Stupefying
The Effect of Medical Marijuana on Sickness Absence
Darin Ullman
Health Economics, forthcoming
Abstract:
Utilizing the Current Population Survey, the study identifies that absences due to sickness decline following the legalization of medical marijuana. The effect is stronger in states with ‘lax’ medical marijuana regulations, for full-time workers, and for middle-aged males, which is the group most likely to hold medical marijuana cards.
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Astha Singhal, Yu-Yu Tien & Renee Hsia
PLoS ONE, August 2016
Abstract:
Prescription drug abuse is a growing problem nationally. In an effort to curb this problem, emergency physicians might rely on subjective cues such as race-ethnicity, often unknowingly, when prescribing opioids for pain-related complaints, especially for conditions that are often associated with drug-seeking behavior. Previous studies that examined racial-ethnic disparities in opioid dispensing at emergency departments (EDs) did not differentiate between prescriptions at discharge and drug administration in the ED. We examined racial-ethnic disparities in opioid prescription at ED visits for pain-related complaints often associated with drug-seeking behavior and contrasted them with conditions objectively associated with pain. We hypothesized a priori that racial-ethnic disparities will be present among opioid prescriptions for conditions associated with non-medical use, but not for objective pain-related conditions. Using data from the National Hospital Ambulatory Medical Care Survey for 5 years (2007–2011), the odds of opioid prescription during ED visits made by non-elderly adults aged 18–65 for ‘non-definitive’ conditions (toothache, back pain and abdominal pain) or ‘definitive’ conditions (long-bone fracture and kidney stones) were modeled. Opioid prescription at discharge and opioid administration at the ED were the primary outcomes. We found significant racial-ethnic disparities, with non-Hispanic Blacks being less likely (adjusted odds ratio ranging from 0.56–0.67, p-value < 0.05) to receive opioid prescription at discharge during ED visits for back pain and abdominal pain, but not for toothache, fractures and kidney stones, compared to non-Hispanic whites after adjusting for other covariates. Differential prescription of opioids by race-ethnicity could lead to widening of existing disparities in health, and may have implications for disproportionate burden of opioid abuse among whites. The findings have important implications for medical provider education to include sensitization exercises towards their inherent biases, to enable them to consciously avoid these biases from defining their practice behavior.
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Irene Geisner et al.
Addictive Behaviors, January 2017, Pages 57–61
Objective: There has been ample research on college student risks and consequences related to 21st Birthday Drinking. To date, no studies we are aware of have examined how 21st birthday drinking impacts subsequent drinking and related consequences. This study evaluates the effect of a single night of drinking on peak drinking, heavy drinking, and negative consequences over 12 months following the event. Furthermore, we examine if typical drinking behavior prior to 21st birthday moderates the relationship between the event drinking and subsequent use.
Method: Participants included 599 college students (46% male) who intended to consume at least five/four drinks (men/women respectively) on their 21st birthday. Screening and baseline assessments were completed approximately four weeks before turning 21. A follow-up assessment was completed approximately one week after students' birthdays and every 3 months for one year thereafter.
Results: Those who drank more on their 21st birthday, also reported higher peak consumption, increased likelihood of consequences, and increased number of consequences throughout the year. Additionally, baseline peak drinking moderated the relationship such that those who drank less at peak occasion prior to turning 21 showed the strongest effects of 21st BD drinking on subsequent consumption.
Conclusions: 21st BD drinking could impact subsequent choices and problems related to alcohol. Interventions are warranted and implications discussed.
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Cannabis Control and Crime: Medicinal Use, Depenalization and the War on Drugs
Arthur Huber, Rebecca Newman & Daniel LaFave B.E.
Journal of Economic Analysis & Policy, forthcoming
Abstract:
To date, 27 states and the District of Columbia have passed laws easing marijuana control. This paper examines the relationship between the legalization of medical marijuana, depenalization of possession, and the incidence of non-drug crime. Using state panel data from 1970 to 2012, results show evidence of 4–12 % reductions in robberies, larcenies, and burglaries due to the legalization of medical marijuana, but that depenalization has little effect and may instead increase crime rates. These effects are supported by null results for crimes unrelated to the cannabis market and are consistent with the supply-side effects of medicinal use that are absent from depenalization laws as well as existing evidence on the substitution between marijuana and alcohol. The findings contribute new evidence to the complex debate surrounding marijuana policy and the war on drugs.
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Young People’s More Permissive Views About Marijuana: Local Impact of State Laws or National Trend?
Laura Schmidt, Laurie Jacobs & Joanne Spetz American
Journal of Public Health, August 2016, Pages 1498-1503
Objectives: To determine whether state medical marijuana laws “send the wrong message,” that is, have a local influence on the views of young people about the risks of using marijuana.
Methods: We performed multilevel, serial, cross-sectional analyses on 10 annual waves of the US National Survey on Drug Use and Health (2004–2013) nationally and for states with marijuana laws using individual- and state-level controls.
Results: Living in medical marijuana states was associated with more permissive views regarding marijuana across 5 different measures. However, these associations became non–statistically significant after we adjusted for state-level differences. By contrast, there was a consistent and significant national time trend toward more permissive attitudes, which was less pronounced among children of middle school age than it was among their older counterparts.
Conclusions: Passing medical marijuana laws does not seem to directly affect the views of young people in medical marijuana states. However, there is a national trend toward young people taking more permissive views about marijuana independent of any effects within states.
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Why Alcoholics Ought to Compete Equally for Liver Transplants
Alexander Zambrano
Bioethics, forthcoming
Abstract:
Some philosophers and physicians have argued that alcoholic patients, who are responsible for their liver failure by virtue of alcoholism, ought to be given lower priority for a transplant when donated livers are being allocated to patients in need of a liver transplant. The primary argument for this proposal, known as the Responsibility Argument, is based on the more general idea that patients who require scarce medical resources should be given lower priority for those resources when they are responsible for needing them and when they are competing with patients who need the same resources through no fault of their own. Since alcoholic patients are responsible for needing a new liver and are in direct competition with other patients who need a new liver through no fault of their own, it follows that alcoholic patients ought to be given lower priority for a transplant. In this article, I argue against the Responsibility Argument by suggesting that in order for it to avoid the force of plausible counter examples, it must be revised to say that patients who are responsible for needing a scarce medical resource due to engaging in behavior that is not socially valuable ought to be given lower priority. I'll then argue that allocating organs according to social value is inconsistent or in tension with liberal neutrality on the good life. Thus, if one is committed to liberal neutrality, one ought to reject the Responsibility Argument.
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David Levy et al.
Nicotine & Tobacco Research, forthcoming
Introduction: The public health impact of vaporized nicotine products (VNPs) such as e-cigarettes is unknown at this time. VNP uptake may encourage or deflect progression to cigarette smoking in those who would not have otherwise smoked, thereby undermining or accelerating reductions in smoking prevalence seen in recent years.
Methods: The public health impact of VNP use are modeled in terms of how it alters smoking patterns among those who would have otherwise smoked cigarettes and among those who would not have otherwise smoked cigarettes in the absence of VNPs. The model incorporates transitions from trial to established VNP use, transitions to exclusive VNP and dual use, and the effects of cessation at later ages. Public health impact on deaths and life years lost is estimated for a recent birth cohort incorporating evidence-informed parameter estimates.
Results: Based on current use patterns and conservative assumptions, we project a reduction of 21% in smoking-attributable deaths and of 20% in life years lost as a result of VNP use by the 1997 US birth cohort compared to a scenario without VNPs. In sensitivity analysis, health gains from VNP use are especially sensitive to VNP risks and VNP use rates among those likely to smoke cigarettes.
Conclusions: Under most plausible scenarios, VNP use generally has a positive public health impact. However, very high VNP use rates could result in net harms. More accurate projections of VNP impacts will require better longitudinal measures of transitions into and out of VNP, cigarette and dual use.
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Kathleen Parks et al.
Addictive Behaviors, forthcoming
Abstract:
The present study of college students investigated (a) the prevalence of nonmedical use of three classes of prescription drugs (stimulants, anxiolytics/sedatives, analgesics), (b) the prevalence of negative sexual events (NSE) associated with any nonmedical use of prescription drugs (NMUPD), and (c) a set of correlates of NSE. The specific NSE were sexual aggression victimization and perpetration, and regretted sex. The correlates of the NSE were sex, race/ethnicity, year in school, psychological symptoms, alcohol use, illegal drug use, and NMUPD. Participants were 509 (254 females, 255 males) randomly-selected college students who reported any NMUPD. The majority (76.2%) of the sample reported ever using stimulants, 38.9% reported ever using anxiolytics/sedatives, and 40.9% reported using analgesics. During NMUPD, 14.3% of the students reported regretted sex, 7.1% of female students reported sexual victimization, and 6.3% of male students reported perpetrating sexual aggression. Multiple logistic regression analyses indicated that anxiolytic/sedative use (Adj. OR = 1.99; 95% CI = 1.51—2.62) was positively associated with regretted sex, whereas anxiolytic/sedative use (Adj. OR = 1.79; 95% CI = 1.01—3.16) and psychological symptoms (Adj. OR = 1.06; 95% CI = 1.02—1.10) were positively associated with sexual victimization. Illegal drug use was positively associated with perpetrating sexual aggression (Adj. OR = 4.10; 95% CI = 1.21—13.86). These findings suggest that among these college students, NMUPD-associated NSE were not uncommon, and primarily associated with anxiolytic/sedative use. Given the academic, physical, and psychological implications associated with NSE, research needs to further explore the causal nature of these relations.
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Alcohol consumption by youth: Peers, parents, or prices?
Olugbenga Ajilore, Aliaksandr Amialchuk & Keven Egan
Economics & Human Biology, December 2016, Pages 76–83
Abstract:
Using data from the National Longitudinal Survey of Adolescent to Adult Health, we estimate the effect of peers’ alcohol consumption and alcohol prices on the drinking habits of high-school-age youth. We use the two-stage residual inclusion method to account for the endogeneity of peer drinking in nonlinear models. For our sample of high school students, we find that peer effects are statistically and economically significant regarding the choice to participate in drinking but are not significant for the frequency of drinking, including binge drinking. Regarding alcohol prices, even though we have good price variation in our sample, alcohol prices are not found to be significant. The results are important for policymakers who are considering policies to reduce underage drinking, as we conclude that no significant impact on underage drinking will result from low-tax states’ increasing excise taxes on alcohol so they are similar to those of high-tax states. Policymakers may choose to focus instead on the influence of peers and changing the social norm behavior.
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The Couple That Smokes Together: Dyadic Marijuana Use and Relationship Functioning During Conflict
Cory Crane et al.
Psychology of Addictive Behaviors, forthcoming
Abstract:
Self-reported marijuana use has been associated with poor relationship functioning and decreased stability over time. The present study examined the behavioral interactions of couples with concordant and discordant patterns of marijuana use during conflict, using individual self-reports and observation by independent coders. Heavy drinking community couples (N = 149) participated in a conflict resolution paradigm. Interactions were recorded and coded by naïve coders. Approximately 30% of the sample reported past year marijuana use. Actor-Partner Interdependence Models and analysis of covariance (ANCOVA) were used to evaluate the individual and interactive effects of dyadic marijuana use on maladaptive relationship functioning. A Robust Actor × Partner Marijuana Use interaction was detected for a range of behavioral outcomes, assessed by both self-report and direct observation, including relationship satisfaction, anger experience, patterns of demand and withdrawal during conflict, constructive behaviors, and overall relationship quality. Specifically, couples in which both partners used or abstained from marijuana displayed more adaptive relationship functioning across indicators relative to couples in which only 1 partner identified as a marijuana user. This pattern was particularly strong for couples in which the female partner used marijuana and the male partner did not. Couples with discordant, rather than concordant, marijuana use displayed distinct conflict resolution behaviors that were consistent with the long-term negative relationship outcomes that have been observed in previous studies.
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Christopher Jones
Addictive Behaviors, forthcoming
Methods: Data from the National Survey on Drug Use and Health were used to assess trends in opioid analgesic nonmedical use, abuse, and dependence for 2003–2005, 2006–2008, 2009–2011, and 2012–2014. Multivariable logistic regression was used to identify characteristics associated with opioid analgesic abuse or dependence.
Results: Rates of past-year opioid analgesic nonmedical use decreased from 48.4 per 1000 persons aged 12 years and older in 2003–2005 to 43.3 in 2012–2014. Declines were seen among most demographic and substance using groups. In contrast, rates of past-year opioid analgesic abuse or dependence increased from 6.0 per 1000 persons in 2003–2005 to 7.5 in 2012–2014; increases were seen among most demographic and substance using groups. In 2012–2014, odds of opioid analgesic abuse or dependence were highest among those with sedative or tranquilizer and heroin abuse or dependence.
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U.S. Demand for Tobacco Products in a System Framework
Yuqing Zheng et al.
Health Economics, forthcoming
Abstract:
This study estimated a system of demand for cigarettes, little cigars/cigarillos, large cigars, e-cigarettes, smokeless tobacco, and loose smoking tobacco using market-level scanner data for convenience stores. We found that the unconditional own-price elasticities for the six categories are −1.188, −1.428, −1.501, −2.054, −0.532, and −1.678, respectively. Several price substitute (e.g., cigarettes and e-cigarettes) and complement (e.g., cigarettes and smokeless tobacco) relationships were identified. Magazine and television advertising increased demand for e-cigarettes, and magazine advertising increased demand for smokeless tobacco and had spillover effects on demand for other tobacco products. We also reported the elasticities by U.S. census regions and market size. These results may have important policy implications, especially viewed in the context of the rise of electronic cigarettes and the potential for harm reduction if combustible tobacco users switch to non-combustible tobacco products.
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From Maize to Haze: Agricultural Shocks and the Growth of the Mexican Drug Sector
Oeindrila Dube, Omar García-Ponce & Kevin Thom
Journal of the European Economic Association, forthcoming
Abstract:
Understanding how economic incentives affect illegal drug production is essential for crafting policies in response to the international drug trade. Policymakers typically face a choice between two strategies: targeting criminal groups via law enforcement, and offering producers incentives to engage in alternate activities. Yet, little is known about how the returns to alternate legal activities affect drug supply. We contribute to this literature by examining how shocks to legal commodity prices affect the drug trade in Mexico. Our analysis exploits exogenous movements in the Mexican maize price stemming from weather conditions in US maize-growing regions, as well as exports of other major maize producers. Using data on over 2200 municipios spanning 1990–2010, we show that lower prices differentially increased the cultivation of both marijuana and opium poppies in municipios more climatically suited to growing maize. We also find impacts on downstream drug-trade outcomes, including drug cartel operations and killings perpetrated by these groups. Our findings demonstrate that maize price changes contributed to the burgeoning drug trade in Mexico, and point to the violent consequences of an expanding drug sector.