Smoking something
The Effects of Health Insurance Parity Laws for Substance Use Disorder Treatment on Traffic Fatalities: Evidence of Unintended Benefits
Ioana Popovici, Johanna Catherine Maclean & Michael French
NBER Working Paper, May 2017
Abstract:
Each year, 10,000 individuals die in alcohol-impaired traffic accidents in the United States, while psychoactive drugs are involved in 20% of all fatal traffic accidents. We investigate whether state parity laws for substance use disorder (SUD) treatment have the unintended benefit of reducing fatal traffic accidents. Parity laws compel insurers to cover SUD treatment in private insurance markets, thereby reducing the financial costs of and increasing access to treatment for beneficiaries. We employ over 20 years of administrative data from the national Fatal Accident Reporting System coupled with a differences-in-differences research design to investigate the potential spillover effects of parity laws to traffic safety. Our findings indicate that passage of a state parity law reduces fatal traffic accident rates by 4.1 to 5.4%. These findings suggest that government regulations requiring insurers to cover SUD treatment can significantly improve traffic safety, possibly by reducing the number of impaired drivers on roadways.
Medical Marijuana Laws May Be Associated With A Decline In The Number Of Prescriptions For Medicaid Enrollees
Ashley Bradford & David Bradford
Health Affairs, May 2017, Pages 945-951
Abstract:
In the past twenty years, twenty-eight states and the District of Columbia have passed some form of medical marijuana law. Using quarterly data on all fee-for-service Medicaid prescriptions in the period 2007–14, we tested the association between those laws and the average number of prescriptions filled by Medicaid beneficiaries. We found that the use of prescription drugs in fee-for-service Medicaid was lower in states with medical marijuana laws than in states without such laws in five of the nine broad clinical areas we studied. If all states had had a medical marijuana law in 2014, we estimated that total savings for fee-for-service Medicaid could have been $1.01 billion. These results are similar to those in a previous study we conducted, regarding the effects of medical marijuana laws on the number of prescriptions within the Medicare population. Together, the studies suggest that in states with such laws, Medicaid and Medicare beneficiaries will fill fewer prescriptions.
Examining the high rate of cigarette smoking among adults with a GED
Charlotte Schoenborn, Manfred Stommel & Jacqueline Lucas
Addictive Behaviors, forthcoming
Methods: We pooled data from the 2006–2014 National Health Interview Surveys (NHIS) for adults aged 25 and older (n = 235,031) to describe cigarette smoking behaviors and smoking history for adults in six education categories, with a focus on comparing GED holders to HS graduates. Logistic regression was used to predict the odds of current cigarette smoking and successful quitting, accounting for demographic, employment, family/sociocultural, mental health, and other potential confounders.
Results: The smoking rate among adults with a GED (44.1%) was more than five times the rate for those with a college degree (8.3%) and almost twice the rate of adults whose highest level of education was a high school diploma (23.6%). GED holders were also more likely to have started smoking before the age of 15 (32.2%) compared with HS graduates (12.2%) (p < 0.001). Even after controlling for 23 socio-demographic and health characteristics, GED holders retained significantly higher odds of current smoking compared to HS graduates (OR = 1.73; 95% CI: 1.56, 1.93) and significantly lower odds of successful quitting (OR = 0.83, 95% CI: 0.73, 0.94).
The Influence of College Attendance on Risk for Marijuana Initiation in the United States: 1977 to 2015
Richard Miech et al.
American Journal of Public Health, June 2017, Pages 996-1002
Methods: Data come from the Monitoring the Future study, which has followed longitudinal panels drawn from annual nationally representative, baseline samples of 12th-grade students starting with the class of 1976. We studied panel members aged 19 to 22 years who had never used marijuana by 12th grade between 1977 and 2015.
Results: College as a risk factor for marijuana initiation has increased significantly since 2013. The increased probability of past-year marijuana use for those enrolled versus not enrolled in college was 51% in 2015, 41% in 2014, and 31% in 2013; it averaged 17% to 22% from 1977 to 2012 among youths who had never used marijuana by 12th grade.
The Effect of Public Insurance Expansions on Substance Use Disorder Treatment: Evidence from the Affordable Care Act
Johanna Catherine Maclean & Brendan Saloner
NBER Working Paper, April 2017
Abstract:
We examine the early effects of U.S. state Medicaid expansions under the Affordable Care Act (ACA) on substance use disorder (SUD) treatment utilization. We couple administrative data on admissions to specialty SUD treatment and prescriptions for medications used to treat SUDs in outpatient settings with a differences-in-differences design. We find no evidence that admissions to specialty treatment changed in expanding states relative to non-expending states. However, post expansion, Medicaid-reimbursed prescriptions for medications used to treat SUDs in outpatient settings increased by 33% in expanding states relative to non-expanding states. Among patients admitted to specialty SUD treatment, we find that in expanding states Medicaid insurance and use of Medicaid to pay for treatment increased by 58% and 57% following the expansion. In an extension to the main analyses we find no evidence that the expansions affected fatal alcohol poisonings or drug-related overdoses. Overall, our findings provide evidence on the early effects of the ACA on SUD treatment utilization with the newly-eligible Medicaid population.
Support for marijuana legalization in the US state of Washington has continued to increase through 2016
Meenakshi Sabina Subbaraman & William Kerr
Drug and Alcohol Dependence, June 2017, Pages 205–209
Methods: Data come from geographically representative general population samples of adult (aged 18 and over) Washington residents collected over five timepoints (every six months) between January 2014 and April 2016 (N = 4,101). Random Digit Dial was used for recruitment. Statistical analyses involved bivariate comparisons of proportions across timepoints and subgroups (defined by age, gender, and marijuana user status), and multivariable logistic regression controlling for timepoint (time) to formally test for trend while controlling for demographic and substance use covariates. All analyses adjusted for probability of selection.
Results: Support for legalization in Washington has significantly increased: support was 64.0% (95% CI: 61.2%-67.8%) at timepoint 1 and 77.9% (95% CI: 73.2%-81.9%) at timepoint 5. With each six months’ passing, support increased 19% on average. We found no statistically significant change in support for home-growing.
Increased use of heroin as an initiating opioid of abuse
Theodore Cicero, Matthew Ellis & Zachary Kasper
Addictive Behaviors, forthcoming
Methods: Individuals entering substance abuse treatment for an opioid use disorder in the period 2010–2016 (N = 5885) were asked about the specific opioid they first regularly used to get high. To limit long-term recall and survival bias, analyses was restricted to opioid initiation that occurred in the past ten years (2005–2015).
Results: In 2005, only 8.7% of opioid initiators started with heroin, but this sharply increased to 33.3% (p < 0.001) in 2015, with no evidence of stabilization. The use of commonly prescribed opioids, oxycodone and hydrocodone, dropped from 42.4% and 42.3% of opioid initiators, respectively, to 24.1% and 27.8% in 2015, such that heroin as an initiating opioid was now more frequently endorsed than prescription opioid analgesics.
Conclusions: Our data document that, as the most commonly prescribed opioids – hydrocodone and oxycodone – became less accessible due to supply-side interventions, the use of heroin as an initiating opioid has grown at an alarming rate. Given that opioid novices have limited tolerance to opioids, a slight imprecision in dosing inherent in heroin use is likely to be an important factor contributing to the growth in heroin-related over dose fatalities in recent years.
Increases in prescription opioid injection abuse among treatment admissions in the United States, 2004-2013
Christopher Jones, Aleta Christensen & Matthew Gladden
Drug and Alcohol Dependence, July 2017, Pages 89–95
Methods: Prescription opioid abuse treatment admissions in the 2004-2013 Treatment Episode Data Set were used to calculate counts and percentages of prescription opioid treatment admissions reporting oral, injection, or smoking/inhalation abuse overall, by sex, age, and race/ethnicity. Multivariable multinomial logistic regression was used to identify demographic and substance use characteristics associated with injection or smoking/inhalation abuse.
Results: From 2004-2013, oral abuse decreased from 73.1% to 58.9%; injection abuse increased from 11.7% to 18.1%; and smoking/inhalation abuse increased from 15.3% of admissions to 23.0%. Among treatment admissions, the following were associated with injection abuse: male sex, 18-54 year-olds, non-Hispanic whites, non-Hispanic other, homeless or dependent living, less than full-time work, living in the Midwest or South, ≥ 1 prior treatment episodes, younger age of first opioid use, and reporting use of cocaine/crack, marijuana, heroin, or methamphetamine.
School, Drugs, Mentoring, and Peers: Evidence from a Randomized Trial in the US
Núria Rodríguez-Planas
Journal of Economic Behavior & Organization, July 2017, Pages 166–181
Abstract:
This paper finds that the expensive, comprehensive, and controversial mentoring program, Quantum Opportunity Program (QOP), was successful among youths with ex-ante high-predicted risk of drug-use as it increased their likelihood of graduating from high-school by 15%, attending post-secondary education by 21%, and completing 2 years of post-secondary education by 32%. It also finds some evidence that, for this group, QOP improved employment and wages. Many of these impacts persisted 10 years after random assignment. The lack of QOP effects on curbing these youths’ risky behaviors while they were in their late teens hides beneficial results for those with ex-ante bad peers, and detrimental effects for those with ex-ante good peers as other treated youths during QOP group activities may have been a bad influence.
The acute effect of pleasurable music on craving for alcohol: A pilot crossover study
Walter Mathis & Xiaotong Han
Journal of Psychiatric Research, July 2017, Pages 143–147
Abstract:
Chronic administration of drugs of abuse leads to a dopamine deficient state in the mesolimbic system, causing dysphoria in abstinence and contributing to craving and return to use. Recent functional imaging studies have shown that listening to personally pleasing music activates the mesolimbic reward system in a fashion similar to drugs of abuse. It has been proposed that such activation could ameliorate the dysphoria and craving of the hypodopaminergic state. The present study sought to evaluate the efficacy of listening to personally pleasing or moving music on reducing craving in abstinent alcoholics using a single-blind, within-subject randomized block design, with three randomly determined presentations of each condition. Twelve participants with Alcohol Use Disorder on a residential substance rehabilitation unit reported their level of craving with a Visual Analog Scale before and after listening to either the participant-selected song or white noise. Using a mixed model to analyze the crossover design, the music intervention was found to have a statistically significant advantage in craving reduction compared to the noise control. Our results indicate that personally pleasing music might have a role in augmenting substance use disorder treatment via craving reduction. Further study is warranted to elucidate factors which predict the most robust response from this intervention.
The Health Consequences of Aerial Spraying Illicit Crops: The Case of Colombia
Adriana Camacho & Daniel Mejía
Journal of Health Economics, forthcoming
Abstract:
This paper exploits variations in aerial spraying across time and space in Colombia and employs a panel of individual health records in order to study the causal effects of the aerial spraying of herbicides (glyphosate) on short-term health-related outcomes. Our results show that exposure to the herbicide used in aerial spraying campaigns increases the number of medical consultations related to dermatological and respiratory illnesses, as well as the number of miscarriages. These findings are robust to the inclusion of individual fixed effects, which compare the prevalence of these medical conditions for the same person under different levels of exposure to the herbicide used in the aerial spraying program over a period of 5 years. Also, our results are robust to controlling for the extent of illicit coca cultivation in the municipality of residence.
Risk is still relevant: Time-varying associations between perceived risk and marijuana use among US 12th grade students from 1991 to 2016
Yvonne Terry-McElrath et al.
Addictive Behaviors, forthcoming
Background: Perceived risk of harm has long been a key preventive factor for adolescent marijuana use. However, in recent years, perceived risk has decreased markedly and marijuana use has increased only slightly, leading to new questions about their association. This study investigates the magnitude and stability of the US adolescent marijuana risk/use association from 1991 to 2016, overall and by gender and race/ethnicity.
Methods: Self-reported data on past 12-month marijuana use, perceived risk of regular marijuana use, gender, and race/ethnicity were obtained from 275,768 US 12th grade students participating in the nationally representative Monitoring the Future study. Time-varying effect modeling (TVEM) was used to examine the marijuana risk/use association over time.
Results: Both before and after controlling for gender and race/ethnicity, perceived risk was a strong protective factor against adolescent marijuana use. The magnitude of the great risk/use association strengthened for Hispanic students; remained generally stable over time for 12th graders overall, males, females, and White students; and weakened for Black students. The magnitude of the moderate risk/use association strengthened for 12th graders overall, males, females, White and Hispanic students, but did not continue to strengthen for Black students from 2005 onwards. In general, marijuana use prevalence decreased over time within all levels of perceived risk.
Conclusions: Perceived risk remains a strong protective factor for adolescent marijuana use, and the protective association for moderate risk (vs. no/slight risk) is actually increasing over time. Results suggest that accurate and credible information on the risks associated with marijuana use should remain a key component of prevention efforts.
The Cross-Border Spillover Effects of Recreational Marijuana Legalization
Zhuang Hao & Benjamin Cowan
NBER Working Paper, May 2017
Abstract:
We examine the spillover effects of recreational marijuana legalization (RML) in Colorado and Washington on neighboring states. We find that RML causes a sharp increase in marijuana possession arrests in border counties of neighboring states relative to non-border counties in these states. RML has no impact on juvenile marijuana possession arrests but is rather fully concentrated among adults. We do not find evidence that marijuana sale/manufacture arrests, DUI arrests, or opium/cocaine possession arrests in border counties are affected by RML.
The Impact of Single-Container Malt Liquor Sales Restrictions on Urban Crime
Patricia McKee et al.
Journal of Urban Health, April 2017, Pages 289–300
Abstract:
Many US cities have adopted legal restrictions on high-alcohol malt liquor sales in response to reports of crime and nuisance behaviors around retail alcohol outlets. We assessed whether these policies are effective in reducing crime in urban areas. We used a rigorous interrupted time-series design with comparison groups to examine monthly crime rates in areas surrounding alcohol outlets in the 3 years before and after adoption of malt liquor sales restrictions in two US cities. Crime rates in matched comparison areas not subject to restrictions served as covariates. Novel methods for matching target and comparison areas using virtual neighborhood audits conducted in Google Street View are described. In Minneapolis, Minnesota, sales of single containers of 16 oz or less were prohibited in individual liquor stores (n = 6). In Washington, D.C., the sale of single containers of any size were prohibited in all retail alcohol outlets within full or partial wards (n = 6). Policy adoption was associated with modest reductions in crime, particularly assaults and vandalism, in both cities. All significant outcomes were in the hypothesized direction. Our results provide evidence that retail malt liquor sales restrictions, even relatively weak ones, can have modest effects on a range of crimes. Policy success may depend on community support and concurrent restrictions on malt liquor substitutes.