The Gran Torino problem

What’s the matter with middle-aged working class white Americans?

06114132_Clint Eastwood’s Gran Torino hasn’t yet made it into Keith and Johann’s film selections, but no doubt will. It’s a witty and moving, if formulaic, exploration of the psyche of the American white working class, represented by Eastwood’s character Walt Kowalski, a retired car worker in industrial Michigan.

The film has a happy ending. Not so real life. The health of middle-aged white American men with no college education has been deteriorating to a surprising and shocking extent. RBC readers deserve for the weekend a comment thread on this now famous chart:


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Marijuana Legalization Goes Corporate

In a few days, the voters of Ohio will decide whether to let a cartel of well-heeled investors control legal marijuana cultivation in perpetuity, with low taxes and high profits locked in forever at public expense.

I write about the Ohio initiative at The Week, noting that if it passes, old line legalization organizations and individual grassroots activists will become nearly irrelevant for the future of legalized pot. Instead legalized marijuana will become a corporate industry dominated by 1 percenters, very much on the model of the tobacco industry.

4 Reasons Drug Arrests Matter—And 2 Reasons Why They Don’t

A few weeks ago the FBI released its estimate of 2014 arrests and it appears that we are still, as a country, addicted to drug arrests—particularly marijuana arrests. More than 1.5 million people were arrested for drug offenses in 2014. I’ll start with one of my reasons why this doesn’t matter. Count me among those who know that drug sentencing is not the only reason our prisons and jails are full—let all drug offenders out and we’d still have one of the highest incarceration rates in the world, which means we have some tough work to do if we really want to reduce mass incarceration—but that doesn’t mean that drug arrests are irrelevant. Here are four reasons why drug arrests themselves are worth spotlighting, with an initial caveat—drug arrests encompass a wide variety of activity. Simple possession of a limited amount of pot could account for a drug arrest; so could trying to sell meth to a kid. For this analysis, then, I’ll focus on the single biggest contributor to drug arrests: marijuana possession arrests, which account for almost forty percent of all drug arrests.

Reason 1: Racial disparities. Marijuana possession arrests are wildly disproportionate on the basis of race, as any reader of Michelle Alexander  knows. If you assume that white drug usage rates are roughly the same as those of people of color (and you can do your own math here), there’s no making sense of the fact that drug arrest rates affect communities of color at such a high rate. One way to equalize this, of course, would be to arrest more white people. I think if we did, we’d start to see the political calculus changing on drug arrests (so watch out, those of you who attend Phish concerts). But at the very least this poses some legitimacy problems for law enforcement, and, as Tom Tyler reminds us, legitimacy is the key to community cooperation, and community cooperation is the key to solving crimes.

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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.