Tag: drugs

Does Marijuana Legalization Cause Pedestrian Fatalities?

A recent report from the Governors Highway Safety Alliance suggests that the legalization of recreational marijuana in many U.S. states has been associated with increases in pedestrian traffic fatalities. To substantiate this claim, the report cites that:

“[t]he seven states (Alaska, Colorado, Maine, Massachusetts, Nevada, Oregon, Washington) and DC that legalized recreational use of marijuana between 2012 and 2016 reported a collective 16.4 percent increase in pedestrian fatalities for the first six months of 2017 versus the first six months of 2016, whereas all other states reported a collective 5.8 percent decrease in pedestrian fatalities.” 

This statistic, however, does not indicate the impact of legalization on pedestrian fatalities because many states did not legalize between the time periods cited.  An appropriate analysis should examine what happens, state-by-state, at the time of each state’s own legalization.

The graphs below depict pedestrian fatalities for states that legalized recreations marijuana between 2012 and 2016. The red lines represents the year in which the state legalized.  The graphs suggest no relation between legalization and pedestrian deaths.

Pedestrian Fatalities by State

For the states that did legalize in 2016 (Maine, Massachusetts, and Nevada), the provisional January-June 2017 used in the GHSA report are the only data available for comparison. Between January-June 2016 and January-June 2017, these three states saw an average increase in pedestrian fatalities of 4 percent.
However, on average, all states saw an average decrease of 12% in pedestrian traffic fatalities in the first six months after legalizing relative to the same six months of the prior year, indicating no clear effect of legalization on pedestrian traffic fatalities.

percent change

Percent Change in Traffic Fatalities

The concern about legalization and traffic fatalities is also inconsistent with several recent studies on the topic. One study, published in the American Journal of Public Health, concluded that “[t]hree years after recreational marijuana legalization, changes in motor vehicle crash fatality rates for Washington and Colorado were not statistically different from those in similar states without recreational marijuana legalization.”

Additionally, preliminary research indicates that marijuana legalization may reduce traffic fatalities. In their study of statewide medical marijuana liberalization, Anderson et al find that “the legalization of medical marijuana is associated with a 13.2 percent decrease in fatalities in which at least one driver involved had a positive BAC level.”  Marijuana and alcohol are substitute goods, meaning that consumers’ preferences are often indifferent between the use of one good or the other. By allowing individuals to legally use marijuana, many choose to do so instead of using alcohol, thus decreasing the prevalence of drunk driving. Furthermore, medical marijuana legalization does not seem to result in an increase in “driving while high” deaths, for the same study reports that total “traffic fatalities fall by 8–11 percent the first full year after legalization.” 

 

Robert Capodilupo contributed to this blogpost.

Marijuana Legalization and the Opioid Crisis Creates Strange Bedfellows

In a surprising move, former House speaker John Boehner has joined the board of directors of Acreage Holdings, a multi-state company focused on growing and selling marijuana. Boehner was a long-time opponent to marijuana legalization but is quoted in the Washington Post as saying:

I have concluded descheduling [marijuana] is needed so that we can do research and allow [the Department of Veterans Affairs] to offer it as a treatment option in the fight against the opioid epidemic that is ravaging our communities.

The Post article goes on to note that:

Descheduling cannabis would not legalize it nationally, but it would end federal marijuana enforcement and allow states to set their own marijuana policies without federal interference.

It remains to be seen whether Boehner’s reversal on marijuana legalization is indicative of a larger trend, but at a minimum it is a step in the right direction.

Marijuana Liberalization Reduces the Opioid Crisis

Two new studies released this week find that medical marijuana laws are associated with lower levels of opioid prescribing for Medicare and Medicaid patients. The authors find that:

 “Medical cannabis policies may be one mechanism that can encourage lower prescription opioid use and serve as a harm abatement tool in the opioid crisis.”

 and:

 “Medical and adult-use marijuana laws have the potential to lower opioid prescribing for Medicaid enrollees, a high-risk population for chronic pain, opioid use disorder, and opioid overdose, and marijuana liberalization may serve as a component of a comprehensive package to tackle the opioid epidemic.” 

These studies add to a growing literature suggesting that marijuana legalization, not stronger prohibition, will help address the current opioid crisis.

Lessons for the Opioid Epidemic from Meth

As the nation remains fixated on the opioid epidemic, methamphetamine is making a resurgence. Meth is less expensive than heroin, and it is gaining users who fear opioid overdoses.

Meth is not new; it burst onto the scene in the early 1990, as the crack epidemic waned.  Synthesized from readily available chemicals, meth provided a cheaper, homemade alternative to other drugs. As use increased, legislators and law enforcement officials took note.

The first major legislation targeting meth was the 1996 Comprehensive Methamphetamine Control Act. Passed unanimously by the Senate and by 386-34 in the House, the legislation required that individuals buying and selling chemicals used in meth production register with the federal government, which sought to track such chemicals and reduce their supply to manufactures.

Despite this legislation, meth use – and fatal overdoses – increased. In response, Congress passed the Combat Methamphetamine Epidemic Act of 2005 (officially enacted in March 2006), which limited over-the-counter sales of ephedrine and pseudoephedrine, and required retailers to log customer purchase of such drugs. Simultaneously, federal and state authorities were instituting restrictions on pharmaceutical amphetamines including Ritalin and Adderall. And many states instituted prescription drug monitoring programs to reduce the availability of prescription amphetamines acquired legally and resold on the black market.

While well-intentioned, these policies may have induced users to substitute from expensive prescription drugs to cheap, readily available meth. And this switch had the usual impact of restrictions on access.

Overdose deaths related to methamphetamine initially declined after the crackdown on prescription access, but by 2016, the meth overdose rate had reached four times its level a decade ago. The likely explanation is that restrictions pushed users from prescription versions to black market meth, where uncertainty about purity generated increasing overdoses.

 Methamphetamine Overdose Death Rates

As the opioid crisis worsens and calls for supply restrictions increase, policymakers should consider how the same approach failed to halt – indeed exacerbated – the meth epidemic.

 

Research assistant Erin Partin contributed to this blogpost.

When “Zero Tolerance” Is Deadly

In his testimony before Congress advocating for the legalization of medicinal marijuana, National Review senior editor Richard Brookhiser argued that “the law disgraces itself when it harasses the sick.” How much more so when a school’s absurd “zero tolerance” drugs policy prevents a child with asthma from reaching his life-saving inhaler in time:

Ryan Gibbons was only 12 years old when he died from a severe asthma attack during recess at school. He would have simply reached for the prescription inhaler that he always carried with him, but his school took it away and locked it in the principal’s office.

As Ryan gasped for air, his friends picked him up and carried him to the office where his inhaler was held. But they couldn’t get there in time. Ryan passed out before they reached his potentially life-saving medicine. He never recovered. The date was Oct. 9, 2012.

The tragedy took place at Elgin County School in Straffordville, Ontario, Canada. Now Ryan’s grieving mom, Sarah Gibbons, is leading a campaign to get schools to change their senseless policy of keeping essential inhalers away from asthmatic children — by law.

The bill that she wants lawmakers to pass is dubbed “Ryan’s Law,” in honor of her son’s memory. The proposed law would force schools to let kids who have a doctor’s okay carry inhalers in school, in a pocket or backpack.

It’s too often the case that would-be laws named after deceased children are hastily conceived with little thought given to unintended consequences, but here it is the policy that the law seeks to overturn that was implemented without enough forethought. Schools certainly have a legitimate interest in keeping even legal drugs like alcohol and tobacco off its premises and preventing potentially-harmful prescription drugs from falling into the wrong hands. But inhalers are different than antibiotics or other prescription drugs that are taken at regularly scheduled intervals. The risk that some non-asthmatic students might abuse the inhalers is dwarfed by the risk of blocking access to inhalers. According to the Asthma and Allergy Foundation of America, nearly 25 million Americans suffer from asthma, including over 9 percent of children, and there are about 3,300 deaths resulting from asthma each year, “many of which are avoidable with proper treatment and care.”

This isn’t the first time a school policy came between a student with asthma and his inhaler. Last year, a student with asthma experiencing breathing difficulties passed out when a school nurse and school dean refused to allow him to use his inhaler – which was “still in its original packaging, complete with his name and directions for its use” – because his mother hadn’t filled out the proper form. The school did not call 911 and insisted even after the fact that it had done the right thing by following its policy to the letter.

Overregulation: The View From a Helicopter Cockpit

Philip Greenspun discovers that an FAA inspector is happy to march a little helicopter charter outfit run by a single owner/pilot through the same paperwork slog that a much busier operation would face:

Finally, the FAA inspector looked at my random drug testing program to make sure that everything was in place. I’m subject to the same drug testing requirements as United Airlines. I am the drug testing coordinator for our company, so I am responsible for scheduling drug tests and surprising employees when it is their turn to be tested. As it happens, I’m also the only “safety-sensitive employee” subject to drug testing, so basically I’m responsible for periodically surprising myself with a random drug test. As a supervisor, I need to take training so that I can recognize when an employee is on drugs. But I’m also the only employee, so really this is training so that I can figure out if I myself am on drugs. As an employee, I need to take a second training course so that I learn about all of the ways that my employer might surprise me with a random drug test and find out about drug use. But I’m also the employer so really I’m learning about how I might trap myself. … Five minutes after the FAA inspector left, I received a phone call. “I’m from the FAA and we’d like to schedule an audit of your drug testing program.”

Things proceed to get crazier from there. And none of the craziness is likely to change so long as being worried about regulatory overkill is construed in Washington as being Against Air (or Food or Toy or Drug) Safety.

A Hospital Drug Shortage Made In Washington

As readers may know, I’ve been beating the drum for a while on the increasingly dangerous shortages that doctors are encountering in the availability of common, off-patent drugs used in hospital and clinical settings, including drugs that are important in chemotherapy, anesthesia, and infection control. Among the reasons for the shortages: the Food and Drug Administration has toughened its regulation of pharmaceutical makers in ways that lead to manufacturing line shutdowns and withdrawals from production.

John Goodman has a must-read blog post at Health Affairs Blog on the mounting crisis, amplified by a post by George Mason economist Alex Tabarrok at Marginal Revolution, getting into further specifics. In particular:

• 246 drugs are now considered to be in shortage, a record high, and the number has been rising for years. Rationing of scarce chemotherapy drugs is now making a difference in which patients have a chance at survival. In the absence of familiar compounds, doctors are falling back on inexact substitutes, sometimes more dangerous and less effective.

• After “tainted drugs” scares a few years ago, the FDA stepped up its Good Manufacturing Practice regulations, which control the production of pharmaceuticals. In particular, it now proclaims zero tolerance, barbed by tough fines, for many technical infractions whose actual impact on patient risk is at best doubtful, and it is unafraid of shutting down production lines again and again for retooling until its regulations are satisfied to the letter. It also changes its formulation and manufacturing requirements often, with scant forgiveness for makers who have trouble retooling to the new specifications quickly.

• Remarkably, the feds have inserted themselves into the role of central planners of drug output. Goodman:

For example, a drug manufacturer must get approval for how much of a drug it plans to produce, as well as the timeframe. If a shortage develops (because, say, the FDA shuts down a competitor’s plant), a drug manufacturer cannot increase its output of that drug without another round of approvals. Nor can it alter its timetable production (producing a shortage drug earlier than planned) without FDA approval.

That the results might include many unpleasant surprises will surprise only those unfamiliar with the record of a century of central planning failure.

• Pre-1938 drugs are suffering particular disruptions because of a separate FDA program, long demanded by consumer groups, to subject these “grandfathered” compounds to regulatory oversight just as tough as newer drugs. The dictates of the Drug Enforcement Administration also contribute to problems with some controlled substances.

• Several leading professional organizations, including the American Society of Anesthesiologists and the American Society of Clinical Oncology, collaborated on a meeting last November to raise the visibility of the issue and seek possible solutions. You can read its summary report here. Objectively, it’s a damning indictment, but be warned that — rather typically in a field where many key players live in fear of offending the FDA — the report refrains from outspoken criticism of the agency and in fact proposes widening the agency’s funding and powers.

Wouldn’t this make a good subject for hearings at the newly Waxman-liberated House Commerce Committee?

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