Association of Marijuana Laws With Teen Marijuana Use: New Estimates From the Youth Risk Behavior Surveys
Mark Anderson et al.
JAMA Pediatrics, forthcoming
"Here, we report estimates of the association between the legalization of marijuana and its use, simultaneously considering both MMLs [medical marijuana laws] and RMLs [recreational marijuana laws]. Using data from the Youth Risk Behavior Surveys (YRBS) from 1993 to 2017, more policy variation was captured than in any previous study in the literature, to our knowledge. Between 1993 and 2017, 27 states and Washington, DC, contributed data to the YRBS before and after MML adoption; 7 states contributed data to the YRBS before and after RML adoption...In the fully adjusted models, MMLs were not statistically associated with either measure of marijuana use, but RMLs were associated with an 8% decrease (OR, 0.92; 95% CI, 0.87-0.96) in the odds of marijuana use and a 9% decrease (OR, 0.91; 95% CI, 0.84-0.98) in the odds of frequent marijuana use."
Overdosing on Regulation: How Government Caused the Opioid Epidemic
Jeffrey Miron, Greg Murphy Sollenberger & Laura Nicolae
Cato Institute Working Paper, February 2019
Opioid overdose deaths have risen dramatically in the United States over the past two decades. The standard explanation blames expanded prescribing and advertising of opioids beginning in the 1990s. This “more prescribing, more deaths” explanation has spurred increased legal restrictions on opioid prescribing. Federal and state governments have enacted a variety of policies to curtail prescribing and doctor shopping, and the federal government has raided pain management facilities deemed to be overprescribing. Supporters believe these policies reduce the supply of prescription opioids and thereby decrease overdose deaths. We find little support for this view. We instead suggest that the opioid epidemic has resulted from too many restrictions on prescribing, not too few. Rather than decreasing opioid overdose deaths, restrictions push users from prescription opioids toward diverted or illicit opioids, which increases the risk of overdose because consumers cannot easily assess drug potency or quality in underground markets. The implication of this “more restrictions, more deaths” explanation is that the United States should scale back restrictions on opioid prescribing, perhaps to the point of legalization.
Assessment of Underage Sales Violations in Tobacco Stores and Vape Shops
April Roeseler et al.
JAMA Pediatrics, forthcoming
Methods: This study used data from the 2018 sample (n = 1746) of the California Tobacco Control Program’s Young Adult Tobacco Purchase Survey that was drawn from the statewide tobacco retail license list. The data were collected by the California State University, Sacramento. Their institutional review board did not consider this study to involve human subjects’ research. From March through June 2018, decoys (aged 18-19 years) were randomly assigned to purchase either cigarettes (n = 1123) or vape products (n = 498), such as e-liquids and e-cigarettes. The sample also included stores that were considered noncompletes (n = 98) and stores where decoys asked for other tobacco products (eg, little cigars or cigars) (n = 27). According to the standard protocol, decoys did not carry identification (ID) and told the truth about their age. A trained chaperone observed whether ID was requested from the decoy and whether a sale occurred. Tobacco and vape shops were defined as retailers that primarily sell tobacco products. Data were weighted to account for sampling design. Rao-Scott χ2 tests (2-sided with significance set at P < .05) were performed to examine the association between retailer type and outcomes using SAS, version 9.4.
Results: Although FDA regulation requires retailers to check ID for all persons under 27 years, 49.8% of tobacco and vape shops failed to check ID for underaged decoys when decoys attempted to purchase vape products. The violation rate in tobacco and vape shops was significantly higher than for other types of retailers (P < .05). Furthermore, 44.7% of tobacco and vape shops sold vape products to underage decoys also at a higher rate compared with other tobacco retailers (P < .05). Overall sales violations were higher for vape products compared with cigarettes (χ2 = 4.3938; P < .05).
Association between medical cannabis laws and opioid overdose mortality has reversed over time
Chelsea Shover et al.
Proceedings of the National Academy of Sciences, 25 June 2019, Pages 12624-12626
Medical cannabis has been touted as a solution to the US opioid overdose crisis since Bachhuber et al. [M. A. Bachhuber, B. Saloner, C. O. Cunningham, C. L. Barry, JAMA Intern. Med. 174, 1668–1673] found that from 1999 to 2010 states with medical cannabis laws experienced slower increases in opioid analgesic overdose mortality. That research received substantial attention in the scientific literature and popular press and served as a talking point for the cannabis industry and its advocates, despite caveats from the authors and others to exercise caution when using ecological correlations to draw causal, individual-level conclusions. In this study, we used the same methods to extend Bachhuber et al.’s analysis through 2017. Not only did findings from the original analysis not hold over the longer period, but the association between state medical cannabis laws and opioid overdose mortality reversed direction from −21% to +23% and remained positive after accounting for recreational cannabis laws. We also uncovered no evidence that either broader (recreational) or more restrictive (low-tetrahydrocannabinol) cannabis laws were associated with changes in opioid overdose mortality. We find it unlikely that medical cannabis — used by about 2.5% of the US population — has exerted large conflicting effects on opioid overdose mortality. A more plausible interpretation is that this association is spurious. Moreover, if such relationships do exist, they cannot be rigorously discerned with aggregate data. Research into therapeutic potential of cannabis should continue, but the claim that enacting medical cannabis laws will reduce opioid overdose death should be met with skepticism.
Medical Marijuana Laws and Suicide
Bradley Bartos et al.
Archives of Suicide Research, forthcoming
Objective: To estimate the causal effect of a medical marijuana initiative on suicide risk. In 1996, California legalized marijuana use for medical purposes. Implementation was abrupt and uniform, presenting a “natural experiment.”
Method: Total, gun and non-gun suicides were aggregated by state for the years 1970-2004. California’s control time series was constructed as a weighted combination of the 41 states that did not legalize marijuana during the time-frame. Post-intervention differences for California and its constructed control time-series were interpreted as the effects of the medical marijuana law on suicide. Significance of the effects were assessed with permutation tests.
Results: The 1996 legalization resulted in mean annual reductions of 398.9 total suicides, 208 gun suicides, and 135 non-gun suicides. The effect estimates for total and gun suicides were statistically significant (p<.05) but the effect estimate for non-gun suicides was not (p≥.488).
Using wastewater‐based analysis to monitor the effects of legalized retail sales on cannabis consumption in Washington State, USA
Daniel Burgard et al.
Design: Laboratory study of raw wastewater samples collected and analyzed over the 3‐year period from 2014 to 2016.
Setting and Participants: Samples obtained from the two wastewater treatment plants that serviced a municipality of 200 000 people in the state of Washington, USA.
Measurements: Quantitative analysis of 24‐hour composite influent samples for the metabolite of the active ingredient in cannabis, 11‐nor‐9‐Carboxy‐Δ9‐tetrahydrocannabinol (THC‐COOH) were performed by liquid chromatography coupled to mass spectrometry.
Findings: Wastewater estimates for THC‐COOH increased by 9% per quarter, suggesting a doubling in cannabis consumption from 1 December 2013 to 31 December 2016. State‐sold THC increased at nearly 70% per quarter, while stores operated from 1 August 2014 to 31 December 2016. Estimating the proportion of the total cannabis market supplied by state‐regulated cannabis from these data is not currently achievable.
Free trade and opioid overdose death in the United States
Adam Dean & Simeon Kimmel
SSM - Population Health, August 2019
Opioid overdose deaths in the U.S. rose dramatically after 1999, but also exhibited substantial geographic variation. This has largely been explained by differential availability of prescription and non-prescription opioids, including heroin and fentanyl. Recent studies explore the underlying role of socioeconomic factors, but overlook the influence of job loss due to international trade, an economic phenomenon that disproportionately harms the same regions and demographic groups at the heart of the opioid epidemic. We used OLS regression and county-year level data from the Centers for Disease Controls and the Department of Labor to test the association between trade-related job loss and opioid-related overdose death between 1999 and 2015. We find that the loss of 1000 trade-related jobs was associated with a 2.7 percent increase in opioid-related deaths. When fentanyl was present in the heroin supply, the same number of job losses was associated with a 11.3 percent increase in opioid-related deaths.
First- and Continuing-Generation Students, Substance Use, and College Graduation
Raymond Swisher & Christopher Dennison
Social Forces, forthcoming
Graduation from a four-year college is an important potential means of social mobility for those from lower socioeconomic backgrounds. For “first-generation” students, the path to a degree is often made more difficult by circumstances such as working long hours and living with parents, as well as an unfamiliar college environment. One concerning aspect of college life is the continuing prevalence of substance use, which has hampered graduation rates and led many universities to reconsider the impact that the party subculture has on student well-being. In this paper, we use data from The National Longitudinal Study of Adolescent to Adult Health to examine differences in substance use (binge drinking, marijuana use, other illicit drug use) and four-year college graduation across unique combinations of students defined by college generation, work, and residential statuses. Consistent with previous qualitative studies into the class-specific consequences of the college party subculture, substance use is generally found to be higher among continuing-generation students who are not working nor living with their parents. In addition, substance use appears to have little consequence for the graduation prospects of these most traditional continuing-generation students. In contrast, substance use is negatively associated with graduation for most other groups, particularly first-generation students or those working long hours.
Price Isn't Everything: Behavioral Response around Changes in Sin Taxes
Alex Rees-Jones & Kyle Rozema
NBER Working Paper, June 2019
Taxes change behavior. But how does this change arise? In traditional economic models, change is achieved through the price channel: assuming all else is held constant, taxes increase prices and thus decrease demand. However, the assumption that all else is held constant may be violated in the course of a legal change, in part because the process by which laws are changed often involves the provision of information, attempts at persuasion, and the deployment of alternative dissuasive tools. We examine violations of this assumption in a particular policy domain: discouraging smoking with cigarette taxes. We document a marked increase in related media coverage, lobbying efforts, place-based smoking restrictions, and anti-smoking appropriations in the time period surrounding a tax law change. The intensity of these factors is directly associated with decreases in cigarette consumption in a manner that could be confused with price effects. Our results suggest that price effects may have a surprisingly small role in the behavioral response that occurs around tax law changes.
Do State Excise Taxes Reduce Alcohol-Related Fatal Motor Vehicle Crashes?
Robert McClelland & John Iselin
Economic Inquiry, forthcoming
We study the effect of alcohol excise taxes on alcohol‐related fatal traffic crashes by examining two large increases in excise taxes in Illinois that occurred in 1999 and in 2009. Using the synthetic control method, we do not find evidence that the tax increases led to a long‐term reduction in fatal alcohol‐related motor vehicle crashes following either tax increase. These results are robust across several specifications and pass sensitivity tests. However, we find evidence that following the 2009 increase Illinois counties that do not share a border with another state experienced a temporary drop in alcohol‐related traffic fatalities.
The Effects of Traditional Cigarette and E-Cigarette Taxes on Adult Tobacco Product Use
Michael Pesko, Charles Courtemanche & Johanna Catherine Maclean
NBER Working Paper, June 2019
We study the effects of traditional cigarette tax rate changes and e-cigarette tax adoption on use of these products among U.S. adults. Data are drawn from the Behavioral Risk Factor Surveillance System and National Health Interview Survey data over the period 2011 to 2017. Using a differences-in-differences model, we find that higher traditional cigarette taxes reduce adult traditional cigarette use and increase adult e-cigarette use, suggesting that the products are economic substitutes. E-cigarette tax adoption reduces e-cigarette use, with some heterogeneity across groups, and dilutes the own-tax responsiveness of traditional cigarettes.
Does Intra-household Contagion Cause an Increase in Prescription Opioid Use?
Mathijs de Vaan & Toby Stuart
American Sociological Review, forthcoming
Opioid use claims many thousands of lives each year. This article considers the diffusion of prescription opioid (PO) use within family households as one potential culprit of the proliferation of these medications. In an analysis of hundreds of millions of medical claims and almost 14 million opioid prescriptions in one state between 2010 and 2015, we show that the use of POs spreads within family households. We also show that the treatment effect of exposure to a family member’s PO use is driven by an increase in PO consumption for medical conditions that members of treated and untreated families experience at nearly identical rates. This pattern of results suggests household exposure causes an uptick in patient demand for prescription opioids. We use an instrumental variable estimation strategy to address the well-known challenges to estimating a causal effect of intra-household contagion, such as genotypic similarities among family members, assortative matching in partner selection, and clustering of health conditions within households. The results spotlight the salience of the most ubiquitous social structure, the family household, in accelerating opioid consumption to unprecedented levels. The findings also suggest that rather than direct social influence between physicians, the spread of prescription behavior in physician networks may be driven by shifts in patient demand that propagate through the patient sharing network.
Evaluating the relationship between binge drinking rates and a replicable measure of U.S. state alcohol policy environments
Diana Silver et al.
PLoS ONE, June 2019
Excessive alcohol consumption contributes significantly to premature mortality, injuries and morbidity, and a range of U.S. state policies have been shown to reduce these behaviors. Monitoring state alcohol policy environments is essential, but methodologically challenging given that new laws may be passed (or repealed) each year, resulting in considerable variation across states. Existing measures have not been made public or have only a single year available. We develop a new replicable measure, the state alcohol policy score, for each state and year 2004–2009, that captures the essential features of a state’s evidence-based alcohol policies. We evaluate its similarity to two existing alcohol policy measures and validate it by replicating findings from a previous study that used one of those measures to assess its relationship with several binge drinking outcomes. Estimates of the association between one-year lagged state alcohol policy scores and state binge drinking outcomes, obtained from the 2005–2010 Behavioral Risk Factor Surveillance System surveys (n = 440,951, 2010), were produced using Generalized Linear Models that controlled for state and individual-level co-variates, with fixed effects for year and region. We find a 10-percentage point increase in the state alcohol policy score was associated with a 9% lower odds of binge drinking (aOR = 0.91, 95% CI 0.89, 0.92; N = 1,992,086), a result consistent for men, women and for most age and race subgroups. We find that gender gaps in binge drinking behaviors narrowed in states with higher state alcohol policy scores. These results were nearly identical to those found in other studies using different scores obtained with the aid of expert opinions. We conclude that the score developed here is a valid measure that can be readily updated for monitoring and evaluating the variation and impact of state alcohol policies and make available our state scores for the years of the study.
Experimental Acute Exposure to Thirdhand Smoke and Changes in the Human Nasal Epithelial Transcriptome: A Randomized Clinical Trial
Giovanna Pozuelos et al.
JAMA Network Open, June 2019
Design, Setting, and Participants: Nasal epithelium samples were obtained from participants in a randomized clinical trial (2011-2015) on the health effects of inhaled THS. In a crossover design, participants were exposed, head only, to THS and to conditioned, filtered air in a laboratory setting. The order of exposures was randomized and exposures were separated by at least 21 days. Ribonucleic acid was obtained from a subset of 4 healthy, nonsmoking women.
Exposures: By chance, women in the subset were randomized to receive clean air exposure first and THS exposure second. Exposures lasted 3 hours.
Results: Participants were 4 healthy, nonsmoking women aged 27 to 49 years (mean [SD] age, 42 [10.2] years) with no chronic diseases. A total of 389 differentially expressed genes were identified in nasal epithelium exposed to THS, while only 2 genes, which were not studied further, were affected by clean air. Enriched gene ontology terms associated with stress-induced mitochondrial hyperfusion were identified, such as respiratory electron transport chain (q = 2.84 × 10−3) and mitochondrial inner membrane (q = 7.21 × 10−6). Reactome pathway analysis identified terms associated with upregulation of DNA repair mechanisms, such as nucleotide excision repair (q = 1.05 × 10−2). Enrichment analyses using ingenuity pathway analysis identified canonical pathways related to stress-induced mitochondrial hyperfusion (eg, increased oxidative phosphorylation) (P = .001), oxidative stress (eg, glutathione depletion phase II reactions) (P = .04), and cell survival (z score = 5.026).