasing rapidly among both adults and youths. At the heart of the regulatory debate are fundamental questions regarding whether e-cigarettes will draw cigarette smokers away from a dangerous habit or lure new initiates into tobacco use. We provide some of the first causal evidence on whether e-cigarette advertising on television and in magazines (which comprise about 90% of total media spending on e-cigarettes) encourage adult smokers to quit. We find that the answer to this question is a tentative yes for TV advertising but no for magazine advertising. Our results indicate that a policy to ban TV advertising of e-cigarettes would have reduced the number of smokers who quit in the recent past by approximately 3%, resulting in roughly 105,000 fewer quitters in that period. On the other hand, if the FDA were not considering regulations and mandates that would likely eliminate many e-cigarette producers during our sample period, e-cigarette ads might have reached the number of nicotine replacement therapy TV ads during that period. That would have increased the number of smokers who quit by around 10%, resulting in an additional 350,000 quitters.
Effect of Including Alcohol and Cannabis Content in a Sexual Risk-Reduction Intervention on the Incidence of Sexually Transmitted Infections in Adolescents: A Cluster Randomized Clinical Trial
Angela Bryan et al.
JAMA Pediatrics, forthcoming
Design, Setting, and Participants: Cluster randomized clinical trial with 3 conditions. Between July 1, 2010, and December 10, 2014, adolescents living at a juvenile detention facility in the southwestern United States were tested and treated for STI before randomization and again 12 months after the intervention. Data analyses were conducted in July and August 2017. Eligibility criteria included (1) being aged 14 to 18 years, (2) able to speak English, (3) having a remaining detention term of less than 1 month, and (4) signing a release granting access to STI results if tested at intake. Six hundred ninety-three adolescents were assessed for eligibility. Of these, 460 completed baseline assessments and were randomized to 1 of 3 intervention conditions. Data analysis was by intent-to-treat.
Interventions: There were 3 intervention conditions: sexual risk reduction intervention (SRRI); SRRI plus alcohol content (SRRI + ETOH); and SRRI + ETOH plus cannabis content (SRRI + ETOH + THC). Interventions were conducted in same-sex groups by trained clinicians and included video presentations with discussion, group activities, and active feedback by participants, consistent with the principles of motivational enhancement therapy.
Results: Of the 460 participants randomized, mean (SD) age was 15.8 (1.1) years, 347 participants (75.4%) were male, and 57.0% were of Hispanic ethnicity. Among the participants, 143 were randomized to SSRI, 155 to SRRI + ETOH, and 162 to SRRI + ETOH + THC. Attrition at 12-month follow-up was 99 (21.5%) for the STI outcome variable. Participants in the SRRI + ETOH + THC intervention had lower incidence of STI at follow-up (3.9%) than those in either the SRRI (12.4%; odds ratio, 0.29; 95% CI, 0.10-0.84) or the SRRI + ETOH (10.2%; odds ratio, 0.36; 95% CI, 0.12-1.05) interventions.
Aggression is associated with greater subsequent alcohol consumption: A shared neural basis in the ventral striatum
David Chester & Nathan DeWall
Aggressive Behavior, forthcoming
Abstract:
Alcohol use and abuse (e.g., binge drinking) are among the most reliable causes of aggressive behavior. Conversely, people with aggressive dispositions (e.g., intermittent explosive disorder) are at greater risk for subsequent substance abuse. Yet it remains unknown why aggression might promote subsequent alcohol use. Both aggressive acts and alcohol use are rewarding and linked to greater activity in neural reward circuitry. Through this shared instantiation of reward, aggression may then increase subsequent alcohol consumption. Supporting this mechanistic hypothesis, participants’ aggressive behavior directed at someone who had recently rejected them, was associated with more subsequent beer consumption on an ad-lib drinking task. Using functional MRI, both aggressive behavior and beer consumption were associated with greater activity in the bilateral ventral striatum during acts of retaliatory aggression. These results imply that aggression is linked to subsequent alcohol abuse, and that a mechanism underlying this effect is likely to be the activation of the brain's reward circuitry during aggressive acts.
A randomized, open label trial of methadone continuation versus forced withdrawal in a combined US prison and jail: Findings at 12 months post-release
Lauren Brinkley-Rubinstein et al.
Drug and Alcohol Dependence, March 2018, Pages 57-63
Abstract:
Recently, incarcerated individuals are at increased risk of opioid overdose. Methadone maintenance treatment (MMT) is an effective way to address opioid use disorder and prevent overdose; however, few jails and prisons in the United States initiate or continue people who are incarcerated on MMT. In the current study, the 12 month outcomes of a randomized control trial in which individuals were provided MMT while incarcerated at the Rhode Island Department of Corrections (RIDOC) are assessed. An as-treated analysis included a total of 179 participants — 128 who were, and 51 who were not, dosed with methadone the day before they were released from the RIDOC. The results of this study demonstrate that 12 months post-release individuals who received continued access to MMT while incarcerated were less likely to report using heroin and engaging in injection drug use in the past 30 days. In addition, they reported fewer non-fatal overdoses and were more likely to be continuously engaged in treatment in the 12-month follow-up period compared to individuals who were not receiving methadone immediately prior to release. These findings indicate that providing incarcerated individuals continued access to MMT has a sustained, long-term impact on many opioid-related outcomes post-release.