Medicating
Drug Abuse and the Internet: Evidence from Craigslist
Jiayi Liu & Anandhi Bharadwaj
Management Science, forthcoming
Abstract:
The United States is in the midst of a drug overdose epidemic. Although the online availability of drugs has been a growing concern with considerable speculation that digital platforms are contributing to this epidemic, empirical assessments have been lacking. To quantify this impact, we rely on the phased rollout of Craigslist, a major online platform, as an experimental setup. Applying a difference-in-differences approach on a national panel data set for all counties in the United States from 1997 to 2008, we find a 14.9% increase in drug abuse treatment admissions, a 5.7% increase in drug abuse violations, and a 6.0% increase in drug overdose deaths after Craigslist’s entry. The impacts of Craigslist’s entry are larger among women, whites, Asians, and the more educated. Further, the unintended consequences of Craigslist are more likely to accrue in larger, wealthier areas with initially low levels of drug abuse. These findings raise the possibility that the marked growth in U.S. drug abuse may have partially stemmed from the wider availability of illicit drugs online at the very beginning of its evolution.
Retail Marijuana Deregulation and Housing Prices
Donggeun Kim, Sean O'Connor & Brent Norwood
University of Oklahoma Working Paper, February 2020
Abstract:
Despite federal law, twelve American states and Washington D.C. have legalized recreational marijuana since 2012. Using a national housing data set from the online real estate listing database Zillow.com, we identify the cross and inter-state effects of marijuana legalization on house prices in different points of the price distribution function. We find positive effects upwards of ten percent in the top half of the price distribution following successful legalization ballot initiatives, and between five and fifteen percent across the distribution after the state enacts the ballot initiative and the first legal sales take place. A spatial difference-in-differences model reveals that within Colorado and Washington, prices in neighborhoods with new dispensary openings nearby experience a seven percent price appreciation. Considered together, this research suggests that there are second order benefits associated with marijuana legalization that policy makers and voters should be aware of when deciding the drug’s legal status.
Adolescent Treatment Admissions for Marijuana Following Recreational Legalization in Colorado and Washington
Jeremy Mennis & Gerald Stahler
Drug and Alcohol Dependence, forthcoming
Methods: Annual data on 2008-2017 treatment admissions for marijuana use from the SAMHSA TEDS-A dataset for adolescents age 12-17 were used to model state treatment admissions trends. Difference-in-differences models were used to investigate whether treatment admissions increased following RML in Colorado/Washington compared to non-RML states, after adjusting for socioeconomic characteristics and treatment availability.
Results: Over all states in the analysis, the rate of adolescent treatment admissions for marijuana use declined significantly over the study period (β=-3.375, 95% CI=-4.842, -1.907), with the mean rate falling nearly in half. The decline in admissions rate was greater in Colorado and Washington compared to non-RML states following RML, though this difference was not significant (β=-7.671, 95% CI=-38.798, 23.456).
Medical marijuana and workers' compensation claiming
Keshar Ghimire & Johanna Catherine Maclean
Health Economics, April 2020, Pages 419-434
Abstract:
We study the effect of state medical marijuana laws (MMLs) on workers' compensation (WC) claiming among adults. Medical marijuana is plausibly related to WC claiming by allowing improved symptom management, and thus reduced need for the benefit, among injured or ill workers. We use data on claiming drawn from the Annual Social and Economic supplement to the Current Population Survey over the period 1989 to 2012, coupled with a differences‐in‐differences design to provide the first evidence on this relationship. Our estimates show that, post MML, WC claiming declines, both the propensity to claim and the level of income from WC. These findings suggest that medical marijuana can allow workers to better manage symptoms associated with workplace injuries and illnesses and, in turn, reduce need for WC. However, the reductions in WC claiming post MML are very modest in size.
The Evolving Consequences of OxyContin Reformulation on Drug Overdoses
David Powell & Rosalie Liccardo Pacula
NBER Working Paper, April 2020
Abstract:
Recent evidence suggests that the short-term transition of the opioid crisis from prescription opioids to heroin can be attributed to the reformulation of OxyContin, which substantially reduced access to abusable prescription opioids. In this paper, we find that over a longer time horizon, reformulation stimulated illicit drug markets to grow and evolve. We compare overdose trajectories in areas more exposed to reformulation, defined as states with high rates of non-medical OxyContin use before reformulation, to less exposed areas. More exposed areas experienced disproportionate increases in fatal overdoses involving synthetic opioids (fentanyl) and non-opioid substances like cocaine, suggesting that these new epidemics are related to the same factors driving the rise in heroin deaths. Instead of just short-term substitution from prescription opioid to heroin overdoses, the transition to illicit markets spurred by reformulation led to growth in the overall overdose rate to unprecedented levels.
Specialty Substance Use Disorder Treatment Admissions Steadily Increased In The Four Years After Medicaid Expansion
Brendan Saloner & Johanna Catherine Maclean
Health Affairs, March 2020, Pages 453-461
Abstract:
The Affordable Care Act’s Medicaid expansion provided insurance coverage to many low-income adults with substance use disorders, but it is unclear whether this led to more people receiving treatment. We used the Treatment Episode Data Set and a difference-in-differences approach to compare annual rates of specialty treatment admissions in expansion versus nonexpansion states in the period 2010–17. We found that admissions to treatment steadily increased in the four years after Medicaid expansion, with 36 percent more people entering treatment by the fourth expansion year in expansion states compared to nonexpansion states. Changes were largest for people entering intensive outpatient programs and those seeking medication treatment for opioid use disorder. The share of admissions paid for by Medicaid increased 23 percentage points in expansion states compared to nonexpansion states, largely displacing treatment paid for by state and local governments. The gradual increase in specialty substance use disorder treatment admissions after Medicaid expansion may reflect improving capacity and access to care.
A randomized-controlled pilot trial of an online compassionate mind training intervention to help people with chronic pain avoid analgesic misuse
Mayoor Dhokia et al.
Psychology of Addictive Behaviors, forthcoming
Abstract:
Problematic use of prescribed and over-the-counter analgesics is widespread and increasing among people with chronic pain, but the availability of preventative and treatment services is limited. We evaluated a 21-day online intervention based on compassionate mind training in a prospective, randomized-controlled trial. The participants were 73 adults with concerns about their use of analgesics for chronic pain conditions. Participants completed measures of analgesic use, misuse and dependence, plus self-criticism and self-reassurance (self-inadequacy, self-reassurance, and self-hate), cognitive impulsivity (negative urgency, lack of perseverance, lack of premeditation, sensation-seeking, and positive urgency) and behavioral impulsivity (delay discounting) at baseline, postintervention, and 1-week postintervention follow-up. Following baseline assessment, participants were randomized to compassionate mind training (CMT; n = 38) or relaxation music (n = 35), both delivered online. No adverse events or safety issues were reported and high participant retention and exercise completion rates showed that the intervention was acceptable to participants. Repeated measures analysis of variance showed that by comparison with relaxation music, the CMT group had reduced prescription analgesic use, F = 6.123, p = .015, analgesic dependence, F = 14.322, p < .001, self-hate, F = 12.218, p < .001, negative urgency, F = 7.323, p = .006, and lack of perseverance, F = 7.453, p = .001, from baseline to postintervention, and those improvements were maintained at follow-up. The results show that exercises based on CMT principles and techniques and delivered online can reduce analgesic use, risk of analgesic dependence, and some aspects of self-criticism and impulsivity.
Market Structure and Product Assortment: Evidence from a Natural Experiment in Liquor Licensure
Gastón Illanes & Sarah Moshary
NBER Working Paper, April 2020
Abstract:
We examine how market structure, measured as the number of firms, affects prices, quantities, product assortment, and consumer surplus. Our analysis exploits Washington’s deregulation of spirit sales, which generated exogenous variation in market structure across the state. Consistent with the uniform pricing literature, we find no effect of increased competition on prices. Rather, we document an expansion of product assortment, which in turn increases purchasing. Using a discrete-choice demand model, we estimate that wider assortments increase consumer surplus by $3.20/month when moving from monopoly to duopoly. However, the likelihood that a household engages in heavy drinking, as defined by the CDC, increases by 5.6 percentage points, raising concerns about social welfare.
Cannabinoids and psychotic symptoms: A potential role for a genetic variant in the P2X purinoceptor 7 (P2RX7) gene
Marco Boks et al.
Brain, Behavior, and Immunity, forthcoming
Abstract:
To investigate the biological mechanisms underlying the higher risk for psychosis in those that use cannabis, we conducted a genome-wide environment-interaction study (GWEIS). In a sample of individuals without a psychiatric disorder (N=1262), we analyzed the interactions between regular cannabis use and genotype with psychotic-like experiences (PLE) as outcome. PLE were measured using the Community Assessment of Psychic Experiences (CAPE). The sample was enriched for those at the extremes of both cannabis use and PLE to increase power. A single nucleotide polymorphism in the P2RX7 gene (rs7958311) was associated with risk for a high level of psychotic experiences in regular cannabis users (p=1.10 x10-7) and in those with high levels of lifetime cannabis use (p= 4.5 x 10-6). This interaction was replicated in individuals with high levels of lifetime cannabis use in the IMAGEN cohort (N=1217, p=0.020). Functional relevance of P2RX7 in cannabis users was suggested by in vitro experiment on activated monocytes. Exposure of these cells to tetrahydrocannabinol (THC) or cannabidiol (CBD) reduced the immunological response of the P2X7 receptor, which was dependent on the identified genetic variant. P2RX7 variants have been implicated in psychiatric disorders before and the P2X7 receptor is involved in pathways relevant to psychosis, such as neurotransmission, synaptic plasticity and immune regulation. We conclude that P2RX7 plays a role in vulnerability to develop psychotic symptoms when using cannabis and point to a new pathway that can potentially be targeted by newly developed P2X7 antagonists.
Tripping on nothing: Placebo psychedelics and contextual factors
Jay Olson et al.
Psychopharmacology, forthcoming
Methods: Thirty-three students completed a single-arm study ostensibly examining how a psychedelic drug affects creativity. The 4-h study took place in a group setting with music, paintings, coloured lights, and visual projections. Participants consumed a placebo that we described as a drug resembling psilocybin, which is found in psychedelic mushrooms. To boost expectations, confederates subtly acted out the stated effects of the drug and participants were led to believe that there was no placebo control group. The participants later completed the 5-Dimensional Altered States of Consciousness Rating Scale, which measures changes in conscious experience.
Results: There was considerable individual variation in the placebo effects; many participants reported no changes while others showed effects with magnitudes typically associated with moderate or high doses of psilocybin. In addition, the majority (61%) of participants verbally reported some effect of the drug. Several stated that they saw the paintings on the walls “move” or “reshape” themselves, others felt “heavy… as if gravity [had] a stronger hold”, and one had a “come down” before another “wave” hit her.
Acute tolerance to alcohol-induced impairment in cognitive performance
Edward Comley & Matthew Dry
Experimental and Clinical Psychopharmacology, forthcoming
Abstract:
Acute tolerance is a rapid decrease in the effect of alcohol relative to the blood alcohol concentration (BAC) occurring within the duration of a single dose of alcohol. It remains uncertain which cognitive domains are susceptible to acute tolerance, because findings vary between tasks used to measure the effect of alcohol. This study examined acute tolerance in subjective intoxication and in 2 cognitive domains: information processing, measured using the Inspection Time Task (ITT), and response inhibition, measured with the Sustained Attention to Response Task (SART). Forty participants were allocated to either an alcohol or placebo group. After baseline measures, the alcohol group were given an active dose to produce a peak BAC of 0.07%, whereas the placebo group received a placebo beverage. ITT and SART performance were measured at a BAC of 0.05% twice during the course of the dose, once when BAC was ascending and again when descending. The placebo group was tested at equivalent times. When BAC was ascending, the alcohol group showed increased ratings of subjective intoxication and impaired performance on the ITT. Consistent with an acute tolerance effect, ratings of subjective intoxication and impairment on the ITT in the alcohol group were lower when BAC was descending. Performance on the SART was not found to be affected by alcohol. The findings suggest information processing is a domain of behavior that shows acute tolerance to alcohol and that the subjective intoxication felt at a BAC of 0.05% can decrease substantially within the duration of a single dose.