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24/7 Sobriety programs largely focus on reducing alcohol consumption among justice-involved individuals whose alcohol use has led them to repeatedly threaten public safety. Participants are ordered to abstain from alcohol use and subject to frequent alcohol testing (e.g., twice daily breathalyzers, remote alcohol monitoring); those testing positive face an immediate sanction, typically a night or two in jail. Unlike drug courts and other forms of coerced substance use disorder treatment, 24/7 does not require participants to enter a treatment program or attend self-help group meetings; however, these approaches are not necessarily mutually exclusive. The empirical evidence suggests that participants largely abstain from heavy drinking while in the program and that 24/7 participation is associated with lower probability of criminal legal involvement and mortality. This evidence is largely based on research in the Great Plains states with large rural populations. Several questions remain about these programs (e.g., optimal program length, possible benefits of incorporating positive incentives, efficacy of different alcohol testing technologies), many of which can best be answered in an experimental setting. In addition to reviewing the existing research on 24/7, this paper highlights additional research questions and ideas for conducting randomized controlled trials with the program, especially in more urban areas. [ABSTRACT FROM AUTHOR]

Background: Financial barriers in substance use disorder service systems have limited the widespread adoption—i.e., provider-level reach—of evidence-based practices (EBPs) for youth substance use disorders. Reach is essential to maximizing the population-level impact of EBPs. One promising, but rarely studied, type of implementation strategy for overcoming barriers to EBP reach is financing strategies, which direct financial resources in various ways to support implementation. We evaluated financing strategies for the Adolescent Community Reinforcement Approach (A-CRA) EBP by comparing two US federal grant mechanisms, organization-focused and state-focused grants, on organization-level A-CRA reach outcomes. Method: A-CRA implementation took place through organization-focused and state-focused grantee cohorts from 2006 to 2021. We used a quasi-experimental, mixed-method design to compare reach between treatment organizations funded by organization-focused versus state-focused grants (164 organizations, 35 states). Using administrative training records, we calculated reach as the per-organization proportion of trained individuals who received certification in A-CRA clinical delivery and/or supervision by the end of grant funding. We tested differences in certification rate by grant type using multivariable linear regression models that controlled for key covariates (e.g., time), and tested threats to internal validity from our quasi-experimental design through a series of sensitivity analyses. We also drew on interviews and surveys collected from the treatment organizations and (when relevant) interviews with state administrators to identify factors that influenced reach. Results: The overall certification rates were 27 percentage points lower in state-focused versus organization-focused grants (p =.01). Sensitivity analyses suggested these findings were not explained by confounding temporal trends nor by organizational or state characteristics. We did not identify significant quantitative moderators of reach outcomes, but qualitative findings suggested certain facilitating factors were more influential for organization-focused grants (e.g., strategic planning) and certain barrier factors were more impactful for state-focused grants (e.g., states finding it difficult to execute grant activities). Discussion: As the first published comparison of EBP reach outcomes between financing strategies, our findings can help guide state and federal policy related to financing strategies for implementing EBPs that reduce youth substance use. Future work should explore contextual conditions under which different financing strategies can support the widespread implementation of EBPs for substance use disorder treatment. [ABSTRACT FROM AUTHOR]

The authors discuss a debate in the U.S. and Canada about providing a safer supply to people who use drugs. Topics include an approach to safer supply which involves offering medications to people who use drugs, how policy debates about reducing harms posed by the increasingly dangerous drug supply would be more productive, and an example of interventions sometimes referred to as safer supply.

Background and aims: Synthetic opioids, mostly illegally manufactured fentanyl (IMF), were mentioned in 60% of United States (US) drug overdose deaths in 2020, with dramatic variation across states that mirrors variation in IMF supply. However, little is known about IMF markets in the United States and how they are changing. Researchers have previously used data from undercover cocaine, heroin, and methamphetamine purchases and seizures to examine how their use and related harms respond to changes in price and availability. This analysis used US Drug Enforcement Administration (DEA) data to address two questions: (i) "To what extent does IMF supply vary over time and geography?" and (ii) "What has happened to the purity‐adjusted price of IMF?" Methods: We developed descriptive statistics and visualizations using data from 66 713 observations mentioning IMF and/or heroin from the DEA's System to Retrieve Information from Drug Evidence (STRIDE; now STARLIMS) from 2013 to 2021. Price regressions were estimated with city‐level fixed effects examining IMF‐only powder observations with purity and price information at the low‐to‐medium wholesale level (>1 g to ≤100 g; n = 964). Results: From 2013 to 2021, the share of heroin and/or IMF observations mentioning IMF grew from near zero to more than two‐thirds. The share of heroin observations also containing IMF grew from <1% to ~40%. There is important geographic variation: in California, most IMF seizures involved counterfeit tablets, whereas New York and Massachusetts largely involved powder formulation. The median price per pure gram of IMF powder sold at the >10 to ≤100 g level fell by more than 50% from 2016 to 2021; regression analyses suggested an average annual decline of 17% (P < 0.001). However, this price decline appears to have been driven by observations from the Northeast. Conclusions: Since 2013, the illegally manufactured fentanyl problem in the United States has become more deadly and more diverse. [ABSTRACT FROM AUTHOR]

Background and aim: In Uruguay, residents age 18 and older seeking legal cannabis must register with the government and choose one of three supply mechanisms: self‐cultivation, non‐profit cannabis clubs or pharmacies. This is the first paper to measure the association between type of legal cannabis supply mechanism and traffic crashes involving injuries. Design Ecological study using ordinary least squares regression to examine how department‐level variation in registrations (overall and by type) is associated with traffic crashes involving injuries. Setting: Uruguay. Cases 532 department‐quarters. Measurements Quarterly cannabis registration counts at the department level and incident‐level traffic crash data were obtained from government agencies. The analyses controlled for department‐level economic and demographic characteristics and, as a robustness check, we included traffic violations involving alcohol for departments reporting this information. Department‐level data on crashes, registrations and alcohol violations were denominated by the number of residents ages 18 and older. Findings From 2013 to 2019, the average number of registrations at the department‐quarter level per 10 000 residents age 18 and older for self‐cultivation, club membership and pharmacy purchasing were 17.7 (SD = 16.8), 3.6 (SD = 8.6), and 25.1 (SD = 50.4), respectively. In our multivariate regression analyses, we did not find a statistically significant association between the total number of registrations and traffic crashes with injuries (β = −0.007; P = 0.398; 95% CI = −0.023, 0.01). Analyses focused on the specific supply mechanisms found a consistent, positive and statistically significant association between the number of individuals registered as self‐cultivators and the number of traffic crashes with injuries (β = 0.194; P = 0.008; 95% CI = 0.058, 0.329). Associations for other supply mechanisms were inconsistent across the various model specifications. Conclusions: In Uruguay, the number of people allowed to self‐cultivate cannabis is positively associated with traffic crashes involving injuries. Individual‐level analyses are needed to assess better the factors underlying this association. [ABSTRACT FROM AUTHOR]

The spread of illegally manufactured opioids, including fentanyl, has brought unprecedented levels of drug overdose deaths in North America. In some markets, illegally manufactured fentanyl (IMF) is essentially displacing heroin, not just being used to adulterate it. It is not possible at this time to provide an accurate point estimate of the amount of IMF consumed in the United States. Yet for various purposes (e.g. assessing changes in production levels and the appropriate role for various supply reduction efforts), it is important to have a sense of scale. This article provides guidance through two thought experiments that provide a hypothetical upper bound on U.S. consumption. The first considers a scenario in which IMF replaces heroin in all illegal opioid markets. The second starts with the number of individuals with an opioid use disorder and considers what total consumption would be if IMF was the only opioid they consumed. Both calculations suggest it is unlikely that the annual consumption of IMF in 2021 could have been more than single digit pure metric tons. For comparison, the most recent best estimates of the amount of cocaine and heroin consumed in the U.S. are 145 and 47 pure metric tons, respectively. The article also raises questions about the limitations of using traditional equianalgesic morphine equivalent dose conversions to estimate the total market consumption of IMF. [ABSTRACT FROM AUTHOR]

This study examines the associations of 24/7 sobriety programs with reduced alcohol-involved offenses. [ABSTRACT FROM AUTHOR]

Background and Aims: The US state of South Dakota's 24/7 Sobriety Program (24/7) requires individuals charged or convicted of alcohol‐involved offenses to avoid alcohol and submit to twice‐daily or continuous alcohol testing. We evaluated the impact of the 24/7 program in the US state of Montana. Methods: Using data from everyone in Montana who was convicted of their second driving under the influence (DUI) offense from 2009 to August 2013, we described program violations among 24/7 participants and then estimated the effect of 24/7 participation on the probability of DUI re‐arrest. To address potential selection issues related to individual‐level 24/7 participation, we used an instrumental variables approach that exploits county‐level variation in program adoption. Results: Among 2768 people convicted of a second DUI in our analytical sample, 356 participated in 24/7 and were monitored for an average of 173 days (median = 112 days). Among the 332 participants monitored by breath test, 95.5% of scheduled alcohol breath tests were completed and did not lead to a program violation. After controlling for individual‐ and community‐level covariates as well as year and county fixed effects, our instrumental variable models suggested that participation in 24/7 reduced the 1‐year DUI re‐arrest probability by at least 80% (preferred model: 86% decrease; 8.9 percentage points) compared with a counterfactual group of people convicted of a second DUI over the same period but not assigned to the program. Conclusions: South Dakota USA's 24/7 Sobriety Program appears to work in Montana as well. Certain delivery of immediate but modest sanctions for repeat driving under the influence (DUI) arrestees who violate alcohol abstinence orders appears to be able to reduce future DUI arrests. [ABSTRACT FROM AUTHOR]

Objectives: Evaluate the deterrent effect of a program that increases the certainty and celerity of sanction for arrestees ordered to abstain from alcohol and other drugs on substance-impaired driving arrests. Methods: We examine participant compliance with orders to abstain from alcohol and other drug use via breathalyzer, body-worn continuous alcohol monitoring devices, transdermal drug patches, and urinalyses. We then evaluate the impact of the 24/7 Sobriety program on substance-impaired driving arrests. Using variation across counties in the timing of program implementation in North Dakota as a natural experiment, we use difference-in-differences fixed effects Poisson regressions to measure the program's effect on county-level arrests for substance-impaired driving. Results: Over half of participants ordered to abstain from substance use complete 24/7 Sobriety without a detected substance use event. At the county level, the program is associated with a 9% reduction in substance-impaired driving arrests after accounting for the impact of oil exploration in the Bakken region, law enforcement intensity, alcohol availability, whether the state's large universities were in session, and socio-demographic characteristics. We find that the Bakken oil boom is associated with a 22% increase in substance-impaired driving arrests. Conclusions: The results suggest frequent monitoring combined with increased sanction celerity deters substance use-involved crime. While the results are generally consistent with an earlier study of 24/7 Sobriety in another state, differences in the study outcome measures implementation choices across states make direct comparisons difficult. More can be learned by conducting randomized controlled trials that vary time on program, testing technology, and/or level of sanction. [ABSTRACT FROM AUTHOR]

Background: Overdose deaths related to illegal drugs in North American markets are now dominated by potent synthetic opioids such as fentanyl, a circumstance foreshadowed by often‐overlooked events in Estonia since the turn of the century. Market transitions generate important and far‐reaching implications for drug policy. Argument and analysis: The supplier‐driven introduction of illegally manufactured synthetic opioids into street opioids is elevating the risk of fatal overdose. Using the most recent overdose mortality and drug seizure data in North America, we find that overdose deaths and seizures involving synthetic opioids are geographically concentrated, but this might be changing. Examination here suggests that in some places fentanyl and its analogues have virtually displaced traditional opioids, such as heroin. The concealing of synthetic opioids in powders sold as heroin or pressed into counterfeit medications substantially increases harms. The nature and scale of the challenge posed by synthetic opioids is unprecedented in recent drug policy history. Conclusions: There is urgent need for policy and technological innovation to meet the challenges posed by illegally produced synthetic opioids. Novel interventions worth examining include supervising drug use, proactively deterring on‐line distribution and new technologies aimed at improving transparency, such as point‐of‐use drug content testing. Continuing to approach this problem only with existing policies and available methods, such as naloxone, is unlikely to be enough and will result in many premature deaths. [ABSTRACT FROM AUTHOR]

Cannabis prohibition has created disparate harms--especially for Black, Indigenous, and People of Color ("BIPOC")--largely through arrest disparities for possession and their downstream effects. Addressing inequities is increasingly featured in discussions to legalize cannabis supply and adult possession for nonmedical purposes. While there is little disagreement that these inequities exist, those hoping to use cannabis policy to respond to them have proposed multiple options that each come with their own set of potential benefits and costs. This Essay describes some of these opportunities as well as some major puzzles and trade-offs surrounding the use of cannabis policy to advance social equity. Additionally, it offers insights into the number of people who could benefit from various social equity efforts related to cannabis policy. In particular, sealing or expunging cannabis possession convictions could affect many more BIPOC--possibly close to two orders of magnitude more--than prioritizing these individuals for entrepreneurship or employment opportunities in the cannabis industry. These options are not mutually exclusive, but decision makers should consider the possibility of federal legalization and what it will mean for small cannabis businesses when developing cannabis equity programs. [ABSTRACT FROM AUTHOR]

Background and aims: Debates regarding lowering the blood alcohol concentration (BAC) limit for drivers are intensifying in the United States and other countries, and the World Health Organization recommends that the limit for adults should be 0.05%. In January 2016, Uruguay implemented a law setting a zero BAC limit for all drivers. This study aimed to assess the effect of this policy on the frequency of moderate/severe injury and fatal traffic crashes. Design A quasi‐experimental study in which a synthetic control model was used with controls consisting of local areas in Chile as the counterfactual for outcomes in Uruguay, matched across population counts and pre‐intervention period outcomes. Sensitivity analyses were also conducted. Setting: Uruguay and Chile. Cases Panel data with crash counts by outcome per locality‐month (2013–2017). Intervention and comparator: A zero blood alcohol concentration law implemented on 9 January 2016 in Uruguay, alongside a continued 0.03 g/dl BAC threshold in Chile. Measurements Per‐capita moderate/severe injury (i.e. moderate or severe), severe injury and fatal crashes (2013–2017). Findings Our base synthetic control model results suggested a reduction in fatal crashes at 12 months [20.9%; P‐value = 0.018, 95% confidence interval (CI) = −0.340, −0.061]. Moderate/severe injury crashes did not decrease significantly (10.2%, P = 0.312, 95% CI = −0.282, 0.075). The estimated effect at 24 months was smaller and with larger confidence intervals for fatal crashes (14%; P = 0.048, 95% CI = −0.246, −0.026) and largely unchanged for moderate/severe injury crashes (−9.4%, P = 0.302, 95% CI = −0.248, 0.058). Difference‐in‐differences analyses yielded similar results. As a sensitivity test, a synthetic control model relying on an inferior treatment–control match pre‐intervention (measured by mean squared error) yielded similar‐sized differences that were not statistically significant. Conclusions: Implementation of a law setting a zero blood alcohol concentration threshold for all drivers in Uruguay appears to have resulted in a reduction in fatal crashes during the following 12 and 24 months. [ABSTRACT FROM AUTHOR]

Background and Objectives: To expand on epidemiologic studies examining associations between the legalization of recreational cannabis and use among young adults, we examined the associations between licensed and unlicensed cannabis outlet density and cannabis outcomes. Methods: A total of 1097 young adults aged 21 and older living in Los Angeles County were surveyed before licensed recreational cannabis outlets opened (Time 1: July to December 2017) and after (Time 2: July 2018 to June 2019). Using a database of open licensed and unlicensed cannabis retailers to calculate individual‐level cannabis outlet density measures, we examined associations between outlet density within a 4‐mile radius of participants' residences with Time 2 outcomes of any past‐month use, daily use, intentions to use, quantity used, consequences, and cannabis use disorder (CUD) symptoms. Results: After controlling for demographic factors and cannabis outcomes at a time point prior to their opening (Time 1), licensed cannabis outlets were associated with young adults' cannabis use, heavy use, and intentions, and unlicensed outlets were associated with young adults' heavy cannabis use and CUD symptoms. Conclusion and Scientific Significance: This study expands beyond studies of outlet prevalence to find that, after controlling for outcomes 1 year prior, licensed and unlicensed outlets were associated with young adults' cannabis outcomes. The current study is among the first to find associations between cannabis use outcomes and density of cannabis outlets among young adults using data from two time points: preopening and postopening of recreational cannabis retailers. Findings can inform policies around the density and placement of cannabis outlets. (Am J Addict 2020;00:00–00) [ABSTRACT FROM AUTHOR]

Police–community relations are strained in the United States, especially along racial lines. This paper assesses community perceptions of crime and the police before and after the implementation of an intervention aimed at eliminating overt drug markets through focused deterrence and police–community partnerships emphasizing racial reconciliation. Mail surveys were sent to every household living within a two-mile radius of the block group where the intervention took place and we estimate differences-in-differences OLS models to examine whether the intervention changed perceptions of crime and police trust and legitimacy. Relative to non-black respondents, black respondents perceived a reduction in non-violent crimes and disorder as well as less racial profiling after the intervention; these results are robust to a number of robustness checks. We did not observe a change with respect to perceptions of police effectiveness, fairness, or other measures of police legitimacy. [ABSTRACT FROM AUTHOR]

The authors discuss Hawaii’s Opportunity Probation with Enforcement, a program for the reduction of substance abuse by convicted persons. They mention the success of the initial program in modifying the behavior of participants, the less-successful results in other locations, and the reasons for the program's failure.

Reducing substance use among individuals subject to community supervision is an important goal for many judges and community corrections officers. Some jurisdictions have had success by ordering justice-involved individuals to frequent substance use testing with swift, certain, and fair (SCF) sanctions for non-compliance. South Dakota's 24/7 Sobriety program is one example of a SCF program that has also been adopted statewide in Montana, North Dakota, and other jurisdictions. As other entities outside the Great Plains attempt to adopt the 24/7 approach, there is a need to examine how the program is implemented. This paper examines a 24/7-inspired pilot program that was implemented in a southwestern county in the US in 2018. Data on participation rates and testing results for the 6-month pilot program were examined. Using a semi-structured interview protocol with questions that were adapted from the Consolidated Framework for Implementation Research (CFIR) interview guide, we interviewed nine individuals from six stakeholder groups: 1) Court, 2) District Attorney, 3) Public Defender, 4) Probation, 5) Sheriff, and 6) the non-profit organization that administered the testing. There were important differences in how the program was implemented in the county versus South Dakota's 24/7 program—namely, there was a different target population, participation was voluntary, and testing was conducted in a different setting which increased costs. While county stakeholders decided to discontinue the program after the pilot period, it was able to implement a SCF program and overcome many of the challenges it confronted. There is some interest in exploring implementation of the SCF with those arrested for driving under the influence of alcohol in the county. For jurisdictions considering the implementation of an SCF program, it makes sense to start with a pilot program with pre-determined objectives and timeline for consistency. It is also crucial to hold regular meetings with all relevant stakeholders before and during the pilot to address context-specific challenges. Conducting an implementation analysis of this process based on the CFIR guide can be useful for understanding why the pilot was a success or failure, and how it may be improved. [ABSTRACT FROM AUTHOR]

Decisionmakers continue to search for new ways to deter criminal behavior that do not rely on increasing the severity of punishment. This paper evaluates South Dakota's 24/7 Sobriety Program—a novel, large‐scale intervention requiring those arrested for or convicted of an alcohol‐related offense to abstain from alcohol and submit to alcohol tests multiple times daily. Those testing positive or missing a test receive a swift,certain, and moderate sanction; typically, a night or two in jail. To estimate the causal effect of the 24/7 program on the probability of rearrest or probation revocation for those arrested for a second or third driving under the influence (DUI) offense, we instrument an individual's 24/7 participation with program availability in the county of arrest. We estimate that the individual‐level probability of rearrest or probation revocation is 13.7 percentage points (49 percent; p = 0.002) lower for 24/7 participants than non‐participants 12 months after their DUI arrest. We detect substantive decreases at 24 and 36 months, but the precision of those estimates depends on model specification. These findings provide empricial support for applying "swift‐certain‐fair" sanctions to deter noncompliance in community supervision settings. This paper also provides policymakers with evidence for a new approach to reduce criminal activity among those whose alcohol use leads them to repeatedly threaten public health and safety. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Jurisdictions considering or implementing alternatives to cannabis supply prohibition will confront several decisions that will influence health, safety, and social equity outcomes. This essay highlights 14 of these design considerations, which all conveniently begin with the letter P: 1) Production, 2) Profit motive, 3) Power to regulate, 4) Promotion, 5) Prevention and treatment, 6) Policing and enforcement, 7) Penalties, 8) Prior criminal records, 9) Product types, 10) Potency, 11) Purity, 12) Price, 13) Preferences for licenses, and 14) Permanency. For each factor, the paper explains why it is important, describes the various approaches, and highlights how some of the jurisdictions that have legalized have addressed these choices. The primary audiences are decision makers considering alternatives to prohibiting cannabis supply and analysts making projections or conducting evaluations of these changes. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Public support for legalizing marijuana use increased from 25% in 1995 to 60% in 2016, rising in lockstep with support for same-sex marriage. Between November 2012 and November 2016, voters in eight states passed ballot initiatives to legalize marijuana sales for nonmedical purposes-covering one-fifth of the US population. These changes are unprecedented but are not independent of the changes in medical marijuana laws that have occurred over the past 20 years. This article suggests five ways in which the passage and implementation of medical marijuana laws smoothed the transition to nonmedical legalization in the United States: ( a) They demonstrated the efficacy of using voter initiatives to change marijuana supply laws, ( b) enabled the psychological changes needed to destabilize the 'war on drugs' policy stasis, ( c) generated an evidence base that could be used to downplay concerns about nonmedical legalization, ( d) created a visible and active marijuana industry, and ( e) revealed that the federal government would allow state and local jurisdictions to generate tax revenue from marijuana. [ABSTRACT FROM AUTHOR]

Background and aims Prohibitions on producing, distributing and selling cannabis are loosening in various jurisdictions around the world. This paper describes the diversification of cannabis supply laws and discusses the challenges to and opportunities for learning from these changes. Methods We document changes in cannabis supply laws that de jure legalized cannabis production for medical and/or non-medical purposes (excluding industrial hemp) in Australasia, Europe, North America and South America. We also highlight challenges to evaluating these legal changes based on our experiences studying cannabis laws and policies in the United States. Findings As of August 2016, two countries have passed laws to legalize large-scale cannabis production for non-medical purposes at the national (Uruguay) or subnational level (four US states). At least nine other countries legally allow (or will soon allow) cannabis to be supplied for medicinal purposes. Most of the changes in cannabis supply laws have occurred since 2010. The data available in most countries are inadequate for rigorously evaluating the changes in cannabis supply laws. Conclusion The evidence base for assessing changes in cannabis supply laws remains weak. Efforts should focus upon collecting information about quantities consumed and market transactions as well as validating self-report surveys. [ABSTRACT FROM AUTHOR]

The synthetic control method is an increasingly popular tool for analysis of program efficacy. Here, it is applied to a neighborhood-specific crime intervention in Roanoke, VA, and several novel contributions are made to the synthetic control toolkit. We examine high-dimensional data at a granular level (the treated area has several cases, a large number of untreated comparison cases, and multiple outcome measures). Calibration is used to develop weights that exactly match the synthetic control to the treated region across several outcomes and time periods. Further, we illustrate the importance of adjusting the estimated effect of treatment for the design effect implicit within the weights. A permutation procedure is proposed wherein countless placebo areas can be constructed, enabling estimation ofp-values under a robust set of assumptions. An omnibus statistic is introduced that is used to jointly test for the presence of an intervention effect across multiple outcomes and post-intervention time periods. Analyses indicate that the Roanoke crime intervention did decrease crime levels, but the estimated effect of the intervention is not as statistically significant as it would have been had less rigorous approaches been used. Supplementary materials for this article are available online. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background Violent drug markets are not as prominent as they once were in the United States, but they still exist and are associated with significant crime and lower quality of life. The drug market intervention (DMI) is an innovative strategy that uses focused deterrence, community engagement, and incapacitation to reduce crime and disorder associated with these markets. Although studies show that DMI can reduce crime and overt drug activity, one perspective is prominently missing from these evaluations: those who purchase drugs. Objectives This study explores the use of respondent-driven sampling (RDS)—a statistical sampling method—to approximate a representative sample of drug users who purchased drugs in a targeted DMI market to gain insight into the effect of a DMI on market dynamics. Methods Using RDS, we recruited individuals who reported hard drug use (crack or powder cocaine, heroin, methamphetamine, or illicit use of prescriptions opioids) in the last month to participate in a survey. The main survey asked about drug use, drug purchasing, and drug market activity before and after DMI; a secondary survey asked about network characteristics and recruitment. Conclusions Our sample of 212 respondents met key RDS assumptions, suggesting that the characteristics of our weighted sample approximate the characteristics of the drug user network. The weighted estimates for market purchasers are generally valid for inferences about the aggregate population of customers, but a larger sample size is needed to make stronger inferences about the effects of a DMI on drug market activity. [ABSTRACT FROM AUTHOR]

Despite a growing literature examining the costs and benefits of increasing the number of police officers in a jurisdiction, the costs associated with specific tactics and approaches police departments can use to reduce crime in their jurisdictions remain largely unknown. This article contributes to this literature by generating policing cost estimates associated with implementing the Drug Market Intervention (DMI) in two cities. Using an ex post micro-cost analysis, we estimated the costs for police resources used though the DMI 'call-in' ranged from $91,477 to $142,280 in one city, and from $104,878 to $155,668 in the other (in 2011 dollars). Although we do not know the value of the resources that would have been spent without DMI, our analyses provide police departments and others with cost estimates, information about the order of magnitude of the efforts involved, and how the cost estimates might vary from the base analysis under a variety of alternative scenarios. [ABSTRACT FROM AUTHOR]

Aims Drug policy strategies and discussions often use prevalence of drug use as a primary performance indicator. However, three other indicators are at least as relevant: the number of heavy users, total expenditures and total amount consumed. This paper stems from our efforts to develop annual estimates of these three measures for cocaine (including crack), heroin, marijuana and methamphetamine in the United States. Methods The estimates exploit complementary strengths of a general population survey ( National Survey on Drug Use and Health) and both survey and urinalysis test result data for arrestees ( Arrestee Drug Abuse Monitoring Program), supplemented by many other data sources. Results Throughout the 2000s US drug users spent in the order of $100 billion annually on these drugs, although the spending distribution and use patterns changed dramatically. From 2006 to 2010, the amount of marijuana consumed in the United States probably increased by more than 30%, while the amount of cocaine consumed in the United States fell by approximately 50%. These figures are consistent with supply-side indicators, such as seizures and production estimates. For all the drugs, total consumption and expenditures are driven by the minority of users who consume on 21 or more days each month. Conclusions Even for established drugs, consumption can change rapidly. The halving of the cocaine market in five years and the parallel (but independent) large rise in daily/near-daily marijuana use are major events that were not anticipated by the expert community and raise important theoretical, research, and policy issues. [ABSTRACT FROM AUTHOR]

There has been relatively little effort at cross-national analysis of data concerning drug policy, though there is growing variation in how nations deal with illegal drugs. Systematic accounts of barriers to, and opportunities for, making comparisons are scarce. Comparisons of drug use prevalence, the focus of most cross-national studies, are undermined by fundamental and unacknowledged methodological differences. Prevalence is a poor measure of drug problems, but more appropriate indicators, such as drug-related crime and morality, are generated by institutional and legal systems that differ across countries, making them even more difficult to compare. The same is true of intensity of enforcement; besides problems of creating comparable arrest, conviction, and incarceration data, there is difficulty in generating an appropriate denominator of offenses. Collaboration among national data collection programs can help somewhat, but substantial progress will depend on harmonization of basic measurement systems, such as arrests and incarceration and on more subtle measures such as the prevalence of problem drug use. [ABSTRACT FROM AUTHOR]

The authors present their thoughts on desistance mandates as a method of treating drug addicts within a criminal justice setting. They detail how such mandates do not prevent individuals from receiving formal treatment or participating in self-help groups but avoids forcing participants into treatment against their will.

Until November 2012, no modern jurisdiction had removed the prohibition on the commercial production, distribution, and sale of marijuana for nonmedical purposes—not even the Netherlands. Government agencies in Colorado and Washington are now charged with granting production and processing licenses and developing regulations for legal marijuana, and other states and countries may follow. Our goal is not to address whether marijuana legalization is a good or bad idea but, rather, to help policymakers understand the decisions they face and some lessons learned from research on public health approaches to regulating alcohol and tobacco over the past century. [ABSTRACT FROM AUTHOR]

The article discusses the potential decriminalization of marijuana use and possession in the U.S. in relation to tax revenues, black and gray markets, and marijuana legalization efforts and laws in American states such as Colorado and Washington as of June 2013. The U.S. Controlled Substances Act is addressed, along with excise taxes, ad valorem taxation, and various types of cannabis. Sales taxes and government monopolies are also mentioned.

Objectives. We examined the public health impact of South Dakota's 24/7 Sobriety Project, an innovative program requiring individuals arrested for or convicted of alcohol-involved offenses to submit to breathalyzer tests twice per day or wear a continuous alcohol monitoring bracelet. Those testing positive are subject to swift, certain, and modest sanctions. Methods. We conducted differences-in-differences analyses comparing changes in arrests for driving while under the influence of alcohol (DUI), arrests for domestic violence, and traffic crashes in counties with the program to counties without the program. Results. Between 2005 and 2010, more than 17 000 residents of South Dakota--including more than 10% of men aged 18 to 40 years in some counties--had participated in the 24/7 program. At the county level, we documented a 12% reduction in repeat DUI arrests (P = .023) and a 9%reduction in domestic violence arrests (P = .035) following adoption of the program. Evidence for traffic crashes was mixed. Conclusions. In community supervision settings, frequent alcohol testing with swift, certain, and modest sanctions for violations can reduce problem drinking and improve public health outcomes. [ABSTRACT FROM AUTHOR]

ABSTRACT Aims No modern jurisdiction has ever legalized commercial production, distribution and possession of cannabis for recreational purposes. This paper presents insights about the effect of legalization on production costs and consumption and highlights important design choices. Methods Insights were uncovered through our analysis of recent legalization proposals in California. The effect on the cost of producing cannabis is largely based on existing estimates of current wholesale prices, current costs of producing cannabis and other legal agricultural goods, and the type(s) of production that will be permitted. The effect on consumption is based on production costs, regulatory regime, tax rate, price elasticity of demand, shape of the demand curve and non-price effects (e.g. change in stigma). Results Removing prohibitions on producing and distributing cannabis will dramatically reduce wholesale prices. The effect on consumption and tax revenues will depend on many design choices, including: the tax level, whether there is an incentive for a continued black market, whether to tax and/or regulate cannabinoid levels, whether there are allowances for home cultivation, whether advertising is restricted, and how the regulatory system is designed and adjusted. Conclusions The legal production costs of cannabis will be dramatically below current wholesale prices, enough so that taxes and regulation will be insufficient to raise retail price to prohibition levels. We expect legalization will increase consumption substantially, but the size of the increase is uncertain since it depends on design choices and the unknown shape of the cannabis demand curve. [ABSTRACT FROM AUTHOR]

Trajectories of drug use are usually studied empirically by following over time persons sampled from either the general population (most often youth and young adults) or from heavy or problematic users (e.g., arrestees or those in treatment). The former, population-based samples, describe early career development, but miss the years of use that generate the greatest social costs. The latter, selected populations, help to summarize the most problematic use, but cannot easily explain how people become problem users nor are they representative of the population as a whole. This paper shows how microsimulation can synthesize both sorts of data within a single analytical framework, while retaining heterogeneous influences that can impact drug use decisions over the life course. The RAND Marijuana Microsimulation Model is constructed for marijuana use, validated, and then used to demonstrate how such models can be used to evaluate alternative policy options aimed at reducing use over the life course. [ABSTRACT FROM AUTHOR]

User sanctions influence the legal risk for consumers who engage in illegal drug markets. If a reduction in user sanctions leads to an increase in consumption, drug prices will rise unless supply is perfectly elastic. In equilibrium, a change in consumption associated with decreasing user sanctions could be relatively small if supply is upward sloping. Using a novel dataset with rich transaction-level information, this paper evaluates the impact of recent changes in user sanctions for marijuana on marijuana prices. The results suggest that lower legal risks for users are associated with higher marijuana prices in the short-run, which ceteris paribus, implies an upward sloping supply curve, higher consumption, and higher profits for drug dealers. The findings have important implications for the current policy debates regarding decriminalization of marijuana. [ABSTRACT FROM AUTHOR]

Because punishment is scarce, costly, and painful, optimal enforcement strategies will minimize the amount of actual punishment required to effectuate deterrence. If potential offenders are sufficiently deterrable, increasing the conditional probability of punishment (given violation) can reduce the amount of punishment actually inflicted, by "tipping" a situation from its high-violation equilibrium to its low-violation equilibrium. Compared to random or "equal opportunity" enforcement, dynamically concentrated sanctions can reduce the punishment level necessary to tip the system, especially if preceded by warnings. Game theory and some simple and robust Monte Carlo simulations demonstrate these results, which, in addition to their potential for reducing crime and incarceration, may have implications for both management and regulation. [ABSTRACT FROM AUTHOR]

Despite the ubiquity of drug testing in criminal justice settings, there is little experimental evidence suggesting that testing reduces drug use or engenders pro-social behavior. This paper estimates the effect of parolee drug testing on labor and education outcomes with data from a randomized experiment involving 1,958 young parolees. It provides the first estimates in the literature suggesting that drug testing with graduated sanctions can improve short-run employment and education outcomes for parolees. After controlling for parole office fixed effects, juvenile criminal history, and a host of other covariates, the analyses suggest that parolees randomly assigned to testing are 6–8 percentage points (∼11%) less likely to be unemployed and not in school for the month following release to parole when compared to those assigned to the no-testing condition. Racially- and ethnically-stratified analyses find that Hispanics assigned to testing are 10–13 percentage points (∼22%) less likely to be unemployed and not in school, while the estimated coefficient for Blacks is statistically insignificant and hovers around zero. Analyses that use instrumental variable techniques to account for noncompliance by parole officers yield local average treatment effects that are almost twice as large as the intention-to-treat effects. [ABSTRACT FROM AUTHOR]

The cannabis policy landscape is changing rapidly. In November 2012 voters in Colorado and Washington State passed ballot initiatives to remove the prohibition on the commercial production, distribution, and possession of cannabis. This paper does not address the question of whether cannabis should be legal; it instead focuses on the design considerations confronting jurisdictions that are pondering a change in cannabis policy. Indeed, whether or not cannabis legalization is net positive or negative for public health and public safety largely depends on regulatory decisions and how they are implemented. This essay presents eight of these design choices which all conveniently begin with the letter 'P': production, profit motive, promotion, prevention, potency, purity, price, and permanency. [ABSTRACT FROM AUTHOR]

The article notes the benefits of evaluating medical articles with essay commentaries, exploring commentaries written in the issue about the articles "Supervised consumption sites: a nuanced assessment of the causal evidence," "The unmaking of 'evil': claiming space for rational discourse on US drug policy," and "How much do we need to know about supervised consumption sites? It depends who's asking."

The author discusses a study by L. Bainbridge on the transfer of 24/7 Sobriety, the Mayor's Office for Policing And Crime (MOPAC) alcohol abstinence monitoring requirement pilot, from South Dakota to South London, England. The author questions which aspects of the program have the greatest impact on reducing alcohol consumption and improving other outcomes for participants, their families and society.

A response is provided to articles in the same issue of the journal which address additional data sources for cannabis markets, the legalization of the cannabis industry, and changes in cannabis policies as of 2017. The economic profitability of marijuana as a commodity is examined, along with the structure, performance, and conduct of an industrial organization. Company loyalty and frequent buyer programs are assessed, along with data mining and smart vaporizer pens.