Publications by authors named "Jonathan P Caulkins"

65 Publications

Heroin use cannot be measured adequately with a general population survey.

Addiction 2021 Mar 2. Epub 2021 Mar 2.

University of Maryland, Department of Criminology and Criminal Justice, College Park, MD, USA.

Background: Globally, heroin and other opioids account for more than half of deaths and years-of-life-lost due to drug use and comprise one of the four major markets for illegal drugs. Having sound estimates of the number of problematic heroin users is fundamental to formulating sound health and criminal justice policies. Researchers and policymakers rely heavily upon general population surveys (GPS), such as the US National Survey on Drug Use and Health (NSDUH), to estimate heroin use, without confronting their limitations. GPS-based estimates are also ubiquitous for cocaine and methamphetamine, so insights pertaining to GPS for estimating heroin use are also relevant for those drug markets.

Analysis: Four sources of potential errors in NSDUH are assessed: selective non-response, small sample size, sampling frame omissions and under-reporting. An alternative estimate drawing on a variety of sources including a survey of adult male arrestees is presented and explained. Other approaches to prevalence estimation are discussed.

Findings: Under-reporting and selective non-response in NSDUH are likely to lead to substantial underestimation. Small sample size leads to imprecise estimates and erratic year-to-year fluctuations. The alternative estimate provides credible evidence that NSDUH underestimates the number of frequent heroin users by at least three-quarters and perhaps much more.

Implications: GPS, even those as strong as NSDUH, are doomed by their nature to estimate poorly a rare and stigmatized behavior concentrated in a hard-to-track population. Although many European nations avoid reliance upon these surveys, many others follow the US model. Better estimation requires models that draw upon a variety of data sources, including GPS, to provide credible estimates. Recent methodological developments in selected countries can provide guidance. Journals should require researchers to critically assess the soundness of GPS estimates for any stigmatized drug-related behaviors with low prevalence rates.
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http://dx.doi.org/10.1111/add.15458DOI Listing
March 2021

Radical technological breakthroughs in drugs and drug markets: The cases of cannabis and fentanyl.

Int J Drug Policy 2021 Feb 11:103162. Epub 2021 Feb 11.

Carnegie Mellon University, Heinz College, 5000 Forbes Ave., Pittsburgh PA 15213, USA. Electronic address:

Background: Cannabis legalization and the arrival of nonmedical fentanyl are fundamentally altering North American drug markets. An essential part of that change is the ability to produce large quantities of these drugs at low costs, which is like a technological breakthrough in their production technology. This essay explores possible future consequences of these trends.

Methods: Descriptive statistics, historical analogy and economic reasoning.

Results: In North America, wholesale prices for cannabis and opioids - in the form of illegally manufactured fentanyl and other new synthetic opioids - are radically lower than they were a decade ago. Retail prices for cannabis have fallen commensurately, but not yet for opioids. Historical analogies suggest that very large declines in price can have effects on use that go beyond just an expansion of traditional patterns of consumption.

Conclusion: For cannabis and opioids in North America, conditions are ripe for significant changes in not only quantities consumed, and associated harms, but also in the roles these drugs and their control play in society. The overall situation with these drugs may look more different in 2040 compared to today, than today looks different from 2000. There are no obvious reasons why these trends will not spread to other continents.
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http://dx.doi.org/10.1016/j.drugpo.2021.103162DOI Listing
February 2021

The optimal lockdown intensity for COVID-19.

J Math Econ 2021 Mar 3;93:102489. Epub 2021 Feb 3.

Wittgenstein Centre for Demography and Global Human Capital (IIASA, OeAW, University of Vienna), Vordere Zollamtsstraße 3, 1030 Vienna, Vienna, Austria.

One of the principal ways nations are responding to the COVID-19 pandemic is by locking down portions of their economies to reduce infectious spread. This is expensive in terms of lost jobs, lost economic productivity, and lost freedoms. So it is of interest to ask: What is the optimal intensity with which to lockdown, and how should that intensity vary dynamically over the course of an epidemic? This paper explores such questions with an optimal control model that recognizes the particular risks when infection rates surge beyond the healthcare system's capacity to deliver appropriate care. The analysis shows that four broad strategies emerge, ranging from brief lockdowns that only "smooth the curve" to sustained lockdowns that prevent infections from spiking beyond the healthcare system's capacity. Within this model, it can be optimal to have two separate periods of locking down, so returning to a lockdown after initial restrictions have been lifted is not necessarily a sign of failure. Relatively small changes in judgments about how to balance health and economic harms can alter dramatically which strategy prevails. Indeed, there are constellations of parameters for which two or even three of these distinct strategies can all perform equally well for the same set of initial conditions; these correspond to so-called triple Skiba points. The performance of trajectories can be highly nonlinear in the state variables, such that for various times , the optimal unemployment rate could be low, medium, or high, but not anywhere in between. These complex dynamics emerge naturally from modeling the COVID-19 epidemic and suggest a degree of humility in policy debates. Even people who share a common understanding of the problem's economics and epidemiology can prefer dramatically different policies. Conversely, favoring very different policies is not evident that there are fundamental disagreements.
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http://dx.doi.org/10.1016/j.jmateco.2021.102489DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7857053PMC
March 2021

Outcomes associated with scheduling or up-scheduling controlled substances.

Int J Drug Policy 2021 Jan 18;91:103110. Epub 2021 Jan 18.

Carnegie Mellon University, Heinz College, 5000 Forbes Ave., Pittsburgh, PA 15213, USA.

Background: Many nations place drugs into various "schedules" according to their risk of abuse and/or recognized medical value that vary in terms of their restrictions. To mitigate diversion or abuse, drugs sometimes get rescheduled or are scheduled for the first time. Until now, there have not been efforts to integrate lessons from across the range of such past events.

Methods And Data: We searched for peer-reviewed evaluations of instances of (re-)scheduling drugs in the United States after 1969 and a comparably large set of instances from other countries. Those 109 articles were supplemented by 30 others found in other ways but not meeting those search criteria (e.g., because the information on rescheduling was a minor part of a more general article).

Findings: Findings are reported for many outcomes and with diverse measures over different timelines, making standardization of outcomes difficult. For more than half of the events for which quantitative outcomes were reported, there were declines in use-related measures by at least 40 percent. It is common for there to be reports of increases in indicators pertaining to other substances, sometimes more dangerous but sometimes less dangerous; overall, substitution appears to occur, but be partial.

Conclusion: Scheduling and up-scheduling can - though does not always - have substantial effects on a range of outcomes. Substitution to other substances is a possibility and so should be anticipated.
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http://dx.doi.org/10.1016/j.drugpo.2021.103110DOI Listing
January 2021

Variation in the degree of concentration of prescription opioid utilization using different measures.

Drug Alcohol Depend 2020 Jun 11;213:108101. Epub 2020 Jun 11.

RAND Corporation, 4570 Fifth Avenue #600, Pittsburgh, PA, 15213, United States.

Background: Studies of opioid prescribing patterns have shown that a small percentage of prescribers are responsible for a large portion of total prescriptions. There is some evidence that prescription opioid use may be similarly concentrated, but patterns may differ by population and choice of opioid utilization measure. The objective of this study is to determine what proportion of prescription opioid utilization was attributable to the top utilizers among Medicaid beneficiaries and how this proportion varies by the measure used.

Methods: We analyzed 2008-2009 Medicaid claims data from 14 states and created three claims-based measures of aggregate opioid utilization: total number of annual prescriptions, total annual milligrams morphine equivalent, and total days supply. We tested two versions of the total days supply measure: one assuming consecutive use and the other assuming concurrent use of prescriptions.

Results: The top 20 % of prescription opioid users accounted for 66 % of prescriptions, 82-85 % of days supply depending on assumption, and 90 % of morphine milligram equivalents (MME). The degree to which prescription opioid utilization was concentrated among the top 20 % of users varied minimally across states.

Conclusions: A small percentage of prescription opioid users account for a large share of prescription opioid use. Policy efforts should use metrics pertaining to days supply and total MME, not numbers of prescriptions, to more efficiently target heavy utilization. Policies targeting high-dose prescribing should consider the different ways that overlapping prescriptions may be taken.
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http://dx.doi.org/10.1016/j.drugalcdep.2020.108101DOI Listing
June 2020

Intensity of cannabis use: Findings from three online surveys.

Int J Drug Policy 2020 Apr 22;79:102740. Epub 2020 Apr 22.

RAND Drug Policy Research Center, 1776 Main St., Santa Monica, CA 90401, USA.

Background: Drug use is often measured in terms of prevalence, meaning the number of people who used any amount in the last month or year, but measuring the quantity consumed is critical for making informed regulatory decisions and estimating the effects of policy changes. Quantity is the product of frequency (e.g., number of use days in the last month) and intensity (amount consumed per use day). Presently, there is imperfect understanding of the extent to which more frequent users also consume more intensively.

Methods And Data: We examine cannabis flower consumption reported in three similar online surveys fielded in times and places where cannabis was and was not legal. These convenience samples returned enough valid responses (n = 2,618) to examine consumption across different frequencies of use via analyses of measures of central tendency, data visualizations, and multivariate regressions. Additional calculations incorporate data from the National Survey on Drug Use and Health.

Findings: Respondents who reported using daily (i.e., 30 days in the past month) consumed almost twice as much per day of use on average as did those reporting less than daily. We find only modest increases in intensity among those using less than daily, but then a substantial increase (p< 0.001) for those who use daily. Most respondents report that on heavy or light use days their consumption differs from a typical day of use by a factor of 2 or more, but only about 25% of days were described as heavy or light. We estimate those using cannabis 21+ days a month account for 80% of consumption vs. 71% of the days of use.

Discussion: Daily cannabis users consume more intensively than others, including near-daily users. When possible, survey questions should move beyond the presence or absence of use and number of days used.
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http://dx.doi.org/10.1016/j.drugpo.2020.102740DOI Listing
April 2020

Lower-Risk Cannabis Use Guidelines: Will Users Listen?

Am J Public Health 2020 01;110(1):71-72

Jonathan P. Caulkins is with the Heinz College of Information Systems and Public Policy, Carnegie Mellon University, Pittsburgh, PA. Michelle L. Kilborn is with Population, Public, and Indigenous Health at Alberta Health Services, Edmonton, AB, Canada.

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http://dx.doi.org/10.2105/AJPH.2019.305420DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6893331PMC
January 2020

Disagreeing on whether we agree.

Addiction 2020 04 8;115(4):785-786. Epub 2020 Jan 8.

RAND, Drug Policy Research Center, Santa Monica, CA, USA.

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http://dx.doi.org/10.1111/add.14915DOI Listing
April 2020

The benefits of evaluating literatures with essays.

Addiction 2019 12 28;114(12):2120-2121. Epub 2019 Oct 28.

RAND Drug Policy Research Center, Santa Monica, CA, USA.

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http://dx.doi.org/10.1111/add.14802DOI Listing
December 2019

Supervised consumption sites: a nuanced assessment of the causal evidence.

Addiction 2019 12 1;114(12):2109-2115. Epub 2019 Aug 1.

RAND Drug Policy Research Center, RAND, Santa Monica, CA, USA.

Background And Aims: Supervised consumption sites (SCS) operate in more than 10 countries. SCS have mostly emerged as a bottom-up response to crises, first to HIV/AIDS and now overdose deaths, in ways that make rigorous evaluation difficult. Opinions vary about how much favorable evidence must accumulate before implementation. Our aim was to assess the nature and quality of evidence on the consequences of implementing SCS.

Methods: We reviewed the higher-quality SCS literature, focusing on articles evaluating natural experiments and mathematical modeling studies that estimate costs and benefits. We discuss the evidence through the lens of three types of decision-makers and from three intellectual perspectives.

Results: Millions of drug use episodes have been supervised at SCS with no reported overdose deaths; however, uncertainties remain concerning the magnitude of the population-level effects. The published literature on SCS is large and almost unanimous in its support, but limited in nature and the number of sites evaluated. It can also overlook four key distinctions: (1) between outcomes that occur within the facility and possible spillover effects on behavior outside the SCS; (2) between effects of supervising consumption and the effects of other services offered, such as syringe or naloxone distribution; (3) between association and causation; and (4) between effectiveness and the cost-effectiveness of SCS compared to other interventions.

Conclusions: The causal evidence for favorable outcomes of supervised consumption sites is minimal, but there appears to be little basis for concern about adverse effects. This raises the question of how context and priors can affect how high the bar is set when deciding whether to endorse supervised consumption sites. The literature also understates distinctions and nuances that need to be appreciated to gain a rich understanding of how a range of stakeholders should interpret and apply that evidence to a variety of decisions.
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http://dx.doi.org/10.1111/add.14747DOI Listing
December 2019

Triangulating web & general population surveys: Do results match legal cannabis market sales?

Int J Drug Policy 2019 11 2;73:293-300. Epub 2019 Jul 2.

RAND Drug Policy Research Center, 1776 Main St., Santa Monica, CA 90401, USA.

Background: This paper combines complementary attributes of web and general population surveys to estimate cannabis consumption and spending in Washington State. It compares those estimates to legal sales recorded by the state's seed-to-sale tracking system, and thus exploits a rare opportunity to contrast two independent estimates for the same cannabis market. This sheds light on the question of whether nontrivial amounts of black market sales continue even after a state allows licensed production and sale.

Methods: Prevalence of past-month use is estimated from the 2015/16 U.S. National Survey on Drug Use and Health, adjusted for under-reporting. Estimates of consumption and spending per user broken down by age, gender, and frequency of use are developed from RAND's 2013 survey of cannabis users in Washington State. Supply side estimates come from the Washington State Liquor and Cannabis Board's seed-to-sale tracking system. They are expressed in terms of spending, equivalent-weight of flowers, and THC, with THC for edibles imputed using a machine learning technique called random forests.

Results: For the period July 1, 2016 to June 30, 2017, Washington's seed-to-sale data record sales from licensed cannabis stores of $1.17B and across all products an amount of THC that is equivalent to roughly 120-150 MT of flower. Survey responses suggest that amounts spent and quantities consumed are larger than that, perhaps on the order of $1.66B and over 200 MT, respectively.

Conclusion: A perfect match is not expected because of sales to tourists, residual black market activity, production for medical purposes, and diversion across state lines. Nonetheless, the results suggest that three years after state-licensed stores opened, there remained considerable consumption of cannabis supplied outside of the licensed system.
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http://dx.doi.org/10.1016/j.drugpo.2019.06.010DOI Listing
November 2019

Cannabis legalization, regulation, & control: a review of key challenges for local, state, and provincial officials.

Am J Drug Alcohol Abuse 2019 28;45(6):689-697. Epub 2019 May 28.

Alberta Health Services, Population, Public and Indigenous Health Unit, Edmonton, Canada.

: A number of countries are legalizing the supply of cannabis or are considering doing so. Beyond top-level design questions (e.g., who gets to supply and how will it be taxed?) lie many equally important and thorny regulatory issues concerning retail sale and use. These issues will often be hammered out at the local and state/provincial level by policy makers who are generalists, not experts in substance misuse, let alone cannabis.: This review provides a framework for thinking about the role of regulation and delves into three important topics with which these leaders will wrestle: Where and when can cannabis be sold? What can retailers sell? And where can their products be used?: Literature review and drawing parallels with alcohol and tobacco regulation.: The common thread across these questions is that the public health interest is both nuanced and in conflict with other stakeholder interests, such as companies' desire to maximize sales and profits and governments' desire for tax revenues.: There is a need for data and oversight structures that ensure that public health will not lose out over time.
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http://dx.doi.org/10.1080/00952990.2019.1611840DOI Listing
July 2020

Cannabis Funding and Healthy Paranoia.

J Stud Alcohol Drugs 2019 03;80(2):261-262

Carnegie Mellon University, Heinz College, Pittsburgh, Pennsylvania.

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March 2019

Prescribing diamorphine in the United States: Insights from a nationally representative survey.

Drug Alcohol Depend 2019 03 4;196:62-65. Epub 2019 Jan 4.

Carnegie Mellon University Heinz College, 5000 Forbes Ave., Pittsburgh PA 1521, United States.

Background: Some countries allow physicians to prescribe pharmaceutical-grade diamorphine to dependent users who have previously undergone treatment but are still using street-sourced heroin; this is not allowed in the US. This study provides the first nationally representative US data concerning public support for prescribing diamorphine to dependent users. We also test the hypothesis that calling it "diamorphine" instead of "heroin" increases support for this approach.

Methods: The RAND American Life Panel is a nationally representative, probability-based survey of US adults. Of the 3345 panel members invited to take the survey, 2530 (75.6%) provided a valid response to our question module. Respondents were randomly assigned to have the question refer to the prescribed drug as either "heroin" or "diamorphine." The groups did not significantly differ on sex, age, race/ethnicity, or education. We compare the distribution of responses for the two groups and conduct Pearson's chi-squared test with the Rao-Scott correction.

Results: For those asked whether the US should try prescribing pharmaceutical-grade "heroin," the share answering "Yes" (20.8%) was 15 percentage points lower than those responding "No" (35.8%). When the question asked about "diamorphine," the results were nearly reversed: the share answering "Yes" (30.6%) was almost 12 percentage points higher than those responding "No" (18.9%). The distributions of responses were significantly different (p < 0.001).

Conclusions: Support for prescribing diamorphine to dependent users is low in the US. While the results are consistent with the hypothesis that referring to heroin as diamorphine may reduce stigma associated with the substance and increase support for prescribing it, opinions may change as individuals learn they are different names for the same substance.
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http://dx.doi.org/10.1016/j.drugalcdep.2018.12.007DOI Listing
March 2019

In praise of flawed treaties.

Addiction 2018 07;113(7):1224-1225

Heinz College, Carnegie Mellon University, Pittsburgh, PA, USA.

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http://dx.doi.org/10.1111/add.14048DOI Listing
July 2018

Big data on a big new market: Insights from Washington State's legal cannabis market.

Int J Drug Policy 2018 07 27;57:86-94. Epub 2018 Apr 27.

RAND Drug Policy Research Center, 1776 Main St., Santa Monica, CA 90401, USA.

Introduction: Voters in eight U.S. states have passed initiatives to legalize large-scale commercial production of cannabis for non-medical use. All plan or require some form of "seed-to-sale" tracking systems, which provide a view of cannabis market activity at a heretofore unimagined level of detail. Legal markets also create a range of new matters for policy makers to address.

Data: Publicly available data were obtained on approximately 45 million individually priced items purchased in the 35 million retail transactions that took place during the first two and a half years of Washington State's legal cannabis market. Records include product type (flower, extract, lotion, liquid edible, etc.), product name, price, and potency with respect to multiple cannabinoids, notably THC and CBD. Items sold can be traced back up the supply chain through the store to the processor and producer, to the level of identifying the specific production batch and mother plant, the firm that tested the product, and test results.

Method: Data visualization methods are employed to describe spatial-temporal patterns of multiple correlated attributes (e.g., price and potency) broken down by product. Text-analytic methods are used to subdivide the broad category of "extracts for inhalation" into more homogeneous sub-categories. To understand the competitiveness of the legal cannabis market in Washington we calculate the Herfindahl-Hirschman index (HHI) for processors and retailers.

Results: Cannabis prices fell steadily and proportionally at the processor and retailer levels. Retail and wholesale price maintained a roughly 3:1 ratio for multiple product types after some initial fluctuations. Although a wide range of edibles are sold, they account for a modest share of consumer spending; extracts for inhalation are a larger and heterogeneous market segment. The HHI indicates the cannabis market is highly competitive at the processor level, but less so for retail markets at the county level.

Conclusions: Washington's state-legal cannabis market is diverse and rapidly evolving in terms of pricing, products, and organization. Post-legalization, researchers and policy makers may need to think in terms of a family of cannabis products, akin to how we think of new psychoactive substances and amphetamine-type stimulants, not a single drug "cannabis."
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http://dx.doi.org/10.1016/j.drugpo.2018.03.031DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6948109PMC
July 2018

Hedging bets: Applying New Zealand's gambling machine regime to cannabis legalization.

Int J Drug Policy 2018 03 12;53:113-114. Epub 2018 Jan 12.

Carnegie Mellon University, Heinz College, 5000 Forbes Ave., Pittsburgh, PA, 15213, USA. Electronic address:

Cannabis legalization is often falsely depicted as a binary choice between status quo prohibition and legalizing production and distribution by (regulated) for-profit industry. There are, however, many more prudent architectures for legalization, such as restricting production and distribution licenses to not-for-profit entities. Wilkins describes how New Zealand applied that concept to gambling machines and proposes a parallel for cannabis legalization. Greater investment in proposing good designs along these lines, including attending to governance structures, would be valuable.
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http://dx.doi.org/10.1016/j.drugpo.2017.12.015DOI Listing
March 2018

Advertising Restrictions on Cannabis Products for Nonmedical Use: Necessary but Not Sufficient?

Am J Public Health 2018 01;108(1):19-21

Jonathan Caulkins is with Carnegie Mellon University's Heinz College, Pittsburgh, PA.

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http://dx.doi.org/10.2105/AJPH.2017.304199DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5719713PMC
January 2018

Variation in cannabis potency and prices in a newly legal market: evidence from 30 million cannabis sales in Washington state.

Addiction 2017 Dec 4;112(12):2167-2177. Epub 2017 Jul 4.

RAND Corporation, Santa Monica, CA, USA.

Aims: To (1) assess trends and variation in the market share of product types and potency sold in a legal cannabis retail market and (2) estimate how potency and purchase quantity influence price variation for cannabis flower.

Design: Secondary analysis of publicly available data from Washington State's cannabis traceability system spanning 7 July 2014 to 30 September 2016. Descriptive statistics and linear regressions assessed variation and trends in cannabis product variety and potency. Hedonic regressions estimated how purchase quantity and potency influence cannabis flower price variation.

Setting: Washington State, USA.

Participants: (1) A total of 44 482 176 million cannabis purchases, including (2) 31 052 123 cannabis flower purchases after trimming price and quantity outliers.

Measurements: Primary outcome measures were (1) monthly expenditures on cannabis, total delta-9-tetrahydrocannabinol (THC) concentration and cannabidiol (CBD) concentration by product type and (2) excise tax-inclusive price per gram of cannabis flower. Key covariates for the hedonic price regressions included quantity purchased, THC and CBD.

Findings: Traditional cannabis flowers still account for the majority of spending (66.6%), but the market share of extracts for inhalation increased by 145.8% between October 2014 and September 2016, now comprising 21.2% of sales. The average THC-level for cannabis extracts is more than triple that for cannabis flowers (68.7% compared to 20.6%). For flower products, there is a statistically significant relationship between price per gram and both THC [coefficient = 0.012; 95% confidence interval (CI) = 0.011-0.013] and CBD (coefficient = 0.017; CI = 0.015-0.019). The estimated discount elasticity is -0.06 (CI = -0.07 to -0.05).

Conclusions: In the state of Washington, USA, the legal cannabis market is currently dominated by high-THC cannabis flower, and features growing expenditures on extracts. For cannabis flower, both THC and CBD are associated with higher per-gram prices, and there are small but significant quantity discounts.
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http://dx.doi.org/10.1111/add.13886DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5673542PMC
December 2017

Recognizing and regulating cannabis as a temptation good.

Int J Drug Policy 2017 04 10;42:50-56. Epub 2017 Feb 10.

Carnegie Mellon University, H. John Heinz III College, 5000 Forbes Ave., Pittsburgh, PA 15237, USA. Electronic address:

The U.S. appears to be on a path toward legalizing cannabis on the alcohol model, which is to say allowing for-profit corporations to produce, sell, and promote its use. Even after national legalization, it will take decades to observe the full effects on industry structure and behavior, or on use and misuse. However, we should not be surprised if after markets have matured and consumption patterns stabilized, legalization increases acute cannabis intoxication in the U.S. by 40 billion hours per year. This increase in use will be the most important cannabis-specific effect of legalization. The bulk of it will be consumption by daily and near-daily users, and it is possible that roughly half will be by people who meet the medical criteria for substance use disorder. Much resulting harms will be borne by the users, and their families, and the harms are not primarily "medical", at least not in the narrow sense. Hence, legalization replaces the current problems of crime and black markets not so much with a medical or public health problem, but rather with a problem of potentially excessive consumption of a "temptation good" whose acute effects are performance degrading, not performance-enhancing. As legalization removes formal social controls, it might be prudent for society to develop stronger informal social norms - akin to "friends don't let friends drive drunk" - to protect the public and more importantly the users themselves from the performance degradation of bouts of nearly perpetual intoxication.
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http://dx.doi.org/10.1016/j.drugpo.2017.01.012DOI Listing
April 2017

Improving research on drug law enforcement.

Int J Drug Policy 2017 03 4;41:158-159. Epub 2017 Feb 4.

Carnegie Mellon University Heinz College, 5000 Forbes Ave, Hamburg Hall, Pittsburgh, PA 15213-3890, United States. Electronic address:

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http://dx.doi.org/10.1016/j.drugpo.2017.01.002DOI Listing
March 2017

Considering marijuana legalization carefully: insights for other jurisdictions from analysis for Vermont.

Addiction 2016 12 7;111(12):2082-2089. Epub 2016 Feb 7.

RAND Drug Policy Research Center, Santa Monica, CA, USA.

Background And Aims: In 2014 the legislature of Vermont, USA passed a law requiring the Secretary of Administration to report on the consequences of legalizing marijuana. The RAND Corporation was commissioned to write that report. This paper summarizes insights from that analysis that are germane to other jurisdictions.

Method: Translation of key findings from the RAND Corporation report to the broader policy debate.

Results: Marijuana legalization encompasses a wide range of possible regimes, distinguished along at least four dimensions: which organizations are allowed to produce and supply the drug, the regulations under which they operate, the nature of the products that can be distributed and taxes and prices. Vermont's decriminalization had already cut its costs of enforcing marijuana prohibition against adults to about $1 per resident per year. That is probably less than the cost of regulating a legal market. Revenues from taxing residents' purchases after legalization could be many times that amount, so the main fiscal cost of prohibition after decriminalization relative to outright legalization may be foregone tax revenues, not enforcement costs. Approximately 40 times as many users live within 200 miles of Vermont's borders as live within the state; drug tourism and associated tax revenues will be important considerations, as will be the response of other states. Indeed, if another state legalized with lower taxes, that could undermine the ability to collect taxes on even Vermont residents' purchases.

Conclusions: Analysis of possible outcomes if Vermont, USA, legalized marijuana reveal that choices about how, and not just whether, to legalize a drug can have profound consequences for the effects on health and social wellbeing, and the choices of one jurisdiction can affect the options and incentives available to other jurisdictions.
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http://dx.doi.org/10.1111/add.13289DOI Listing
December 2016

The US as an example of how not to legalize marijuana?

Addiction 2016 12 26;111(12):2095-2096. Epub 2016 Jul 26.

Drug Policy Research Center, RAND, Santa Monica, California, USA.

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http://dx.doi.org/10.1111/add.13498DOI Listing
December 2016

Modeling the structure and operation of drug supply chains: The case of cocaine and heroin in Italy and Slovenia.

Int J Drug Policy 2016 05 27;31:64-73. Epub 2016 Feb 27.

Carnegie Mellon University Heinz College, 5000 Forbes Avenue, Pittsburgh 15213, USA.

Multiple layers of dealers connect international drug traffickers to users. The fundamental activity of these dealers is buying from higher-level dealers and re-selling in smaller quantities at the next lower market level. Each instance of this can be viewed as completing a drug dealing "cycle". This paper introduces an approach for combining isolated accounts of such cycles into a coherent model of the structure, span, and profitability of the various layers of the domestic supply chain for illegal drugs. The approach is illustrated by synthesizing data from interviews with 116 incarcerated dealers to elucidate the structure and operation of distribution networks for cocaine and heroin in Italy and Slovenia. Inmates' descriptions of cycles in the Italian cocaine market suggest fairly orderly networks, with reasonably well-defined market levels. The Italian heroin market appears to have more "level-jumpers" who skip a market level by making a larger number of sales per cycle, with each sale being of a considerably smaller weight. Slovenian data are sparser, but broadly consistent. Incorporating prices allows calculation of how much of the revenue from retail sales is retained by dealers at each market level. In the Italian cocaine market, both retail sellers and the international supply chain outside of Italy each appear to receive about 30-40% of what users spend, with the remaining 30% going to higher-level dealers operating in Italy (roughly 10% to those at the multi-kilo level and 20% to lower level wholesale dealers). Factoring in cycle frequencies permits rough estimation of the number of organizations at each market level per billion euros in retail sales, and of annual net revenues for organizations at each level. These analyses provide an approach to gaining insight into the structure and operation of the supply chain for illegal drugs. They also illustrate the value of two new graphical tools for describing illicit drug supply chains and hint at possible biases in how respondents describe their drug dealing activities.
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http://dx.doi.org/10.1016/j.drugpo.2016.02.003DOI Listing
May 2016

Beyond prevalence: importance of estimating drug consumption and expenditures.

Addiction 2015 May;110(5):743-5

Heinz College, Carnegie Mellon University in Qatar, Qatar Campus, Qatar.

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http://dx.doi.org/10.1111/add.12891DOI Listing
May 2015

How much of the cocaine market are we missing? Insights from respondent-driven sampling in a mid-sized American city.

Drug Alcohol Depend 2015 Feb 12;147:190-5. Epub 2014 Dec 12.

Human-Computer Interaction Institute, Carnegie Mellon University, 5000 Forbes Avenue, Pittsburgh, PA 15213, United States. Electronic address:

Background: Studying markets for illegal drugs is important, but difficult. Data usually come from a selected subset of consumers, such as arrestees, treatment clients, or household survey respondents. There are rarely opportunities to study how such groups may differ from other market participants or how much of total consumption they represent.

Methods: This paper uses respondent-driven sampling (RDS) of drug users in a mid-sized American city to estimate the shares of cocaine (powder and crack) users and expenditures that are attributable to different combinations of these groups.

Results: We find that those arrested in the last year accounted for 34% of past-month cocaine users and 40% of past-week cocaine spending in the RDS sample. Augmenting past-year arrestees with those who received treatment in the past year increases these values to 44% (users) and 55% (spending).

Conclusions: Our results suggest that estimates based only on people who were arrested and/or treated in the past year would have to be inflated by 100-200% to capture the market totals. Adding those who own or rent their place of residence increased coverage in this study to 76% (users) and 81% (spending), suggesting that in theory the inflation factor could be reduced to 23-32% by supplementing data on arrestees and treatment populations with household data, although in practice rates of under-reporting by survey respondents may make coverage (sampling frame) a secondary concern for household surveys.
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http://dx.doi.org/10.1016/j.drugalcdep.2014.11.032DOI Listing
February 2015

Diminishing returns and great potential: a comment on Pollack's & Reuter's review on tougher drug enforcement and prices.

Addiction 2014 Dec;109(12):1967-8

Heinz College's, Carnegie Mellon University, 5000 Forbes Avenue, Pittsburgh, PA, 15213, USA.

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http://dx.doi.org/10.1111/add.12535DOI Listing
December 2014

High-frequency drug purity and price series as tools for explaining drug trends and harms in Victoria, Australia.

Addiction 2015 Jan 23;110(1):120-8. Epub 2014 Oct 23.

Burnet Institute, Centre for Population Health, Melbourne, VIC, Australia.

Aims: Methamphetamine-related harms in Victoria have increased recently in the context of stable or declining use prevalence. We determine how changes in price and purity of methamphetamine compared to other drugs such as heroin may, in part, explain these divergent patterns.

Methods: Detailed methamphetamine and heroin purchase price data from 2152 participant interviews from the Melbourne Injecting Drug User cohort study were used to generate drug price series for the period January 2009-June 2013. Data on drug purity from 8818 seizures made within Victoria were used to generate drug purity series during the same period. Purity-adjusted price data for methamphetamine and heroin were obtained for the period 2009-13 by combining the two data sets.

Results: While the average purity of heroin seizures remained consistent and low, the average purity of powder and of crystal methamphetamine seizures increased from 12% [95% confidence interval (CI) = 10-14%] to 37% (95% CI = 20-54%) and 21% (95% CI = 18-23%) to 64% (95% CI = 60-68%), respectively. Crystal methamphetamine purity was bimodal, with observations generally less than 20% or greater than 70%. The average unadjusted price per gram for heroin decreased from $374 (95% CI = $367-381) to $294 (95% CI = $280-308), powder methamphetamine did not change significantly from $252 (95% CI = $233-271), and crystal methamphetamine increased substantially from $464 (95% CI = $416-511) in 2009 to $795 (95% CI = $737-853) in 2011. This increase was offset by an even greater increase in purity, meaning the average purity-adjusted price per gram declined. Furthermore, pure prices of both methamphetamine forms were similar, whereas their unadjusted prices were not. The pure price of heroin fluctuated with no ongoing trends.

Conclusions: Decreases in methamphetamine purity-adjusted price along with the bimodality of crystal methamphetamine purity may account for some of the recent increase in methamphetamine-related harm. For a given amount spent, methamphetamine purchase power has increased and the presence of extreme purity variations may challenge individuals' control of consumption.
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http://dx.doi.org/10.1111/add.12740DOI Listing
January 2015