Cigarettes kill no one

Stupid, right? “Cannabis kills no one” isn’t much better.

There! Can you imagine a more obviously stupid claim? Cigarettes kill about 400,000 people per year in the U.S. alone, and tens of millions more worldwide.

But, so far as I know, it is not physiologically possible to absorb a fatal dose of nicotine by smoking. Nicotine can be lethal if swallowed or injected, but a cigarette contains perhaps 2% of the median lethal dose. There are no published reports of acute fatal overdose from cigarette smoking. When smoking kills, it does so through chronic disease.

Acute alcohol poisoning is the primary cause of about 400 deaths per year and a contributing cause in another 1000 (mostly overdoses of other drugs). That’s out of about 100,000 total alcohol-related deaths, the rest being from chronic disease, accident, suicide, and crime.

So if we looked at acute overdoses alone, we would miss all of the lethality of cigarettes and about 99% of the lethality of alcohol.

That’s why its so outrageous to for Andrew Sullivan to post a headline reading “Cannabis kills no one.”
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Cannabis and alcohol (reprise)

Comparing pot to booze is beside the point; the question is how one influences the other.

David Frum and I agree that “But something else is even worse than X!” is not a good reason to ignore the X problem: autos kill more people than guns, but we should still try to reduce the number of people killed with guns. And the fact that alcohol is a much nastier drug than cannabis, both physiologically and behaviorally, doesn’t make cannabis abuse either rare or benign.

But Point #13 in the post Frum links to wasn’t about the comparison between cannabis and alcohol; it was about the causal connection between cannabis policy and alcohol abuse. As Frum notes, alcohol use and cannabis use are now positively correlated. But that doesn’t tell you anything conclusive about whether making cannabis legally available would increase or decrease heavy drinking.

In my view, an increase of as little as 10% in heavy drinking would wipe out any benefits from cannabis legalization, including the benefit in the form of fewer arrests because of the additional crime that would go along with the additional heavy drinking. Frum is aware of that possibility.

But he ignores the opposite possibility, equally plausible in terms of both logic and evidence. Continue reading “Cannabis and alcohol (reprise)”

Thirteen theses on cannabis policy

A few facts, and many unknowns, for Frum, Riggs, and Sullivan to chew on (or smoke).

Rather than getting into the cultural or media criticism of the FrumRiggsFrumSullivan fracas over cannabis policy, perhaps it makes more sense to try to separate out the knowns and identify the unknowns. Experts on the question see open questions where passionate amateurs are most dogmatic about the answers.

1. Cannabis dependency is rarely as bad as severe alcoholism, but it can be plenty bad enough, and it isn’t very rare, especially among those who start – as most users now do – in their middle teens. (A sixteeen-year-old who goes beyond experimentation has about one chance in six of winding up a heavy daily user for a period of months or years.)

2. Most users – and even many frequent users – don’t go on to diagnosable abuse or dependency. There is little evidence of lasting damage from use that isn’t both heavy and chronic. It would be a mistake to attribute all of the suffering of even the heavy, chronic users to cannabis, as opposed to the social circumstances and personal traits that lead them to acquire and maintain the habit. But it would be equally a mistake to ignore their self-reports that cannabis is a source of trouble in their lives.

3. For the non-abusing majority of users, cannabis is a fairly harmless pleasure. For some of them, cannabis use lastingly enhances their lives by broadening their range of experience, deepening their appreciation of the arts, and enhancing their creativity by teaching them a new way of thinking. Very little is known about these phenomena in any systematic way, partly because the science is hard and partly because of the constraints and incentives that influence research.
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Admirable Obama Administration statement on marijuana legalization

There’s a big gap between what the Administration said and what it should have said.

When the Obama Administration decided to invite petitions from the public, it no doubt anticipated that there would be one or more about legalizing cannabis, a proposal that now has roughly 50% public support. Of course, the Administration isn’t ready to go there, but it had a perfectly sensible response:
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[Wordless shriek of rage and frustration]

Most of the news in the new household survey on drug abuse is good: cocaine and meth use are down, meth initiations are way down. There’s an uptick in cannabis use, especially among young adults. So why is the official press release headlined “National Survey Shows a Rise in Illicit Drug Use”?

Over the past four years, the number of people self-reporting as methamphetamine users on the big household survey is down by half, and meth initiation rates – a leading indicator, and therefore the one to watch – by 60%. The number of people self-reporting cocaine use is down by a third. Middle-school rates of drinking and smoking are also down, though less dramatically. Initiation to non-medical pain relievers remains high, but off its peak in the early 2000s, reached after a decade that saw initiation rise tenfold.

Oh, yes, and cannnabis use is up some (almost 20% from the 2007 trough, from ), especially among young adults (18-25). Cannabis use among those under 18 is flat. Mean age at first use is up from 17 to 18.4: that’s the direction you want to see it going.

So the on-one-foot summary of the results is “Nothing exciting, but basically good news.”

But if you were really, really, really stupid – or had a job that required you to pretend to be that way – you might just treat all use of illicit drugs as alike and simply count the number of users. In that case, the modest rise in cannabis use would swamp all the other results, because cannabis is by far the mostly widely used illicit drug, and a report mostly full of pretty good news would come out as “National Survey Shows a Rise in Illicit Drug Use,” complete with silly viewing-with-alarm quotes from officials.

(No, dammit, we are not “at a crossroads”! Next year is mostly going to look like this year.)

Even after 30 years in the business, it’s hard to get used to how plain damned dumb the official (and journalistic) discourse on this topic is. The household survey (aptly named NS-DUH, where DUH is pronouned “duhhhhhhhhh”) doesn’t get at what’s really interesting: the number of problem users, and especially criminally-active problem users. But it does contain some useful information. Too bad the people running the show mostly ignore that information and concentrate on fluff.

Caulkins on (quasi) medical marijuana

How come the number of “medical” marijuana users in some states is so large compared to the total number of self-reported marijuana users? Is there an epidemic of chronic pain among otherwise healthy thirty-year-old men who have been smoking pot for years?

Jon Caulkins of Carnegie Mellon is the lead author on a book on marijuana legalization scheduled for publication next spring. The rest of the team consists of Angela Hawken of Pepperdine and me (who worked with Jon on Drugs and Drug Policy, part of the same series from Oxford University Press) plus Beau Kilmer, who heads the RAND effort studying the possible effects of legalization.

Jon and I don’t come from the same place culturally or politically, and he’s extraordinarily smart (not to mention conscientious and kind), a combination that makes working with him – as I’ve been doing off and on for twenty years – both a challenge and a pleasure. Angela and Beau bring still different personalities, views, and skills to the enterprise – along with razor-sharp minds –  but so far it’s running very smoothly.  The concluding chapter of the new book will consist of a brief statement by each author laying out a preferred option; I can’t predict any of them in detail (even my own thinking keeps shifting) but I expect the four statements to embody lots of disagreement.

Jon and I agree more about facts than we do about values or policies. For example, he’s clearly right to say that the profile of “medical” marijuana users looks like a profile of recreational drug users, not a profile of patients, and that their sheer numbers in some states suggest that most of the recreational market is now accessing its supplies through quasi-medical channels. And that doesn’t even count the people whose recreational needs are supplied by friends with medical cards. Whether he’s also right to say that the Justice Department would do well to crack down on the scam is less obvious, at least to me.