Don’t just stand there, do something! (Provided there’s something useful to do.)

Of course my brilliant old friend and longtime UCLA colleague Eugene Volokh is right (and Jeb Bush was also right, though tin-eared and hard-hearted).  The impulse do “do something” in the face of a bad situation, and especially after a disaster, can lead to policies that make things worse instead of better (for example, invading Iraq), and it is wiser to resist that impulse than to do something foolish. The “Yes, Minister” syllogism – “We must do something; this is something; therefore we must do this” – is not a form of reasoning that leads to good results.

That’s especially true for gun policy, because the debate heats up after a mass shooting, and mass shootings are completely atypical of gun deaths overall. The question “What would have prevented this particular disaster?” is inevitably the wrong question.

And Eugene is also right – being right in the service of really bad policy choices is one of his annoying habits – to compare guns to alcohol as two commodities whose consumption in the United States leads to the deaths of tens of thousands of people other than consumers, in addition to deaths among the consumers themselves.

But that’s where Eugene stops being right and becomes ridiculously and disastrously wrong. He assumes, falsely, that just because we’re not currently doing much to stop the violence involving guns and alcohol it must be the case that nothing useful can be done.  In the case of guns, the cross-national statistics offer a strong hint that there’s something very wrong with policy in the United States, since no other developed country has anything like our rate of gun deaths. Our rate is three times that of Finland or Switzerland – our closest competitors among developed nations – four times that of Canada, and ten times that of Australia. That suggests we might have something to learn from their policies.

John Donohue’s recent work showing that adopting a “shall-issue” concealed-carry law correlates with future increases in homicide rates  suggests that state-level gun policies matter, though it’s hard to tell whether the results are due specifically “shall-issue” as opposed to “stand-your-ground” and other elements of the NRA policy agenda; states that loosen their gun laws are likely to do so along more than one dimension.  But even if there’s nothing positive to do, reining in the desire of Eugene’s gun-crazed allies to increase the prevalence of gun ownership and gun-carrying would be a good place to start.

One obvious positive thing to do about guns would be to tighten the rules about background checks. Right now, registered gun dealers (Federal Firearms Licensees, or FFLs) must verify that gun buyers are eligible to purchase; that’s the Brady Law background check. But about a third of all gun transfers don’t involve an FFL: they’re private sales, including sales at gun shows, or they’re gifts.

There’s no good reason not to require a check for every transfer; no doubt the gun stores would be happy to provide the service at a competitive price.  That simple change, supported by the vast majority of voters and proposed by the Obama Administration, fits perfectly the NRA slogan that what we need is better enforcement of the laws already on the books. But in fact the NRA opposes it, and if Eugene supports it he’s keeping that support a secret.  No one can estimate how many lives it would save, but surely that number isn’t zero.

If Eugene wants to say – as apparently Jeb wants to say – that protecting the convenience of gun owners and gun merchants is more important than saving lives, that’s his right. But to say that there are no lives to be saved,  at reasonable cost to other goals, is simply false.

That’s even more obviously true with respect to Eugene’s comparison case, alcohol. He writes as if the only alternative to our current insanely loose alcohol policies would be a return to Prohibition, and that what we can do  about controlling alcohol-related deaths is “not much, other than trying to catch and punish alcohol abuse.”

Nonsense. There are at least two options out there that would substantially reduce the number of people who die as a result of other people’s drinking (while also reducing the number who die, suddenly or slowly, as a result of their own drinking).

The first and most obvious (except to a libertarian) is raising alcohol taxes. When something costs more, people use less of it, especially people who use enough of it so its price matters in their personal budgets. Most of the damage from alcohol-related violence comes from heavy drinkers, not casual ones.  So higher alcohol prices will lead to less drinking by heavy drinkers and therefore fewer drunk-driving deaths and fewer drunken homicides.

Philip J. Cook’s Paying the Tab estimates that a 10% increase in the price of drink (which could be achieved by doubling the current federal alcohol tax) would reduce all violent crime – not just alcohol-related crime, but of course including a lot of gun crime – by about 3%.  The effects on traffic fatalities are of about the same magnitude. The effects seem to be roughly linear.

So tripling the alcohol tax – which would cost the median drinker less than 20 cents a day, and which wouldn’t be nearly high enough to create a black market – would eliminate about 6% of the 13,000 murders we suffer each year, saving about 800 lives. It would also eliminate about the same proportion of 32,000 traffic fatalities, saving something more than 2000 additional lives.  In other words, a simple change in the tax code could eliminate about one 9/11′s worth of sudden death per year.

The other straightforward approach to shrinking alcohol-related damage, including homicide, is to deter drinking by people who commit crimes under the influence. That’s the approach of South Dakota’s Sobriety 24/7, which requires people with prior DUI convictions arrested for a fresh DUI to come in twice a day for an alcohol-breath test, under the threat of a night in jail if the result isn’t 0.0.

The results are spectacular: being on the program (for an average of 90 days) reduces DUI recidivism by 50% over the next two years. Applying the program at a county level reduces auto fatalities by 12% and domestic-violence complaints by 9%. (Beau Kilmer and his colleagues at RAND are about to publish an estimate of the effect on all-cause mortality that will blow the top off everybody’s head, but that work is still under review so I can’t more than hint at the results.)

Here’s a more speculative idea, but one I’d like to see tried. A third activity that leads to lots of sudden deaths on the part of bystanders is driving. One thing we do to reduce the carnage is to forbid people to drive if they’re under the influence. Alcohol effects coordination, but it also influences anger management, impulse control, and judgment. So why do we let someome walk around armed when he’s drunk out of his gourd? The old-fashioned Western saloon had a “hang ‘em here” policy; customers were expected to disarm before getting loaded. Why not enact that as law, requiring that anyone possessing a gun in public either (1) remain sober or (2) lock it and unload it? You could think of that as either a modification of gun policy or a modification of alcohol policy.

So Eugene’s comparison case is almost uniquely poorly chosen. There are some things we could do today to reduce gun violence by changing gun policy, but those effects would mostly happen slowly and can’t be estimated with much confidence.  But there are things we could do about alcohol policy today that would reduce violent death, including violent death by firearm, predictably and measurably six months from now.

Yes, the activist impulse to “do something” can and does lead us astray. But so does the libertarian impulse to just sit there and watch people die, all in the name of limited government.











The marijuana movement and the marijuana lobby

Reactions to the “Responsible Ohio” cannabis-legalization initiative have a lot to tell us about the changing politics of the marijuana question. No much of what they have to tell us is encouraging.

Cannabis policy change in the United States has been driven, until now, by people whose interest in the matter was primarily non-commercial: pot smokers yearning to toke free, culture warriors of the (cultural) left, libertarians, criminal justice reformers concerned about arrest and incarceration, and people who think that it’s bad policy to criminalize the behavior of tens of millions of people unless there’s a stronger reason to do so than the risks of cannabis create.

Not that economic interests have been entirely absent; Dennis Peron was in the business of selling “medical marijuana” when he spearheaded Proposition 215. But Peron was also a righteous stoner; there’s no reason to doubt the sincerity of his expressed opinion that “all marijuana use is medical.” But the main funders of the recent initiatives, and of the big marijuana-legalization groups, have been ideologically-driven billionaires such as George Soros and the late Peter Lewis.  (How old am I? Why, I’m s-o-o-o-o-o-o old that I remember when billionaires weren’t a branch of government.) And the people doing the work have been, for the most part, true believers rather than hired hacks.

That has begun to change. Americans for Safe Access has morphed from an advocacy group for medical-marijuana patients to, in effect, a trade association of medical-marijuana growers and sellers. The National Cannabis Industries Association has taken things even further, hiring a Washington lobbyist who might have been provided by Central Casting: about as far, culturally, from a typical NORML or MPP activist as it’s possible to imagine.

Inevitably, then, the marijuana movement has begun to give way to the marijuana lobby. To be sure, I’ve had my share of clashes with movement folks, and I haven’t always been impressed with their policy acumen or their standards of argument, but I’ve never seen any reason to doubt that they’re advocating the public interest as they perceive it. The people now being hired by the guys in suits doing cannabis-business stock promotions play by different rules. I expect them to have about the same ethical standards as lobbyists for the alcohol, tobacco, pharmaceutical, food, and fossil-fuels industries: that is, I expect them to be utterly willing to sacrifice human health and welfare on the altar of the operating statement, just like those folks at VW who decided it would be a cute idea to poison the air just a little bit to goose the performance of their diesel-driven cars. Continue Reading…

A Powerful Family Memoir of Opioid Addiction

51e0ZnJKRYL._SX322_BO1,204,203,200_ Understanding America’s epidemic of prescription opioid and heroin addiction requires grasping certain statistics and trends, some of which I have highlighted in prior posts. At the same time, the stories of people on the front line must also be engaged if we are to truly understand the public health crisis of opioid addiction. I just finished reading a fine book of this sort which I want to recommend here: Saving Jake: When Addiction Hits Home.

The author, D’Anne Burwell, confounds the stereotypes of opioid addiction being a problem of urban ghettos and mean streets. Unlike the 1960s and 1970s heroin epidemic, the most recent wave of addiction has a solid foothold in white, middle-class suburbia. The Burwell family, with two dedicated parents, two promising, intelligent teenage children, a good income and good health insurance may seem utterly unlikely to be ravaged by opioid addiction. But by showing how even a family blessed with psychological and economic resources is not insulated from the epidemic, Burwell highlights the extraordinary power of opioid addiction over human behavior.

D’Anne’s once cheerful, friendly, successful and athletic son Jake begins to struggle in adolescence for reasons that are initially not clear to his parents. His grades slip, he becomes thinner and less healthy, and he drifts into a social network where troubles fall like rain. He always seems to have an explanation for his travails, and his parents are initially satisfied by his accounts, not least because they want to believe there is an innocuous reason for their son’s struggles.

But eventually they discover that Jake is addicted to Oxycontin. His poor grades as a freshman result in the loss of his scholarship. He tumbles downward from there, despite multiple stints in rehabs and numerous other chances to change. Burwell captures vividly the maddening nature of being a parent of an addicted child, both the sadness at seeing your offspring suffer and the hurt and rage at being manipulated and lied to. She learns over time the hard lesson that she cannot control her son anymore than he can control his drug use. But because she learns faster than he does, she lives in terror of the phone call that could come at any time informing her that her son has died of an overdose.

The book is commendably honest about how everyone in the Burwell family at one time or another responds to Jake’s problems in ways that are not constructive. But at the same time it’s impossible for readers not to admire the Burwells’ grit. The way D’Anne, her husband and her daughter hang in with Jake through years of agony defines for me the word “family”.

Many books of this genre define addicted people as having selfish personalities that come from being over-indulged by parents who can’t set limits. Burwell appropriately notes that this framework ignores the effect of addiction on family interactions. A parent who could once easily set limits may stop doing so because of fear that if they don’t rescue their loved one, they will overdose and die. Likewise, prior to the changes which persistent drug use exerts on the brain, an addicted person may have been selfless and giving; the constant felt need for drug can abolish that, producing the selfish behavior that may erroneously be labeled a pre-existing cause of drug use.

This isn’t a medical book and isn’t intended to be. If you want to learn about the naloxone overdose rescue drug, naltrexone therapy or methadone maintenance you should look at a different type of book. But if you are looking for a candid, well-written account of the human experience of loving someone who is addicted to opioids, this quietly powerful book will stay with you for a long time.

A Conversation about America’s Opioid Addiction Epidemic

The word “heroin” strikes terror into the heart of most Americans, with good reason. But the increasing heroin problem in the U.S. is actually just a small part of a much longer and deeper epidemic that was started by doctors and pharmaceutical companies beginning in the late 1990s. Paul Costello, a terrific interviewer, asked me to chart this history and review current policy options in this episode of his show One-on-One.

The Federal Under-Response to the Overdose Epidemic

Uses some already appropriated funds, the White House Office of National Drug Control Policy is allocating $2.5 million to support public health approaches to the heroin epidemic. Meanwhile HHS Secretary Burwell is asking Congress for $133 million to respond to the overdose epidemic and a bipartisan group of legislators has proposed their own $80 million Comprehensive Addiction and Recovery Act.

Blessings on all their heads, but it says a lot about Washington D.C. these days that we are responding to the biggest epidemic in a generation with such small-scale federal actions. Overdoses are killing more Americans each year than the AIDS epidemic did at its peak (in 1995 AIDS claimed 41,700 American lives). The federal government responded to HIV/AIDS on the massive scale required, both at home and abroad. Federal appropriations to respond to HIV/AIDS were in the billions, with the result being the saving of millions of lives.

But in this era where lack of faith of the federal government is widespread and the bulk of Members of Congress will not open the federal pocketbook even in the face of a historic emergency, even the biggest proposal is but a fraction of what was spent to respond to AIDS. Those who are showing the courage to rise to the challenge of overdose deaths are being forced to fight a dragon with a rubber sword.

Will 2016 bring anything different? So far only one Presidential candidate has grasped the nettle: Hillary Clinton. She has just rolled out a $10 billion multi-year initiative on addiction, which reflects that she appreciates the scale and gravity of the problem. With some noble exceptions, the national media responded mainly by…covering her emails more. But her plan may resonate in New Hampshire, where I am informed that some polls show that addiction is outpolling the economy when voters are asked what issues concerned them most. Clinton deserves credit for her leadership. The other candidates in the race should also lay out their vision given that addiction and overdose could well be the biggest public health problems that the next president has to face.

Pharma Lobbying Ensures Meth Lab Explosions

Dan Morse of Washington Post has covered the strangest meth lab explosion case of which I have ever heard, which took place when a police officer named Christopher Bartley tried to make meth in the federal research facility which he was assigned to guard:

According to facts in the case, as laid out in court, Bartley, who had been a lieutenant with the National Institute of Standards and Technology’s internal police force, was on duty the night of July 18 when he slipped into a building on the edge of NIST’s 578-acre campus. He tried to make meth. It exploded, blowing out four windows at the lab — one traveled 22 feet; another, 33 feet.

It is fortunate no one was killed in the explosion. Bartley himself was burned as the temperature in the room rose to 180 degrees, but thankfully survived his injuries.

Meth lab explosions happen with regularity in many states, often with far worse results, including buildings burning to the ground, lasting environmental damage from caustic chemicals, and children and adults being killed or permanently scarred by fires.

The only reason the problem persists is that the manufacturers of pseudoephedrine-containing cold medications used in meth-making continue to flood state legislatures with lobbying money. The states that have resisted the political pressure and put products like Sudafed on prescription-only status have essentially eliminated meth lab explosions.

Meth lab explosions can be eliminated without any need to inconvenience people who want to take pseudoephedrine-containing products for congestion. Cold medicines resistant to pseudoephedrine extraction by meth cooks are available and could be exempted from any prescription requirements. But the pharma companies that profit handsomely from their meth-cooking customers will have none of it, and thus far our political system has rarely been able to resist their power.

Addiction as tragedy

Keith wrote, of deaths caused by drunk driving:

But if we think of tragedy as the Ancient Greeks did — something that was unavoidable — drink driving deaths aren’t a tragedy but an outrage.

Dead right on the outrage. But did the Greeks really see tragedy this way?

maskSFIK the Ancient Greeks did not use the remarkable and unique art form they had developed, the “goat-songs” that they performed in competitive religious festivals, as a metaphor for life. It was the reverse: life and myth gave them stories to be recapitulated and reshaped in the performance of tragedies, and these in turn gave them insights into the human condition. Alexander modelled himself on Homer’s Achilles, but he was an outlier in everything.

The goat-songs and epic recitations came first, the theorising later. Continue Reading…

Weekend Film Recommendation: Traffik


I once saluted the Tinker, Tailor, Soldier, Spy mini-series as the summit of BBC programming. This week’s film recommendation is in the same league: 1989′s Traffik. Most Americans remember Steven Soderbergh’s Oscar-winning adaptation of this series, but far too few have seen the British original, which at just over 5 hours allows much more character and plot development than could Soderbergh’s fine movie.

Simon Moore’s masterful script anchors what could have been a sprawling, confusing series in the lives of a small number of characters: A UK Home Office drugs minister (Bill Paterson) whose daughter is a heroin addict (Julia Ormond), a dogged German cop (Fritz Müller-Scherz) who relentlessly pursues an ice queen (Lindsay Duncan) who steps into the drug trafficking business when her husband (George Kukura) is indicted, and a desperate Pakistani poppy farmer (Jamal Shah) who finds work with a ruthless drug lord (Talat Hussain). As events buffet the protagonists and their respective story arcs cross, Moore’s narrative skills and Alastair Reid’s deft direction ensure that the viewer is irresistibly drawn in emotionally and able to track the complexities of the plot.

The performances by the actors range from good to amazing. Though it is hard to choose some to single out for praise, Müller-Scherz completely inhabits his role as a working class police detective who seems to hate traffickers as much for their wealth as their drugs. Paterson is marvelous in a tragic role, playing a rigid man who desperately wants to do good at home and at work yet almost always fails in both domains. Lindsay Duncan is also impressive, beginning the film as a woman accustomed to wealth and knowing yet not wanting to know where the money comes from. After her husband’s arrest, Duncan makes credible her character’s transformation into someone even more cold-hearted than he, revealing the greed and entitlement that was lurking in her all along. Her character, along with Talat Hussain’s Pakistani drug lord, are used by the film to portray the drug trade much as socialists tend to see all of capitalist enterprise: A system with a few rich sociopaths on the top and countless marginal people (whether in the drug trade or addicted to its products) scraping by and suffering at the bottom.

The cinematic team behind Traffik took a somewhat subjective approach in their portrayal of drug production and daily life in Pakistan. Home Office minister Jack Lithgow (Paterson), improbably, roams around Pakistan unstaffed, not unlike Macbeth lost in the haunted forest. His encounters with the locals are more emblematic than realistic, including his somehow running into Fazal, the farmer who will be a hub of the story that unfolds. Coupled with dreamlike, sun dappled shots of the countryside by cinematographer Clive Tickner, the whole effect of the Pakistan sequences is akin to watching a surrealist play. Yet it works because Lithgow is on a mission of unreality, trying to stop drug production with a feeble crop substitution program and more generally trying to control a culture that he can barely even understand.


In contrast, the scenes set in Europe are more gritty and realistic, particularly Ormond’s descent into addiction. The skies are darker, the shadows longer and the cinematic look grimier. And over both the European and Pakistani scenes hangs Tim Souster’s music, a quasi-mystical threnody that accentuates the emotional anguish that the film creates. You won’t get his score out of your head quickly and you will not want to.

Traffik is a powerful, mournful film that doesn’t speechify or offer easy answers about drugs. Both artistically and as an education about its subject, it’s a triumph from start to finish.

Legalized Pot in California: No Gold Rush, No Cash Cow

There’s no way I will associate myself as a parent first, and as a public servant second, with something that is loosely drafted, that is looking to capitalize on the next California Gold Rush.
Lt. Gov Gavin Newsom

Our Blue Ribbon Commission on Marijuana Policy released our final report today (link here). The report is not an argument for or against legalization but a discussion of what the policy consideration should be if in fact California’s voters choose to legalize recreational marijuana. Gavin’s quote hits one of the key themes of the report, which is that protection of public health is more important than money generation (whether that money is corporate profits or state tax revenues). In America, public health only has a shot against big money if regulations are strong and the oversight process allows public input rather than being a cat’s paw of industry (As Oregon unfortunately has and Ohio might also adopt).

Relatedly, we advocate ongoing policy flexibility rather than a ballot initiative that sets everything in stone up front. The experience of other legalizing states shows that some anticipated problems don’t in fact occur whereas other things go unexpectedly pear-shaped. Because none of us can see the future with complete accuracy, any marijuana regulatory process will have to be dynamic and evolutionary in response.

Is Pot Cultivation Starving Us of Water?

Christopher Ingraham has a fascinating piece in Washington Post on the water demands of marijuana cultivation. Drawing on a study in the journal Bioscience, Christopher notes that growing an acre of weed consumes more water than growing an acre of wine grapes and about as much water as an acre of (notoriously thirsty) almonds.

An environmental catastrophe in the making? I doubt it.

The amount of water required for an agricultural industry is a function of two variables: (1) The amount of water per unit of land (acre, square mile, whatever) and (2) The amount of units of land needed to meet market demand. The Bioscience paper places great emphasis on the first of these variables but in my view, gives short shrift to the second.

The latest USDA data show that 936,000 acres are devoted to growing almonds. In contrast, the marijuana consumption of the entire U.S. population could be cultivated using only 1% of that acreage. Because it takes so little land to grow a large amount of marijuana, weed can be as thirsty as almonds per unit of land but have only a bare fraction of the almond industry’s impact on the water supply.

Drug policy maven Jonathan Caulkins offered me a rough formula that makes this point concrete:

A heavy daily user of marijuana might consume one pound of marijuana a year, which is roughly equal to what a single outdoor plant can yield. Thus, in round terms, that is 1 plant per heavy daily user. So that is 5 months of growing season * 30 days per month * 22 liters per day * 0.26 gallons per liter = 858 gallons, or about 143 toilet flushes. So even a heavy user going to the bathroom only once a day over those 150 days will consume more water flushing the toilet than via the marijuana they consume.

This doesn’t mean of course that marijuana cultivation isn’t straining water supplies in drought-stricken regions of California (e.g. Humboldt County). It is. But from a national viewpoint, the demand that marijuana cultivation imposes on the water supply is rather trivial.