Legalizing pot carries risks. So does prohibition.

As predicted, the Wall Street Journal refused to correct the Bennett/White op-ed that strongly implied (without quite stating explicitly) that I believe cannabis legalization would sextuple the rate of cannabis dependence to 16.2 million. (My previous whining about that here.) However, the Journal did publish my letter, with only helpful edits and an accurate headline that’s a pretty good haiku-length statement of the case.

Like the original article, the letter is behind a paywall, so – on the off chance that some RBC readers don’t pay tribute to the Murdoch empire – I’ve pasted it in below.

 

Legalizing Pot Carries Risks, but So Does Prohibition

To the Editor:

William Bennett and Robert White (“Legal Pot Is a Public Health Menace,” op-ed, Aug. 14) cite my research as support for their claim that the legalization of cannabis would mean creating 16.2 million “marijuana addicts.”

Not only is the attribution false; the claim it purports to buttress is absurd. I made no such prediction, and the idea that legal cannabis could create more addicts than legal alcohol doesn’t pass the giggle test. It would be astounding if the actual number were one-third as high as Messrs. Bennett and White project

Cannabis legalization on the current alcohol model—low taxes and loose regulations—would indeed risk a large increase in the extent of cannabis abuse. That is why some of us are working hard for high taxes and sensible regulations on cannabis, as well as stronger controls on alcohol, which is after all a much more personally and socially dangerous drug.

Cannabis legalization in any form will create some harm; every drug policy has disadvantages. But against that must be set the enormous harms from cannabis prohibition: $40 billion a year in illicit revenue, some of it going to violent criminal organizations in Mexico; tens of thousands of people in prison; and more than half a million users arrested each year.

Our goal should be to eliminate as much as possible of he damage from prohibition while minimizing the harms that would result from a badly designed legalization.

Mark Kleiman

Los Angeles

16.2 million cannabis addicts? No, of course I didn’t say that. Bill Bennett just made it up.

In his latest anti-cannabis-legalization screed, (behind the Wall Street Journal paywall), written with a former federal prosecutor named Robert White, William Bennett writes:

Mark A.R. Kleiman, a professor of public policy at the  the university of California, Los Angeles, has estimated that legalization can be expected to increase marijuana consumption by four to six times. Today’s 2.7 million marijuana dependents (addicts) would thus expand to as many as 16.2 million with nationwide legalization.

Now, if Bennett wants to make silly predictions, and if Rupert Murdoch wants to publish them, all I can say is, “It’s a free country.” But I think I’m entitled to protest when he attributes that silliness to me. It’s hard to count how many ways that short paragraph is wrong, but the central points are simple:

1. An estimate of the possible change in quantity consumed is not an estimate of the change in the number of dependent users. Consumption can also grow because the amount consumed per dependent user increases.

2. Even most dependent users are not, by any reasonable definition, “addicts.”

3. The large estimated impact on consumption depends the  factor-of-ten price decrease (to about $1-2/gm. for moderately potent product) that would result if cannabis were treated like an ordinary commodity. If taxation or production limits prevent such a drastic decrease, the effect of legalization on consumption would be much smaller.

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California’s Strange, Tragic Embrace of Prisons

California has for decades operated a large number of overcrowded prisons, in which conditions were recently described by Supreme Court Justice Kennedy as incompatible with the concept of human dignity and having no place in civilized society. If that were not sufficient cause for reform, the fiscal strain imposed by the state’s correctional system is now nearly $9 billion a year. Yet a generation of California elected officials — unlike their brethren in left-wing bastions such as South Carolina, Texas, South Dakota and Mississippi — have done nothing to reduce the size of the state’s prison population.

A range of lawsuits filed over many years (and fought by successive governors) recently culminated in the federal government forcing the state to move some prisoners to local jails. But Governor Jerry Brown is defying federal pressure to fully comply with the U.S. Supreme Court’s order to reduce overcrowding to a still problematic 137% of capacity.

Even modest reforms to criminal sentencing get little love from elected officials in this Democratic Party-dominated state. Hope for change surged briefly last year when a bill to convert simple drug possession from a felony to a “wobbler” (a crime that could, depending on circumstances, be treated as either a felony or a misdemeanor) actually passed the state legislature after many similar prior bills had failed.

But Brown promptly vetoed it. At the time, he stated that a broad review of all sentencing was commencing, and that would be the vehicle to revamp the criminal justice system more broadly, including sentencing policy.

Almost a year later, Brown has shown no signs of honoring that commitment. Instead he has proposed another half billion dollars in new spending to build more jails and prisons.

Why so many red states have run rings about putatively progressive California in the pursuit of de-incarceration is a mystery that political scientists may one day unravel. In the meantime, a proposition to convert a significant number of felonies to misdemeanor status and to allow prisoners to retroactively appeal their sentences will be on the California ballot this November. The initiative, like the lawsuits before it, is a predictable consequence of elected officials repeatedly proving themselves unwilling to proactively address a serious social problem.

Three Misunderstandings about 24/7 Sobriety for Alcohol-Involved Offenders

Mark Kleiman and I have written extensively about how 24/7 Sobriety and similar programs (e.g., HOPE Probation) have good evidence of reducing crime, imprisonment and drug use. Last week, The Greater London Authority launched a pilot of 24/7 Sobriety for binge drinking criminal offenders. The level of media and public interest in the launch was extraordinary, which to me suggests that many Britons are understandably fed up with alcohol-related violence and disorder in their communities. The media got most of the details right, but not all of them. Let me therefore now make three important clarifications:

1. Alcohol-sensing technology is not by itself 24/7 sobriety. The media focused very heavily on the fascinating technology involved in the alcohol-sensing bracelets that offenders will wear. But 24/7 sobriety doesn’t even require the alcohol-sensing bracelets. Indeed, most of its implementation in South Dakota was done via twice a day in person breathalyzation. Detecting alcohol use is essential for 24/7 sobriety to work but the heart of the program is the criminal justice system responding swiftly and certainly when drinking occurs.

Nick Herbert, MP, who helped us get the 24/7 sobriety law passed when he was Minister for Justice and Policing, puts his finger on the principal challenge the pilot will face:

The key principle in disposals like this is certainty: offenders need to know that a breach will result in instant and decisive penalty. Our criminal justice system resists such practice.

A combination of British law, British habits and British bureaucracy often produces a leisurely approach to responding to misbehavior by offenders under supervision, which is a barrier to changing their behavior. Alcohol-sensing technology, by itself, can’t solve that problem, which requires concerted effort at reform by judges, police and elected officials.

2. 24/7 Sobriety is not a threat to human freedom. A few columnists penned hysterical articles arguing that government using technology to know when people drink is a harbinger of an Orwellian future. It is hard to be completely wrong, but these critics are up to the challenge. If not for programs like 24/7 sobriety the government would send many of these same offenders to prison. Offenders are infinitely more free living in their communities with an alcohol-sensing tag on than they would be in The Scrubs.

3. I did not invent 24/7 Sobriety. Because I worked closely with the Mayor’s Office and Parliament on the law and did many briefings about the evidence supporting the program, some journalists who covered the launch incorrectly described me as the creator of the program.

As I said in my own piece in the Telegraph, 24/7 Sobriety was invented by Judge Larry Long of South Dakota. Getting the provenance right is not just about giving credit where due, though that is important. The larger point is that 24/7 sobriety is not some ivory tower notion conceived by someone who had never been part of the criminal justice system. Rather, it derived from first-hand knowledge of how the system was failing and what could be done to change it. That’s why it’s far more likely to work than anything I or any other professor would have dreamt up from the armchair.

Cannabis legalization: not whether, but how

The New York Times comes out for cannabis legalization.

David Frum is still against it.

Neither deals seriously with the balance of advantage and disadvantage; the Times simply blows off the question of substance use disorder and pretends that passing a law forbidding sales to minors takes care of the problem of increased use by minors, while Frum never mentions the damage done by the $40-billion-per-year illicit market created by cannabis prohibition and proposes nothing that would shrink that market.

And neither the Times editorial board nor David Frum seems interested in the question of how to legalize, as opposed to whether to legalize. The Times doesn’t notice that commercialization is only one approach to legal availability, and arguably not the best; Frum simply dismisses a temperate approach to legalization as politically unworkable, without explaining how to make his kinder, gentler prohibition a political winner.

Alas, I sometimes suspect they’re both right. As a matter of practical politics, our only choices may be a badly-implemented prohibition or a badly-implemented legalization.  (If so, I’m inclined to try the Devil I don’t know.)  So far, my attempts to put political and organizational muscle behind the idea of smart legalization have merely illustrated the wisdom of Ralph Yarborough’s maxim, “They ain’t nuthin’ in the middle of the road but yaller lines and dead armadillas.”  I don’t find life as political roadkill especially uncomfortable, but it does get frustrating. It’s not just that continued prohibition and commercial legalization are both bad ideas; it’s that the arguments for those two bad ideas leave no media space, or mindspace, for discussion of the good ideas that might lie between them.

Footnote Ann Althouse does a good demolition job on the Times editorial, though to the best of my knowledge there’s no evidence of intoxication or health damage from second-hand cannabis smoke or vapor.

The Enduring Myth of “Killer Heroin”

I was at a meeting with the Australian drug addiction researcher Shane Darke last week, which gave me the chance to congratulate him for publically predicting correctly that Philip Seymour Hoffman’s autopsy would show that the actor’s tragic overdose death was due to a combination of drugs and not an unusually strong or contaminated batch of heroin.

I talked with Harold Pollack recently about how careful research on overdoses destroyed my prior belief in “killer heroin” hype:

There’s a very nice paper just out by Professors Shane Darke and Michael Farrell, who are two of the world’s leading experts on the topic…toxicology studies of overdosed people very rarely find that impurities played an important role…victims didn’t particularly receive high doses, either. Such findings surprised me. The fact that we’ve got 16,000 people a year dying from pure, legally-manufactured opiate analgesics shows you that it’s really not about the unpredictability of illegal markets, it’s about the drugs per se.

The killer heroin/impure heroin narrative sounds plausible on its face, but the data completely undermine it. Data notwithstanding, here it is again from Isaac Campos in a recent article by German Lopez.

The most dangerous thing about taking heroin right now is you don’t know what you’re really taking. You don’t know how pure it is, which makes it very easy to overdose,” Campos says

I can’t be judgmental of Campos as I would have said the same thing, with confidence, at one point (particularly before the nation was flooded with pure, consistent, labeled opioids like Oxycodone and the result was…an overdose epidemic). But I would respectfully ask him and everyone else to look at the data on overdoses and have a rethink. Successfully tackling the overdose crisis — which is now causing almost as many deaths in the U.S. a year as AIDS did at its peak — will not be facilitated by incorrect assumptions about the nature of the problem.

Three Ways of Looking at Marijuana Consumption Data

Here’s a nice chart from Andrew Sullivan on marijuana consumption in Colorado. It illustrates a point that has been made many times by drug policy analysts such as Mark Kleiman and Beau Kilmer: The total volume of pot consumption is accounted for almost entirely by users who smoke every day or nearly every day. Envisioning how different stakeholders would respond to this evidence can be helpful both for appreciating the impossibility of value-free evidence-based policy and for understanding one of the basic dilemmas of legal marijuana regulation.

colorado

AT THE PUBLIC HEALTH CONFERENCE: “Colleagues, you can see from this chart that not all marijuana users are of equal concern to us. Some people use the drug rarely, and we know that such users tend to be high social capital individuals who could set their lives right in the unlikely event that they did develop a drug problem. So we should focus instead on these heavy users in the bottom two bars of the chart, who tend not incidentally to be people with less education, less income and poorer access to health care. The evidence we have shows that the primary risks of this drug, for example marijuana dependence, mental health problems and poor school and work performance, are concentrated in the subset of people who use every day or almost every day. Let us therefore resolve to keep the size of this group as small as possible through high taxes that discourage heavy consumption, caps on THC content that reduce the ability of the drug to promote dependence and limits on advertising and points of sale in vulnerable communities.”

AT THE CORPORATE BOARD MEETING: “Well friends, you can see from this chart that not all of our customers are of equal concern to us. We can’t make much money from the people in the top few bars of the chart, so we should focus mainly on the heavy users who provide us the bulk of our revenue. We need to move as much of the population as possible into this high-revenue bracket. So let’s all agree to press for lower taxes, higher THC content and as much advertising and as many retail locations as possible in the communities where our best customers tend to live.”

AT THE STATE LEGISLATURE: “Fellow committee members, as you know we have seen this chart twice today, once when the public health advocates visited and again when the marijuana industry lobbyists visited. Both groups agreed on the evidence but they wanted us to respond to it in opposite ways. And that’s not the end of what we have to consider. The state budget analyst’s office has calculated that almost 90% of the marijuana tax revenue we wanted from legalization comes from the people in the bottom bars of this chart. We care about public health but if we implement policies that make too many of those heavy marijuana users quit, the tax revenue hit we will take might force us to sacrifice other important priorities.”

Into Thin Air

Much has been made about the surge in the use of electronic cigarettes but what might be overlooked are the health effects that low-end electronic cigarettes have on its customers compared to that of the higher grade. With no quality assurance for any electronic smoking device, those who can only use the “economical” types of e cigarettes may be opening themselves up to additional health detriments though poor e cigarette construction.

The low end of the e cig market is filled with disposable products that costs anywhere from five to ten dollars, unsurprisingly these products are sold in lower income neighborhoods. Scientists at the University of California Riverside tested a “lower end” e cigarette model as well as a mid-range brand known as “Mistic”, both bought from a San Diego drug store. During the tests the liquid (or “juice) that is inside the e cig is heated and put inside a centrifuge and spun. The end product of the cheap brand, known as “Smoking Everywhere Platinum”, was a pellet that contained mostly tin, with trace amounts of some nickel and copper. Cheaper e cigarette devices may be prone to releasing metals during use due to the tin soldering coming off of the casing, a result of the cheap construction of the cartridge. The Mistic brand e cig had trace amounts of copper and no amounts of tin found due to no solders being used in the product, something common with higher end e cigs. Regulated manufacturing is inherently more expensive, but the switch to a standard set of rules for e cigarette production could lead to reduced instances of metal inhalation for those who cannot afford higher end e cigs.

The people being exposed to harmful e cigarettes are the same who are exposed to the lower end of actual cigarettes: poor minorities. Though the hold that cigarettes have on low income populations remains in a death grip e cigarette use is on the rise and much like cigarettes that are made on the cheap, e cigarettes made for as little money as possible carry inherently worse risks than those made with the consumer in mind. Lack of regulation in the electronic cigarette market allows bargain brands to pump out cheaply constructed disposable e cigs that open up lower income users to health problems from metal inhalation and nicotine poisoning, a greater push for regulation needs to come in order for lower income users to be as safe as their higher end e cigarette smoking counterparts.

Swift, Certain and Fair Consequences for Substance-Involved Offenders in the UK

I am grateful to Policy Exchange for arranging this recent event about how to improve community supervision of criminal offenders who have problems with alcohol and other drugs. The host, Max Chambers, has since ascended into Number 10, which is a good sign that criminal justice reform is of interest at the highest levels of the UK government.

News Chew

Any platform where a company can engage directly with potential customers is obviously a powerful tool to be harnessed; a healthy social media presence is important for the success of most businesses. When you work in regulated markets like pharmaceuticals or alcohol, engaging with a potential customer base can get a little tricky, especially where “tricky” means harmful and expensive. Let’s agree that this is also your working definition of “risk”.

It would be hard to argue that a company’s social media presence is anything besides a more dynamic outlet for advertising. For regulated markets, mitigating risk even when advertising in “traditional” platforms like print and TV gets a bit lumpy (e.g. the pretty ad with a lady enjoying a tire swing has to be that much more appealing to allay the turn-off of a full page of micro print describing risks and side effects), but the rules and implications around use of social media is fuzzier, so those risks can grow.

Enter Reg-SM, a new launch from the social-media marketing agency, Attention. Reg-SM specializes in helping businesses in those regulated markets use social and mobile media in ways that are legally compliant.

Just in time, it seems, as last week the FDA proposed new guidelines for companies who post about their drugs or medical devices on social media platforms. The guidelines would require that any tweet or post or unit of social media speech (air quotes optional) promoting a drug or medical device to include the product’s risks and adverse side effects. It’s hard for me to imagine a worthwhile tweet about a prescription drug anyway, but to jam anything but the risks of a drug into a tweet seems impossible.

Always helpful, the FDA has offered a sample tweet for a fictional drug that sounds kind of attractive to me.

NoFocus (rememberine HCl) for mild to moderate memory loss-May cause seizures in patients with a seizure disorder www.nofocus.com/risk

Sign me up, I guess. Quick aside, though: how odd for a drug to be named after not the affliction (still weird), but the cause of the affliction the drug is meant to address. When I have a headache I reach for my bottle of JawClenchesWhenSleepDeprived.

These new guidelines are going to make it very difficult for companies to tweet about their products.  The FDA’s NoFocus conveniently has only one risk to list, but even relatively safe drugs often have a number of possible side effects and risks. While I’m not sad about maybe never seeing a tweet about Viagra, these guidelines don’t seem to demonstrate a working knowledge of the platform.

Possibly more quietly impactful, the guidelines also prohibit a company from curating discussions on it’s own website by adding positive reviews and taking down negative ones.