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Background and aims: Multiple countries are considering revising cannabis policies. This study aimed to measure long‐term trends in cannabis use in the United States and compare them with alcohol use. Design and setting: Secondary analysis of United States general population survey data. Participants: The national surveys had a total of 1 641 041 participants across 27 surveys from 1979 to 2022. Measurements: Rates of use reported to the US National Survey on Drug Use and Health and its predecessors are described, as are trends in days of use reported. Four milepost years are contrasted: 1979 (first available data and end of relatively liberal policies of the 1970s), 1992 (end of 12 years of conservative Reagan‐Bush era policies), 2008 (last year before the Justice Department signaled explicit federal non‐interference with state‐level legalizations) and 2022 (most recent data available). Findings Reported cannabis use declined to a nadir in 1992, with partial recovery through 2008, and substantial increases since then, particularly for measures of more intensive use. Between 2008 and 2022, the per capita rate of reporting past‐year use increased by 120%, and days of use reported per capita increased by 218% (in absolute terms from the annual equivalent of 2.3 to 8.1 billion days per year). From 1992 to 2022, there was a 15‐fold increase in the per capita rate of reporting daily or near daily use. Whereas the 1992 survey recorded 10 times as many daily or near daily alcohol as cannabis users (8.9 vs. 0.9 M), the 2022 survey, for the first time, recorded more daily and near daily users of cannabis than alcohol (17.7 vs. 14.7 M). Far more people drink, but high‐frequency drinking is less common. In 2022, the median drinker reported drinking on 4–5 days in the past month, versus 15–16 days in the past month for cannabis. In 2022, past‐month cannabis consumers were almost four times as likely to report daily or near daily use (42.3% vs. 10.9%) and 7.4 times more likely to report daily use (28.2% vs. 3.8%). Conclusions: Long‐term trends in cannabis use in the United States parallel corresponding changes in cannabis policy, with declines during periods of greater restriction and growth during periods of policy liberalization. A growing share of cannabis consumers report daily or near daily use, and their numbers now exceed the number of daily and near daily drinkers. [ABSTRACT FROM AUTHOR]

Background: Globally, heroin and other opioids account for more than half of deaths and years‐of‐life‐lost due to drug use and comprise one of the four major markets for illegal drugs. Having sound estimates of the number of problematic heroin users is fundamental to formulating sound health and criminal justice policies. Researchers and policymakers rely heavily upon general population surveys (GPS), such as the US National Survey on Drug Use and Health (NSDUH), to estimate heroin use, without confronting their limitations. GPS‐based estimates are also ubiquitous for cocaine and methamphetamine, so insights pertaining to GPS for estimating heroin use are also relevant for those drug markets. Analysis Four sources of potential errors in NSDUH are assessed: selective non‐response, small sample size, sampling frame omissions and under‐reporting. An alternative estimate drawing on a variety of sources including a survey of adult male arrestees is presented and explained. Other approaches to prevalence estimation are discussed. Findings Under‐reporting and selective non‐response in NSDUH are likely to lead to substantial underestimation. Small sample size leads to imprecise estimates and erratic year‐to‐year fluctuations. The alternative estimate provides credible evidence that NSDUH underestimates the number of frequent heroin users by at least three‐quarters and perhaps much more. Implications: GPS, even those as strong as NSDUH, are doomed by their nature to estimate poorly a rare and stigmatized behavior concentrated in a hard‐to‐track population. Although many European nations avoid reliance upon these surveys, many others follow the US model. Better estimation requires models that draw upon a variety of data sources, including GPS, to provide credible estimates. Recent methodological developments in selected countries can provide guidance. Journals should require researchers to critically assess the soundness of GPS estimates for any stigmatized drug‐related behaviors with low prevalence rates. [ABSTRACT FROM AUTHOR]

• The Taliban opium ban of 2000–2001 disrupted European heroin supplies. • Effects differed across the seven Nordic and Baltic countries in systematic ways. • Some heroin markets bounced back, although perhaps with less vibrancy. • Other markets substituted to another opioid, either more or less harmful. • Market responses to the 2000–2001 ban may be informative for the new, current ban. The 2000–2001 and the 2022–2023 Taliban opium bans were and could be two of the largest ever disruptions to a major illegal drug market. To help understand potential implications of the current ban for Europe, this paper analyzes how opioid markets in seven Baltic and Nordic countries responded to the earlier ban, using literature review, key informant interviews, and secondary data analysis. The seven nations' markets responded in diverse ways, including rebounding with the same drug (heroin in Norway), substitution to a more potent opioid (fentanyl replacing heroin in Estonia), and substitution to one with lower risk of overdose (buprenorphine replacing heroin in Finland). The responses were not instantaneous, but rather evolved, sometimes over several years. This variety suggests that it can be hard to predict how drug markets will respond to disruptions, but two extreme views can be challenged. It would be naive to imagine that drug markets will not adapt to shocks, but also unduly nihilistic to presume that they will always just bounce back with no lasting effects. Substitution to another way of meeting demand is possible, but that does not always negate fully the benefits of disrupting the original market. Nonetheless, there is historical precedent for a European country's opioid market switching to synthetic opioids when heroin supplies were disrupted. Given how much that switch has increased overdose rates in Canada and the United States, that is a serious concern for Europe at present. A period of reduced opioid supply may be a particularly propitious time to expand treatment services (as Norway did in the early 2000s). [ABSTRACT FROM AUTHOR]

This paper combines complementary attributes of web and general population surveys to estimate cannabis consumption and spending in Washington State. It compares those estimates to legal sales recorded by the state's seed-to-sale tracking system, and thus exploits a rare opportunity to contrast two independent estimates for the same cannabis market. This sheds light on the question of whether nontrivial amounts of black market sales continue even after a state allows licensed production and sale. Prevalence of past-month use is estimated from the 2015/16 U.S. National Survey on Drug Use and Health, adjusted for under-reporting. Estimates of consumption and spending per user broken down by age, gender, and frequency of use are developed from RAND's 2013 survey of cannabis users in Washington State. Supply side estimates come from the Washington State Liquor and Cannabis Board's seed-to-sale tracking system. They are expressed in terms of spending, equivalent-weight of flowers, and THC, with THC for edibles imputed using a machine learning technique called random forests. For the period July 1, 2016 to June 30, 2017, Washington's seed-to-sale data record sales from licensed cannabis stores of $1.17B and across all products an amount of THC that is equivalent to roughly 120–150 MT of flower. Survey responses suggest that amounts spent and quantities consumed are larger than that, perhaps on the order of $1.66B and over 200 MT, respectively. A perfect match is not expected because of sales to tourists, residual black market activity, production for medical purposes, and diversion across state lines. Nonetheless, the results suggest that three years after state-licensed stores opened, there remained considerable consumption of cannabis supplied outside of the licensed system. [ABSTRACT FROM AUTHOR]

Background: A number of countries are legalizing the supply of cannabis or are considering doing so. Beyond top-level design questions (e.g., who gets to supply and how will it be taxed?) lie many equally important and thorny regulatory issues concerning retail sale and use. These issues will often be hammered out at the local and state/provincial level by policy makers who are generalists, not experts in substance misuse, let alone cannabis.Objectives: This review provides a framework for thinking about the role of regulation and delves into three important topics with which these leaders will wrestle: Where and when can cannabis be sold? What can retailers sell? And where can their products be used?Methods: Literature review and drawing parallels with alcohol and tobacco regulation.Results: The common thread across these questions is that the public health interest is both nuanced and in conflict with other stakeholder interests, such as companies' desire to maximize sales and profits and governments' desire for tax revenues.Conclusion: There is a need for data and oversight structures that ensure that public health will not lose out over time. [ABSTRACT FROM AUTHOR]

The author discusses a study by W. Hall and colleagues about bans on high-tetrahydrocannabinol (THC) content cannabis products. Topics include the researchers' observation that many who supported legalization failed to anticipate the trend towards higher-THC products, the complex issue of taxing cannabis, and comments on the viability of banning specific products within a broader class.

Jalal et al. discovered that between 1979 and 2020 total rates and counts of fatal drug overdoses in the United States exhibited exponential growth at a very steady rate even though deaths from individual drugs did not. That is a startling result because it means that the different drugs are in effect "taking turns", with one growing faster just as another drug's death rate growth ebbs. That raises the question of whether this steadiness in the all-drug death rates is in some sense just a coincidence peculiar to the United States or whether it might reflect some more general phenomenon and so manifest in other countries. We fit the same model used by Jalal et al. to data on drug-related death rates for the countries of the United Kingdom. The main finding is largely a failure to replicate the United States result. Simple graphical display of the trends and a number of statistical measures show that the growth in the United Kingdom was not only slower than in the United States, it was also less steady, with the exception of Northern Ireland. Steady exponential growth in the all-drugs mortality rate may be a phenomenon specific to certain contexts. It remains an open question whether the explanation of steady exponential growth in the United States and Northern Ireland relates to demand and supply mechanisms, to social and political conditions, or to coincidence. [ABSTRACT FROM AUTHOR]

Introduction: Voters in eight U.S. states have passed initiatives to legalize large-scale commercial production of cannabis for non-medical use. All plan or require some form of "seed-to-sale" tracking systems, which provide a view of cannabis market activity at a heretofore unimagined level of detail. Legal markets also create a range of new matters for policy makers to address.Data: Publicly available data were obtained on approximately 45 million individually priced items purchased in the 35 million retail transactions that took place during the first two and a half years of Washington State's legal cannabis market. Records include product type (flower, extract, lotion, liquid edible, etc.), product name, price, and potency with respect to multiple cannabinoids, notably THC and CBD. Items sold can be traced back up the supply chain through the store to the processor and producer, to the level of identifying the specific production batch and mother plant, the firm that tested the product, and test results.Method: Data visualization methods are employed to describe spatial-temporal patterns of multiple correlated attributes (e.g., price and potency) broken down by product. Text-analytic methods are used to subdivide the broad category of "extracts for inhalation" into more homogeneous sub-categories. To understand the competitiveness of the legal cannabis market in Washington we calculate the Herfindahl-Hirschman index (HHI) for processors and retailers.Results: Cannabis prices fell steadily and proportionally at the processor and retailer levels. Retail and wholesale price maintained a roughly 3:1 ratio for multiple product types after some initial fluctuations. Although a wide range of edibles are sold, they account for a modest share of consumer spending; extracts for inhalation are a larger and heterogeneous market segment. The HHI indicates the cannabis market is highly competitive at the processor level, but less so for retail markets at the county level.Conclusions: Washington's state-legal cannabis market is diverse and rapidly evolving in terms of pricing, products, and organization. Post-legalization, researchers and policy makers may need to think in terms of a family of cannabis products, akin to how we think of new psychoactive substances and amphetamine-type stimulants, not a single drug "cannabis." [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]

International prohibitions create asymmetries; production and transshipment concentrate in relatively few places that bear the bulk of the negative externalities created by the illegal trade. These externalities fuel calls for altering the United Nations treaty framework and for individual nations to legalize outside of the framework. Analyses of the pros and cons of legalization usually adopt the perspective of a single nation acting in isolation. However, one nation's legalization alters incentives for others to act, and not always in obvious ways. So the proper perspective is that of a dynamic game. The primary contribution of this paper is to make the case for analyzing legalization as a strategic game, but it also offers preliminary analysis for the case of cocaine. Tentative conclusions include:-While decriminalizing possession of amounts of marijuana suitable for personal use has minimal repercussions beyond a nation's borders, even one country's legalization of a commercial cocaine or heroin industry could affect countries around the world.- Legalization of production in one country would draw production away from other producers who retain their prohibitions. This incentivizes current producers to encourage other such countries to legalize first, thereby addressing the first producer's black market externalities without incurring opprobrium from final market countries. - Legalization in one transshipment country would likewise attract transportation activities from existing jurisdictions where drugs remain illegal.-The impact of a transshipment country legalizing cocaine varies by region. It might have minimal effect on the United States or Mexico if the"final mile" continues to be smuggling across the Mexico-United States border. By contrast, if an Eastern European country with large porous land borders were tolegalize, that could dramatically alter supply conditions in Europe and Russia by producing covert smuggling networks similar to those currently existing on the U.S.-Mexico border. [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]

Multiple layers of dealers connect international drug traffickers to users. The fundamental activity of these dealers is buying from higher-level dealers and re-selling in smaller quantities at the next lower market level. Each instance of this can be viewed as completing a drug dealing "cycle". This paper introduces an approach for combining isolated accounts of such cycles into a coherent model of the structure, span, and profitability of the various layers of the domestic supply chain for illegal drugs. The approach is illustrated by synthesizing data from interviews with 116 incarcerated dealers to elucidate the structure and operation of distribution networks for cocaine and heroin in Italy and Slovenia. Inmates' descriptions of cycles in the Italian cocaine market suggest fairly orderly networks, with reasonably well-defined market levels. The Italian heroin market appears to have more "level-jumpers" who skip a market level by making a larger number of sales per cycle, with each sale being of a considerably smaller weight. Slovenian data are sparser, but broadly consistent. Incorporating prices allows calculation of how much of the revenue from retail sales is retained by dealers at each market level. In the Italian cocaine market, both retail sellers and the international supply chain outside of Italy each appear to receive about 30-40% of what users spend, with the remaining 30% going to higher-level dealers operating in Italy (roughly 10% to those at the multi-kilo level and 20% to lower level wholesale dealers). Factoring in cycle frequencies permits rough estimation of the number of organizations at each market level per billion euros in retail sales, and of annual net revenues for organizations at each level. These analyses provide an approach to gaining insight into the structure and operation of the supply chain for illegal drugs. They also illustrate the value of two new graphical tools for describing illicit drug supply chains and hint at possible biases in how respondents describe their drug dealing activities. [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]

Background Studying markets for illegal drugs is important, but difficult. Data usually come from a selected subset of consumers, such as arrestees, treatment clients, or household survey respondents. There are rarely opportunities to study how such groups may differ from other market participants or how much of total consumption they represent. Methods This paper uses respondent-driven sampling (RDS) of drug users in a mid-sized American city to estimate the shares of cocaine (powder and crack) users and expenditures that are attributable to different combinations of these groups. Results We find that those arrested in the last year accounted for 34% of past-month cocaine users and 40% of past-week cocaine spending in the RDS sample. Augmenting past-year arrestees with those who received treatment in the past year increases these values to 44% (users) and 55% (spending). Conclusions Our results suggest that estimates based only on people who were arrested and/or treated in the past year would have to be inflated by 100–200% to capture the market totals. Adding those who own or rent their place of residence increased coverage in this study to 76% (users) and 81% (spending), suggesting that in theory the inflation factor could be reduced to 23–32% by supplementing data on arrestees and treatment populations with household data, although in practice rates of under-reporting by survey respondents may make coverage (sampling frame) a secondary concern for household surveys. [ABSTRACT FROM AUTHOR]

Background: The illegal drug trade is often, and plausibly, asserted to be the largest illegal market, globally and in many individual countries. It is also claimed that a large share of its revenues is laundered, though there are no estimates of that volume. We provide rough estimates of that proportion and its primary determinants.Methods and Data: This paper presents a model of a multi-tiered drug distribution network that is parameterized with data based on one typical, well-studied case, namely British Colombia's market for illegal opioids, supplemented by a corresponding economic interpretation of what determines the share of drug trade revenues that need to be laundered. Sensitivity with respect to key parameters is analyzed.Findings: We suggest that less than half and perhaps no more than a quarter of revenues from established drug markets need laundering. Key parameters governing this proportion include the price mark-up across distribution levels, transaction volumes at each market level, and the capacity of market participants to spend cash on daily living expenses.Conclusion: This model permits estimation of the scale of money laundering associated with a particular drug market. It suggests that there are limits on money laundering controls as a way of reducing drug supply - although money laundering investigations may still be an effective way to identify and investigate high-level drug traffickers. [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]

ABSTRACT Aims Decisions on whether and how to 'schedule' drugs (i.e. to determine their legal status and penalties to be applied for sale or possession) are often heavily criticized. We sought to assess more comprehensively the results of such decisions for newly emerging drugs. Methods Through analysis of legislation and secondary sources, we identified 63 substances that have emerged since 1971, including all that have been added to the most restrictive schedule by the United Nations, United States, United Kingdom, Canada, Australia and/or New Zealand. Measurements For each jurisdiction we recorded whether, when, and how the substance was scheduled and note what decisions engendered substantial criticism or controversy within the international treaties' framework of balancing medical benefits with risk of abuse. Findings (i) The rate of emergence of new drugs has been fairly steady. (ii) There is broad cross-national agreement on what should be scheduled. (iii) The United States often acts first. (iv) Temporary bans that delay final decisions by 12-18 months can sometimes allow final decisions to be grounded on a substantially expanded research base. (v) It appears that no more than seven of the decisions reached by the United States with respect to the 63 substances are candidates for being considered errors, and arguably the United States has committed at most one serious Type I and one serious Type II error. Results for other countries are broadly similar. Conclusions The process for determining the legal status of new psychoactive substances appears to function reasonably well, within the framework of international treaty obligations. Most criticisms relate to one or a few substances (e.g. 3,4-methylenedioxymethamphetamine) and/or complaints that the decisions discount benefits that are not recognized by the treaties (e.g. recreational or religious use). [ABSTRACT FROM AUTHOR]

California nearly legalized commercial marijuana production in 2010; in coming years, other states and California are expected to entertain similar proposals. This raises the question of whether marijuana diverted from legal production could displace current sources of marijuana in other states. Combining prior estimates of legal production cost with new estimates of the cost of smuggling within the United States suggests that in most states, diverted legal production would substantially undercut current prices. So, if one state legalized, then (illegal) interstate "exports" could depress marijuana prices throughout the United States, even if taxes are collected before diversion and export. The authors proxy smuggling costs by the current gradient in prices observed for Mexican or commercial-grade marijuana; based on seven different data sets, it appears to be roughly US$325 to US$475 per pound per 1,000 miles as one moves north from the Mexican border. [ABSTRACT FROM AUTHOR]

ABSTRACT In recent years a number of studies have attempted to rank drugs by a single measure of harmfulness as the basis for decisions about scheduling and classification. These efforts are fundamentally flawed, both conceptually and methodologically. The effort to provide a single measure masks the variety of non-comparable dimensions that are relevant, the fact that benefits are ignored for most, but not all, drugs and that the harms of a drug are not invariant to the policy regime chosen. Methodologically, the most prominent recent effort ignores drug interactions and mixes aggregate and individual harms inappropriately. Instead we suggest that multiple dimensions of harm need to be displayed to inform human judgments of what drugs should be scheduled. Harm is not usefully reducible to a single dimension, and even perfect rankings would not constitute a 'sufficient statistic' for determining scheduling decisions. [ABSTRACT FROM AUTHOR]

In September 1989, amid an emotional and ideological debate regarding problematic drug use in the United States and the 'war on drugs', RAND's Drug Policy Research Center (DPRC) was created through private foundation funds. The purpose of this new research center was to provide objective empirical analysis on which to base sound drug policy. Twenty years later, RAND's DPRC continues its work, drawing on a broad range of analytical expertise to evaluate, compare and assess the effectiveness of a similarly broad range of drug policies. More than 60 affiliated researchers in the United States and Europe make up the Center, which attempts to provide objective empirical analyses to better inform drug policies within the United States and abroad. This paper provides a look back at the creation, evolution and growth of the Center. It then describes how the Center operates today and how it has maintained its clear identity and focus by drawing on the analytical capabilities of a talented group of researchers from a broad range of academic disciplines. [ABSTRACT FROM AUTHOR]

Abstract: Extreme price dispersion is a hallmark of illegal drug markets, and this apparent contradiction to the law of one price has long puzzled drug market economists. We propose a novel explanation for this dispersion: the coupling of dealers’ unwillingness to hold inventory with dealers’ imperfect foresight concerning future prices and/or random lead times when “ordering” drugs from higher-level suppliers. Unwillingness to hold inventory means drug markets might operate consistent with a cobweb model. The classic cobweb model was inspired by the observation of cyclic (typically annual) fluctuations in commodity prices. However, with minor changes that make the model more realistic the resulting price trajectories can be highly variable or even chaotic, not just periodic. Cobweb dynamics can also amplify the variability created by supply chain disruptions. [Copyright &y& Elsevier]

Aims The addiction sciences are intrinsically multi-disciplinary, and economics is among the disciplines that offer useful perspectives on the complex behaviors surrounding substance abuse. This paper summarizes contributions economics has made in the past and could make in the future towards understanding how illegal markets operate, how prices affect use, how use generates various consequences, and how policy shapes all three. Methods Review of literature, concentrating on illegal drugs as insights concerning markets are particularly salient, although we also mention relevant studies from the alcohol and tobacco fields. Findings and Conclusions Economics offers tools and topical expertise that usefully complement other disciplines associated traditionally with the addiction sciences. Its value goes far beyond the ability to monetize non-monetary outcomes or to calculate a cost-benefit ratio. [ABSTRACT FROM AUTHOR]

Abstract: Background: Opponents of harm reduction fear that reducing harmfulness might increase use, and opponents of use reduction fear that efforts to reduce use can increase harmfulness. We raise the possibility that both strategies have a role but at different points in a drug “epidemic”. Methods: We present a stylized two-state, one-control policy simulation model of the use vs. harm reduction choice when initiation stems from susceptible non-users interacting with current users. Results: Within this model, whether harm reduction is a good strategy can depend on the particular drug and/or country, the social cost structure, and the stage of the epidemic. The dynamic solutions also involve indifference curves, consisting of points where the decision maker is indifferent between two transients that will approach the same steady state in the long run. Depending on how overall prevalence feeds back to affect the likelihood a susceptible non-user will initiate after interacting with a current user, the model can have tipping points where small shocks can have amplified long-run effects. For most epidemic states, harm reduction reduces the present value of future social costs, but not near such tipping points. Conclusion: To the extent that drug use patterns involve feedback effects, any shock to initiation – from harm reduction or any other source – can produce changes in use that are more than proportional, or less than proportional, to the shock. Hence, advocates in the use vs. harm reduction debate may wish to explain why their preferred policy is particularly appropriate at the current stage of a country''s drug use trajectory, rather than arguing for universal applicability of their preferred programme. [Copyright &y& Elsevier]

A typology of drug smuggling 'technologies' is developed based on interviews with 110 inmates incarcerated in UK prisons for importing illegal drugs. Approximately three-quarters were involved in courier-based operations. The other 30 collectively accounted for substantially greater smuggling throughput capacity and fell into five groups: operations employing 'bent' lorry drivers; shipping drugs intermingled with legitimate commerce; transporting drugs on commercial airlines with assistance from corrupt officials; mailing drugs into the UK; and smuggling via boats landing between ports of entry. A Pareto Law seems to apply, with a minority of respondents being responsible for the majority of the smuggling. Most participated in smuggling to make money, but more than a few couriers reported being coerced and/or tricked into carrying drugs. Perhaps not coincidentally, rough calculations suggest that, when balancing profits against prison risk, crime does not pay for couriers but can for organizations employing bent lorry drivers. [ABSTRACT FROM AUTHOR]

The fundamental activity of most drug dealers is buying drugs from a supplier and selling them on, usually in smaller lot sizes to multiple customers at a lower market level. Data on such 'cycles' of purchase and resale are derived from interviews with 65 dealers incarcerated in UK prisons. A power function relationship between price and transaction size is confirmed. Analyses reveal great consistency in proportional price markups across drugs and time, high cycle frequencies (typically weekly or more often) and importers who vertically integrate into the highest level of domestic distribution, so that an important share of their net revenues effectively derives from domestic distribution inside the UK, as opposed to importation per se. [ABSTRACT FROM AUTHOR]

This article raises the question of how drug policy should respond to take advantage of market disruptions. A simple mathematical model of the spread of drug use is adapted to a two-stage problem in which drug prices are abnormally low or high in the first stage, and the policy planner is allowed to adjust the level of drug control funding continuously over time. Optimal policies for this model are derived using the methods of optimal control theory. They suggest that whether it is better to increase or decrease drug control efforts in response to a market disruption can depend on the initial number of users and, hence, on the stage of the epidemic, as well as the length and intensity of the drought or glut. Although simple prescriptions are not possible, the potential for adaptive policies to improve outcomes is illustrated. [ABSTRACT FROM AUTHOR]

Abstract: Drug producing regions often supply several geographically distinct drug consumption markets. Disruptions of opium cultivation in Afghanistan and cocaine production in Colombia show that consumption reductions can be much smaller in some final markets than are reductions in cultivation. This paper derives a model for predicting how production deficits will be “allocated” across downstream markets in the form of reduced use. Plausible parameterization suggests that for cocaine, markets outside the US may serve as a sort of “shock absorber”, partially shielding US markets from sharp fluctuations in consumption. One implication is that multi-lateral efforts may be appropriate for source country control. [Copyright &y& Elsevier]

This study compares the costs and consequences of three interventions for reducing heroin dependency: pharmacotherapy maintenance, residential rehabilitation and prison. Using Australian data, the interventions' cost - consequence ratio was estimated, taking into consideration reduction in heroin use during the intervention; the length of intervention; and post-intervention effects (as measured by abstinence rates). Sensitivity analyses were conducted, including varying the magnitude and duration of treatment effects, and ascribing positive outcomes only to treatment completers. A hybrid model that combined pharmacotherapy maintenance with a prison term was also considered. If the post-programme abstinence rates are sustained for 2 years, then for an average heroin user the cost of averting a year of heroin use is approximately AUD$5000 for pharmacotherapy maintenance, AUD$11 000 for residential rehabilitation and AUD$52 000 for prison. Varying the parameters does not change the ranking of the programmes. If the completion rate in pharmacotherapy maintenance was raised above 95% (by the threat of prison for non-completers), the combined model of treatment plus prison may become the most cost-effective option. Relative performance in terms of costs and consequences is an important consideration in the policy decision-making process, and quantitative data such as those reported herein can provide insights pertinent to evidence-based policy. [Moore TJ, Ritter A, Caulkins JP. The costs and consequences of three policy options for reducing heroin dependency. Drug Alcohol Rev 2007;26:369 - 378] [ABSTRACT FROM AUTHOR]

Estimates are developed for the number of people incarcerated in the United States for drug law violations between 1972 and 2002, broken down by type of institution (federal prison, state prison, or jail) and, to the extent possible, by nature of drug offense (possession or use, trafficking, or other). These time series are compared to trends in drug use indicators, revealing at best weak correlations, and the absolute levels are compared to different market indicators to draw various inferences. For example, even though about 480,000 people are incarcerated for drug law violations, on average retail sellers spend less than 2 hours behind bars per sale. Still, full-time sellers might expect to spend 3 months incarcerated per year of selling, suggesting that there are roughly four active drug sellers for every one who is incarcerated. [ABSTRACT FROM AUTHOR]

Abstract: Markets for illicit drugs present an interesting case study for economics, combining non-standard characteristics such as addiction and product illegality. One response has been to argue the generality of economic principles by suggesting that they apply even in the extreme case of markets for addictive substances, e.g., by showing that demand for illicit goods is responsive to price [Reframing health behavior change with behavioral economics. Hillsdale, NJ:Lawrence Earlbaum Associates; 2000. p. 89–111.] and even by modeling addiction as rational [J Political Econ 1988;96:675–700]. This paper sketches examples of an alternative reaction, focusing on idiosyncrasies of drug markets that might plausibly create counter-intuitive effects, including supply curves that slope downward because of enforcement swamping and/or a good serving as the only available store of wealth for its producer, demand reduction programs that increase demand, and consumption by “jugglers” possibly increasing rather than decreasing as prices rise. This analysis yields non-obvious policy recommendations; for example, source country control programs should concentrate on growing regions with a healthy banking sector. [Copyright &y& Elsevier]

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."

Research Summary: Drug policy reformers and defenders contest the extent to which low-level drug offenders are being sent to prison and for how long. Using data from the Survey of Inmates in Federal and State Correctional Facilities, 1997 (BJS. 2000), we assess the seriousness of incarcerated drug offenders along dimensions of dangerousness, culpability, and harm--specifically, functional role and drug group participation, type and amount of drugs, firearms involvement, and criminal conviction and arrest history. We fmd that only about 1.6% of federal and 5.7% of state inmates can be described as "unambiguously low-level." Alternatively, not many are "kingpins." Rather, most fall into a middle spectrum representing different degrees of seriousness that depend on what factors are emphasized. Policy Implications: Our findings dampen hopes of dramatically reducing prison populations by getting out of prison those who are unambiguously low-level drug offenders. They simply do not represent the majority of incarcerated-ated drug offenders. In particular, most played some role in distribution, so eliminating prison terms for users (decriminalization) would not have affected many now in prison. Indeed, if decriminalization increased demand, it could plausibly increase prison populations by increasing the number of suppliers still subject to imprisonment. On the other hand, "drug courier exceptions" to sentencing laws that apply to minor role offenders possessing large quantities could have a greater prison reduction impact. [ABSTRACT FROM AUTHOR]

Background: Cannabis legalization and the arrival of nonmedical fentanyl are fundamentally altering North American drug markets. An essential part of that change is the ability to produce large quantities of these drugs at low costs, which is like a technological breakthrough in their production technology. This essay explores possible future consequences of these trends.Methods: Descriptive statistics, historical analogy and economic reasoning.Results: In North America, wholesale prices for cannabis and opioids - in the form of illegally manufactured fentanyl and other new synthetic opioids - are radically lower than they were a decade ago. Retail prices for cannabis have fallen commensurately, but not yet for opioids. Historical analogies suggest that very large declines in price can have effects on use that go beyond just an expansion of traditional patterns of consumption.Conclusion: For cannabis and opioids in North America, conditions are ripe for significant changes in not only quantities consumed, and associated harms, but also in the roles these drugs and their control play in society. The overall situation with these drugs may look more different in 2040 compared to today, than today looks different from 2000. There are no obvious reasons why these trends will not spread to other continents. [ABSTRACT FROM AUTHOR]

Background: Many nations place drugs into various "schedules" according to their risk of abuse and/or recognized medical value that vary in terms of their restrictions. To mitigate diversion or abuse, drugs sometimes get rescheduled or are scheduled for the first time. Until now, there have not been efforts to integrate lessons from across the range of such past events.Methods and Data: We searched for peer-reviewed evaluations of instances of (re-)scheduling drugs in the United States after 1969 and a comparably large set of instances from other countries. Those 109 articles were supplemented by 30 others found in other ways but not meeting those search criteria (e.g., because the information on rescheduling was a minor part of a more general article).Findings: Findings are reported for many outcomes and with diverse measures over different timelines, making standardization of outcomes difficult. For more than half of the events for which quantitative outcomes were reported, there were declines in use-related measures by at least 40 percent. It is common for there to be reports of increases in indicators pertaining to other substances, sometimes more dangerous but sometimes less dangerous; overall, substitution appears to occur, but be partial.Conclusion: Scheduling and up-scheduling can - though does not always - have substantial effects on a range of outcomes. Substitution to other substances is a possibility and so should be anticipated. [ABSTRACT FROM AUTHOR]

In this article, the authors discuss the commentaries regarding the analysis of drugs' harms. The authors state that almost all of the commentaries concentrate on the weaknesses of drug classification system. The authors add that R. Room, D. Nut, and I. Rossow point out that outcomes of the NKP approach question a drug scheduling system which is politically driven.

Background: Studies of opioid prescribing patterns have shown that a small percentage of prescribers are responsible for a large portion of total prescriptions. There is some evidence that prescription opioid use may be similarly concentrated, but patterns may differ by population and choice of opioid utilization measure. The objective of this study is to determine what proportion of prescription opioid utilization was attributable to the top utilizers among Medicaid beneficiaries and how this proportion varies by the measure used.Methods: We analyzed 2008-2009 Medicaid claims data from 14 states and created three claims-based measures of aggregate opioid utilization: total number of annual prescriptions, total annual milligrams morphine equivalent, and total days supply. We tested two versions of the total days supply measure: one assuming consecutive use and the other assuming concurrent use of prescriptions.Results: The top 20 % of prescription opioid users accounted for 66 % of prescriptions, 82-85 % of days supply depending on assumption, and 90 % of morphine milligram equivalents (MME). The degree to which prescription opioid utilization was concentrated among the top 20 % of users varied minimally across states.Conclusions: A small percentage of prescription opioid users account for a large share of prescription opioid use. Policy efforts should use metrics pertaining to days supply and total MME, not numbers of prescriptions, to more efficiently target heavy utilization. Policies targeting high-dose prescribing should consider the different ways that overlapping prescriptions may be taken. [ABSTRACT FROM AUTHOR]

The author discusses the article by Peter Reuter and Harold Pollack on the relationship between drug prices and enforcement intensity. He mentions that the empirical evidence speaks just to the failures of the past practice of enforcement, and enforcement has not optimized in producing the maximal effect on prices. He states that law enforcement does not frequently think in terms of maximization of social welfare or efficient production with respect to prices or objective function.

Abstract: Data on illicit drug purity and prices are invaluable but challenging. Academic purists argue they are unsuitable for economic analysis [Manski, C.F., Pepper, J.V., Petrie, C.V., 2001. Informing America''s Policy on Illegal Drugs: What We Don’t Know Keeps Hurting Us. National Academy Press, Washington, DC], but in practice they are used frequently [ONDCP, 2001a. What America''s Users Spend on Illegal Drugs. Office of National Drug Control Policy, The White House, Washington, DC; ONDCP, 2001b. The Price of Illicit Drugs: 1981 Through the Second Quarter of 2000. Office of National Drug Control Policy, The White House, Washington, DC; ONDCP, 2004. The Price and Purity of Illicit Drugs: 1981 Through the Second Quarter of 2003. Office of National Drug Control Policy, The White House, Washington, DC; Grossman, M., 2004. Individual behaviors and substance use: the role of price. Plenary Address for the 24th Arne Ryde Symposium on Economics of Substance Abuse at Lund University, Lund, Sweden, August 13–14, 2004]. This paper reviews data and conceptual issues that people producing, analyzing, and consuming drug price and purity series should understand in order to reduce the likelihood of misinterpretation. It also identifies aspects of drug markets that are both poorly understood and relevant to some of these issues. They constitute a useful research agenda for health and law enforcement communities who would benefit from better data on the supply, availability, and use of illicit drugs. [Copyright &y& Elsevier]