New Evidence From British Columbia Provides a Strong Case for Harm Reduction Strategies

A study published last month in the peer-reviewed journal Addiction by researchers at the British Columbia Centre for Disease Control and the British Columbia Centre on Substance Use found that harm reduction strategies were responsible for the province’s opioid-related overdose death rate being less than half of what it otherwise would have been between April 2016 and December 2017.

The researchers noted that 77 percent of opioid-related overdose deaths during that time frame involved illicit fentanyl. Vancouver has long been a major port of entry for fentanyl and fentanyl analogs, produced in China and other parts of East Asia, often using historic seaborn drug trade routes

During the 23 months ending December 2017 there were 2,177 overdose deaths in British Columbia, according to the British Columbia Centre for Disease Control. Using mathematical modeling methodology to estimate monthly overdose and overdose-death risk along with the impact of harm reduction interventions, the researchers concluded an estimated 3,030 overdose deaths were averted.

The three harm reduction strategies investigated were take-home naloxone kits, safe injection sites, and “opioid agonist therapy”— known in the U.S. as Medication Assisted Treatment (which includes methadone, buprenorphine, hydromorphone, and heroin assisted treatments in British Columbia). The researchers employed counterfactual simulations with the fitted mathematical model to estimate the number of deaths averted for each harm reduction strategy as well as the three strategies in combination. 

While the harm reduction strategies combined for more than 3000 deaths averted, the number of lives saved by each strategy taken in isolation broke down as follows: 

  • 1,580 (1,480-1,740) deaths averted by take-home naloxone
  • 230 (160-350) deaths averted by safe injection sites
  • 590 (510-720) deaths averted due to opioid-agonist therapy

All three interventions worked in synergy to greatly reduce the death rate, but the widespread distribution of naloxone saved the most lives. 

Michael Irvine, the study’s lead author, told Canadian Broadcasting Company reporters that in recent years the overdose crisis has been driven by a prevalence of fentanyl and fentanyl analogs. 

Among the developed nations, Canada has been one of the hardest hit by the overdose crisis on a per capita basis, with overdose deaths in Vancouver, BC approximating those of some of the worst-hit states in the U.S. as recently as 2017. This recent study gives us reason to conclude that, had British Columbia not embraced harm reduction strategies, the per capita overdose rate would have far-exceeded that of the U.S.

Canadian policymakers are being urged to curtail the prescription of opioids to patients in pain, despite the fact that more than three-quarters of overdose deaths involve fentanyl and, as in the U.S., the majority of overdose deaths involve multiple other drugs as well, including cocaine, heroin, benzodiazepines, and alcohol. This approach is driven by the failure to recognize there is no correlation between the number of prescriptions written for patients and the incidence of non-medical use of prescription opioids or prescription opioid use disorder. 

The Canadian government has also given in to pressure by the U.S. government to double down on its war on drugs. But in the U.S., researchers have learned that overdoses from the non-medical use of licit and illicit drugs has been on a steady exponential increase since the 1970s–the only variation being which particular drug is in vogue in any particular era–with no evidence of any slowing. It appears to be a result of sociocultural and psychosocial factors. There is no reason to believe things are much different in Canada.

Efforts to approach this problem by doubling down on supply-side interventions and the War on Drugs are doomed to fail—and will only cause more people to die. Fighting a war on drugs is like playing a game of “Whac-a-Mole.”

If the British Columbia experience should teach policymakers anything, it should be that harm reduction is the most effective way to end the overdose crisis. Ending prohibition would be the most consequential form of harm reduction.

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One Year Later, The Harms of Europe’s Data-Privacy Law

The European Union’s General Data Protection Regulation (GDPR), which went into effect just over a year ago, has resulted in a broad array of consequences that are expensive, unintended, or both. Alec Stapp reports at Truth on the Market:

GDPR can be thought of as a privacy “bill of rights.” Many of these new rights have come with unintended consequences. If your account gets hacked, the hacker can use the right of access to get all of your data. The right to be forgotten is in conflict with the public’s right to know a bad actor’s history (and many of them are using the right to memory hole their misdeeds). The right to data portability creates another attack vector for hackers to exploit.

Meanwhile, Stapp writes, compliance costs for larger U.S.-based firms alone are headed toward an estimated $150 billion, “Microsoft had 1,600 engineers working on GDPR compliance,” and an estimated 500,000 European organizations have seen fit to register data officers, while the largest advertising intermediaries, such as Google, appear to have improved their relative competitive position compared with smaller outfits. Venture capital investment in Euro start-ups has sagged, some large firms in sectors like gaming and retailing have pulled out of the European market, and as of March more than 1,000 U.S.-based news sites were inaccessible to European readers.

More in Senate testimony from Pinboard founder Maciej Ceglowski via Tyler Cowen:

The plain language of the GDPR is so plainly at odds with the business model of surveillance advertising that contorting the real-time ad brokerages into something resembling compliance has required acrobatics that have left essentially everybody unhappy.

The leading ad networks in the European Union have chosen to respond to the GDPR by stitching together a sort of Frankenstein’s monster of consent, a mechanism whereby a user wishing to visit, say, a weather forecast is first prompted to agree to share data with a consortium of 119 entities, including the aptly named “A Million Ads” network. The user can scroll through this list of intermediaries one by one, or give or withhold consent en bloc, but either way she must wait a further two minutes for the consent collection process to terminate before she is allowed to find out whether or it is going to rain.

This majestically baroque consent mechanism also hinders Europeans from using the privacy preserving features built into their web browsers, or from turning off invasive tracking technologies like third-party cookies, since the mechanism depends on their being present.

For the average EU citizen, therefore, the immediate effect of the GDPR has been to add friction to their internet browsing experience along the lines of the infamous 2011 EU Privacy Directive (“EU cookie law”) that added consent dialogs to nearly every site on the internet.

On proposals to base legislation in the United States on similar ideas, see Roslyn Layton and Pranjal Drall, Libertarianism.org.

Venezuela’s Murderous Regime

A new United Nations investigation underscores the brutal nature of Nicolas Maduro’s government in Venezuela. As reported in the July 4 edition of the New York Times, UN investigators found that Venezuelan Special Action Forces “have carried out thousands of extrajudicial killings in the past 18 months and then manipulated crime scenes to make it look as if the victims had been resisting arrest.” In essence, government security units acted as death squads to eliminate regime opponents.

The death toll is shockingly large. Security forces “killed 5,287 people in 2018 and another 1,569 by mid-May of this year, in what are officially termed by the Venezuelan government ‘Operations for the Liberation of the People.’” The campaign of cold-blooded mass murder is made worse by the government’s cynical, Orwellian euphemism.

The UN document concludes that the actual number of killings may be even larger, noting that some independent reports put the total extrajudicial executions for “resistance to authority,” at well over 9,000. That higher number would come as no surprise to opponents of Maduro and his predecessor, Hugo Chavez. Critics have alleged for years that forces loyal to Maduro and Chavez have kidnapped, tortured, and murdered political adversaries.

In addition to the death squad outrages, the UN report confirms the Maduro government’s other crimes. Men and women detained for political reasons “were subjected to one or more forms of torture, including electric shock, suffocation with plastic bags, water boarding, beating and sexual violence.”

The UN revelations underscore an important distinction that critics of U.S. policy toward Venezuela must make. It is appropriate to criticize all forms of U.S. meddling in that country’s internal political affairs, including the continuation of U.S. economic sanctions that have worsened the misery of the already suffering Venezuelan people. Such sanctions merely inconvenience the country’s corrupt, socialist elite but have a much greater impact on ordinary citizens. Sanctions also give Maduro and his cronies a convenient, phony excuse for Venezuela’s mounting economic woes.

Americans certainly are justified in denouncing the trial balloons that the Trump administration has sent aloft about using military force to remove Maduro from power. By providing diplomatic and financial backing to the competing government of Juan Guaido, the United States already is excessively involved in Venezuela’s internal affairs. A military intervention would make matters even worse and could entangle the United States in yet another regime-change, nation-building quagmire. Maduro’s misguided supporters have the capability to mount a sustained resistance to a U.S.-led military occupation.

Opposing U.S. meddling, though, in no way requires critics to ignore, minimize, or excuse, the Maduro regime’s increasingly well-documented economic and human-rights abuses. Some left-wing opponents of Washington’s flirtation with another regime-change crusade are prone to conflate resistance to such a policy with acting as apologists for Maduro. The morally appropriate position is to oppose intervention but denounce Maduro for his corrupt, murderous dictatorship. The new UN report should erase all doubt about the shameful nature of his rule. If Guaido and his followers ultimately prevail (although that outcome is increasingly doubtful) decent people in the United States and around the world should rejoice that another regime that abuses human rights has ended up on the ash heap of history.

State and Local Tax Differences

Americans are moving from higher-tax states to lower-tax states.

As I discuss in this study, 578,269 people moved from the highest-tax states to the lower-tax states in 2016, on net. Of the 25 highest-tax states, 24 of them had net out-migration. Of the 25 lowest-tax states, 17 had net in-migration.

The pattern seems clear to me, but the degree to which moves are driven by taxes versus other factors is subject to debate. An annual Census Bureau survey asks Americans who move the reasons for their decision out of 19 choices, but the choices do not include taxes.

Many of the largest migration flows are between states with the highest and lowest taxes. State-local taxes are 14.7 percent of personal income in the largest outflow state, New York, but they are just 7.5 percent in the largest inflow state, Florida. Florida’s government costs half as much as New York’s, yet the services are probably just as good.

There are large tax differences between cities. The District of Columbia government produces an annual study comparing state-local taxes on hypothetical families at various income levels in the largest city in each state. The study includes sales, property, individual income, and automobile taxes.

The table shows results for 2017. Families earning $75,000 a year could save about $5,000 a year moving from a high-tax city to a low-tax city. Families earning $150,000 could save about $10,000 with such a move. Bridgeport and Newark have very high property taxes. Other high-tax cities, such as Detroit and Philadelphia, impose city income taxes on top of state income taxes.

People move because of weather, housing costs, and job opportunities. But these sorts of large tax differences are likely driving migration patterns as well.

Household taxes for largest city in each state

 

A Strong Currency Is No Good Reason to Keep Tariffs High

An interesting debate has arisen in Ecuador during recent weeks over the following proposition advanced by authors at a Quito think tank: a dollarized country shouldn’t reduce its tariffs when the dollar is overvalued relative to the currencies of its regional trading partners (according to purchasing-power-parity measures) because that would undermine its “competitiveness” in export market. As several commentators have noticed, this is reminiscent of the Mercantilist view that a country will lose too much of its gold if it does not discourage imports with tariffs or promote exports with subsidies, a view that David Hume and Adam Smith debunked long ago.

The debate began with the publication of an essay by José Hidalgo Pallares and Daniel Baquero for CORDES, a leading economic policy think tank in Quito. They proposed that it is not “convenient” to reduce the general level of tariffs at the moment, with a strong dollar already making imports cheaper and exports more expensive for Ecuador, and with the economy operating at below capacity. Their concerns were macroeconomic and balance-of-payments related:  “In recent years, imports have also grown more than exports … [T]he trade balance, which is one of the main components of the current account, registered a deterioration: from a surplus of $227 million in the first quarter of 2018 to one of just $2 million in the same period of 2019.” Reducing tariffs across the board, they argue, “would mainly favor consumer goods,” whereas “to revive the Ecuadorian economy, it is more advisable to take measures that really allow some recovery of external competitiveness, in order to encourage exports. Here fits an efficient labor reform, the elimination of excessive paper work[,] and trade agreements” that give Ecuadoran products better access to foreign markets. (This and all other translations are mine, Google-aided.)

Critical response to the essay was swift. Gabriela Calderón tweeted incredulously that CORDES, for years a strong critic of the tariff surcharges imposed by then-President Rafael Correa supposedly to “safeguard” dollarization, was now adopting the Correa position: “Amazing! Spend 10 years complaining about Correa and then reproduce his erroneous arguments in favor of trade restriction.”

I will argue that the CORDES proposition – namely that the advisability of a unilateral general tariff reduction depends on macroeconomic conditions – is mistaken. In a nutshell: The stock of money and the price level are self-regulating for a small country under dollarization. The size of Ecuador’s economy (gross domestic product) is comparable to that of Mississippi. Both are dollarized. What is true for Mississippi, in regard to the balance of payments, is also true for Ecuador: When the local prices of traded goods are too high for equilibrium with neighboring countries, arbitrage will bring them down. The problem of overvaluation that reduces Ecuador’s export competitiveness will resolve itself by a combination of (1) internal adjustments (input price reductions or productivity increases) that lower the cost-covering prices local producers need to charge when exporting goods, and (2) rising nominal prices in the trading partners (Colombia, Peru) whose currencies are presently relatively undervalued in exchange markets because inflation higher than Ecuador’s is anticipated.

77% of Drug Traffickers Are U.S. Citizens, Not Illegal Immigrants

When people think of drug smugglers, they often imagine illegal immigrants sneaking into the United States across the southwest border. But the reality is that the vast majority of drug smuggling occurs at ports of entry (including airports), and the vast majority of traffickers are U.S. citizens. According to data from the U.S. Sentencing Commission, U.S. citizens had 77 percent of federal drug trafficking convictions in 2018. This percentage has grown from 69 percent in 2012. As Figure 1 shows, the share of drug traffickers who were illegal immigrants fell from 21 percent in 2012 to 16 percent in 2018.

Bar Chart

The reason that drug traffickers are largely U.S. citizens is because most drug trafficking occurs at ports of entry because most drugs—other than marijuana—are easier to conceal in legal luggage than while crossing the Rio Grande or the desserts in Arizona. Figure 2 shows the location where Customs and Border Protection seizes drugs by drug type. Port officers seized between 80 and 90 percent of every major drug type except for marijuana. Even there, officers at ports made nearly half of all the seizures so far in 2019.

Congress should not treat illegal immigrants as if they dominate drug trafficking nor should it focus drug interdiction resources between ports of entry where little drug trafficking takes place. The only thing that has reduced drug trafficking at all has been legalization of marijuana at the state level, which shifted supply away from Mexico and to the United States.

Note on comparisons: While 16 percent of trafficking convictions is about five times illegal noncitizens’ share of the U.S. population, this is not an appropriate comparison because the criminal offense inherently involves movement between two countries, so the relevant population includes people residing on both sides of the border. This means that the potential pool of undocumented noncitizen drug smugglers is vastly greater than the 10.5 million illegal residents already living in the United States.

Any of the 7.5 billion undocumented noncitizens around the world could decide tomorrow to attempt to bring drugs into the United States. Only 2,910 were convicted of doing so. That’s 0.00004 percent of all undocumented noncitizens worldwide. By comparison, 14,146 of the approximately 310 million U.S. citizens did so or 0.005 percent.

Obviously, this exercise doesn’t really tell us much, but the bottom line is that these conviction figures cannot be used to say how likely it is for undocumented noncitizens who are in the United States to be convicted a drug trafficking offense. That is not the point of this post. The point is to dispel the myths that undocumented noncitizens control most drug trafficking to the United States and that traffickers rely primarily on illegal immigration between ports of entry to bring drugs to this country. 

-Update added 7/8/2019

Are CBP’s Filthy and Inhumane Immigrant Detention Camps Necessary?

The Office of Inspector General (OIG) for the Department of Homeland Security (DHS) published a report about detention facilities operated by Customs and Border Protection (CBP) yesterday describing “dangerous overcrowding and prolonged detention of children and adults in the Rio Grande Valley.” This report came just over a month after DHS OIG’s May 30 report on “dangerous overcrowding” in El Paso.

What are the conditions in CBP’s detention camps?

Across the entire border, CBP was detaining from May to June between 4 and 5 times as many people as its facilities were designed to hold. It is impossible to list here everything that the OIG reports exposed, but here are some of what they found:

  • A cell with a maximum capacity of 35 held 155 detainees
  • A cell with a maximum capacity of 8 held 41 detainees
  • Detainees were wearing soiled clothing for days or weeks.
  • Children at three of the five Border Patrol facilities visited had no access to showers
  • Most single adults had not had a shower in CBP custody despite several being held for as long as a month
  • Some single adults were held in standing room only conditions for a week
  • Detainees standing on toilets in the cells to make room and gain breathing space, thus limiting access to the toilets
  • A diet of only bologna sandwiches. Some detainees on this diet were becoming constipated and required medical attention.
  • Standing-room-only conditions for days or weeks.

The OIG found that hundreds of children had been detained in these conditions for more than a week. Dozens of children who were under the age of 7 were held for over 2 weeks. Adults were being caged for a month in unsanitary conditions that were spreading illness. Infamously, the Department of Justice is defending these conditions by arguing that a “safe and sanitary” requirement does not require sleep, toothbrushes, or soap for children. CBP stashed families outside sleeping on the ground under a bridge for days as they were “bombarded with pigeon droppings.” When that was discovered, CBP hid what observers are calling “human dog pounds” elsewhere—again, outside in 100+ degree temperatures.

Other documentation of the depraved treatment elsewhere has come to light. Children told a federal court that infants are being forced to wear “clothing stained with vomit.” Lawyers who inspected the conditions told the New Yorker that during a lice outbreak, Border Patrol had children sharing combs and then when one of these combs was lost, the agents took away their blankets and mats as punishment. A doctor received access to a facility only after a flu outbreak that Border Patrol agents failed to contain had sent five infants to the hospital. Her visit found “extreme cold temperatures, lights on 24 hours a day, no adequate access to medical care, basic sanitation, water, or adequate food.”

Are CBP’s detention conditions a problem?

Yes. CBP has reported the deaths of six children so far this fiscal year after no children had died in the last decade. At least four other adults have also died this fiscal year. Another man committed suicide last year after Border Patrol took away his child and forced him into a detention facility. The conditions are rapidly spreading diseases between detainees, and the OIG found that this was also leading to illnesses among the agents themselves. Border Patrol told the OIG that it believes that holding people in these conditions “could turn violent.” Some agents are even retiring or quitting to avoid the situation. Agents told OIG that the situation is “an immediate risk to the health and safety not just of the detainees, but also DHS agents and officers.”

More fundamentally, the detention conditions are a monstrously unjust way to treat peaceful people. Violent felons and murderers receive better treatment in every state than CBP’s treatment of immigrants and asylum seekers.

Are CBP’s detention conditions violating its own standards?

Yes. CBP’s “Transport, Escort, Detention, and Search” (TEDS) standards provide that showers should normally be provided to children within 48 hours. TEDS standards require children and pregnant women receive at least two hot meals per day and that all detainees not be held in “hold rooms or holding facilities” for more than 72 hours. The OIG found children without any access to a shower at all, even though nearly 30 percent had already passed a 72-hour threshold for release and that they received no hot meals until OIG showed up. It found that the agency also violated a requirement that the fire marshal limit on cell occupancy not be exceeded.

Are CBP’s detention conditions violating the law or the Constitution?

Probably. The William Wilberforce Trafficking Victims Protection Reauthorization Act (TVPRA) of 2008 requires that CBP transfer unaccompanied children (i.e. children without a legal guardian) to shelters run by Office of Refugee Resettlement (ORR) within 72 hours except in “exceptional circumstances.” Moreover, the Flores agreement—which is a court settlement agreement enforced by the District Court for Central California—also requires that all children not be detained for more than 3 days except in the case of an “influx” in which case the standard is “as expeditiously as possible.”