If you are a reader of my posts on drug abuse science you will have noticed that it rarely takes long for a commenter or three to opine some version of "The (US) War on Drugs is a complete and utter failure". Similarly, while Big Eddie mostly comments on the liberty aspects (rather than the effectiveness) of the WoD himself, a commenter to his posts will usually weigh in, commenting to a similar effect.
Now I'm open to all the arguments about personal liberty trade offs, economic costs, sentencing disparities, violations of other sovereign nations and the like. Nevertheless, I'm most interested in the fundamental question of whether the War on Drugs worked. That is, to reduce drug use in the US. For those who believe it has not worked, I have a few figures I would like explained to me.
I'm following up a story I started in a prior post by putting up the long term trends for cocaine use in the US. These data are from the 2006 Volume II monograph which focuses on the 18 yr old and older populations. As you will recall my hypothesis was / is that the Len Bias fatality had a dramatic effect on cocaine use. I still think this is the case and that this explains much of the timing of a reduction in cocaine prevalence observed consistently from the 18 yr old to 45+ age groups. However Len Bias's death was not an exclusive effect and must be considered in the context of changes in other drug use patterns. That context is something I want to delve into just a little bit.
As always, I depend on the data from the Monitoring the Future survey (www.monitoringthefuture.org) and I am pulling the figures from the 2006 Volume I monograph which focuses on the 8th, 10th and 12th grade populations in contrast to the older age cohorts outlined in the first graph.
Cocaine
First up are the annual prevalence rates for powder cocaine, which I provide for reference to the previous graph for the older age ranges. I apologize for the blurry figures but my imaging skills are not up to any better- luckily, these reports are freely available on the MtF website. (I also encourage you to get the reports yourself because there are slight changes in the questions asked in some cases- if you see a discontinuity in the longitudinal data this is probably why.) The longest term trends are available for 12th graders, additional grades were added into the survey in the early 1990's. Prevalence of cocaine was reasonably steady in the 1979-1986 interval and it is stunningly apparent that cocaine became less popular with 12th graders after 1986 . It is also clear that it took about 5 additional years for prevalence to drop to the most recent nadir. So it wasn't all about Len Bias (he died of cocaine-related cardiac complications on June 19, 1986).
So, if it isn't all about Len Bias, perhaps we should see similar effects on population prevalence of other illicit drugs?
Marijuana and Amphetamine
It seems reasonable to turn our analysis to two perennial high-prevalence drugs for high school populations; marijuana (duh!) and the amphetamines. (In MtF parlance, the amphetamine class is for tablet or other prescription preparations after 1982.) In this case, the prevalences were at peak in the late 1970s and started to decline in the very early 1980s. Interestingly, there is no evidence of a change in the established trends from 1986-1987 as is observed for powder cocaine; I think this supports the Len Bias hypothesis. Nevertheless we can also see this as additional evidence for something else driving drug use downward.
This brings us to what are illicit drugs for most of these populations but, of course, licit drugs for individuals who have reached the legal age; 21 (alcohol) or 18 (cigarettes; this may be a substantial fraction of 12th graders). In theory, we might use these data to try to dissociate the anti-drug messaging from the drug interdiction / legal penalties side of the equation. Not perfect, but at least a hint.
Alcohol
The trends for annual prevalence of alcohol were very stable from 1978-1988 whereupon a decline was observed (questions were altered in 1993, making further comparison tricky). The trends for 5-drinks-in-a-row (currently the definition of a "binge") in the past two week interval were very stable from 1978-1983 and thereafter exhibited a slow decline until the early 1990s. Very reminiscent of the above mentioned drugs.Cigarettes
In this case, please note that we've shifted to 30-day prevalence rates (any, daily); obviously this is frustrating for direct comparison but this is what they provide in the monographs. Unfortunately the more recent monographs (it is currently on a reliable annual update schedule with available pdfs, the older ones are not available) seem to only start with the 1986 data in the Tables so one is left with their figures for the earlier part of the trends. With that caveat, we can see that cigarette prevalence in the high school population was reasonably stable during the interval in which the prevalence rates for the illicit-for-all drugs mentioned above were in decline.
So Did the War on Drugs Work or Not?
I do think the jury is still out on this one and the problem of shifting definitions about goals and successes is quite difficult. I feel confident the comments will stray afield a bit and explore some of these issues. However, as I intimated at the outset,
for those of you who insist vociferously that the War on Drugs (considered inclusively with the Just Say No, D.A.R.E, main-stream media reporting, and all that stuff that is frequently rolled into a whole by the legalization crowd) is an abject failure...
for those of you who insist vociferously that you cannot tell teenagers anything about the dangers of recreational drugs and expect them to listen to you...
I would like these data explained to me.
__
Update 7/23/08: Followup post from Scott Morgan at StoptheDrugWar.org
Politics
Medicine & Health
Comments
I absolutely agree you can tell teenagers about the dangers and have them listen! Especially if you are speaking from extensive personal experience, and you don't actually tell them not to do it, you just make it clear how you can weigh the hazards
If you're Nancy Regan, on the other hand... I remain unconvinced you have any effect.
As an aside, I still don't buy your pet Len Bias theory, mostly cause you are the only person I've ever heard talk about him . Can I tease you for being old now?
Posted by: Becca | July 21, 2008 11:52 PM
One note, the fall in Cocaine appears to happen around the same time Crack was becoming increasingly popular. Since you only mention powder cocaine, is it possible that the shift is not necessarily due to enforcement, but a shift in the drug being used, and the potential for increasingly serious side-effects and damage from the stronger drugs?
Aside from that, I'm not going to argue the point because I'm in the excluded middle of this argument you want to have. All my arguments about the War on Drugs is in regards to personal liberty trade offs, economic costs, sentencing disparities, violations of other sovereign nations and the like. ;)
I just happen to think that it would be more cost-effective and less intrusive to educate people of the dangers of drugs (preferably without over-the-top scaremongering), restricting sales to minors and encouraging safe-use restrictions, and help fund the public rehabilitation services and safe-use sites through the taxation of those drugs.
Posted by: Left_Wing_Fox | July 21, 2008 11:59 PM
Obviously, the real question of whether the drug war "works" can hardly be separated from side effects of prohibition: all the increased crime and violence from the black market, increased government and police corruption, damage to the environment, deaths and health problems from unregulated drugs, reduction of personal liberties, militarization of police forces, taxpayer costs, destruction of families, inner cities, etc., etc.
But let's say that we, for the purposes of argument, wish to set those aside and just see if the drug war "works." Even then, it is interesting that you define "whether the War on Drugs worked" as whether it can be seen to "reduce drug use in the US."
It would seem to me that the better definition would be whether the drug war reduced drug abuse in the US, or whether the drug war reduced drug-related harm in the US.
Part of the problem of the drug war is that it has been quantity-oriented rather than quality-oriented. By going after recreational and casual users, it's much easier to show reduced numbers of users, as if that's a valuable thing, when, as far as we know, the number of abusers remains constant or rises.
If we wanted to deal with problems of alcohol and decided to outlaw having a glass of wine with dinner, the government would quickly be able to show a dramatic reduction in the number of alcohol users in the US. But that would have little impact on alcoholism (and would serve to hide the real problems).
Of course, it's much harder to get solid data on drug abusers, as separate from non-problematic recreational users. But given the fact that drugs have never, despite extreme levels of prohibition, been hard to get, the problem user will be less likely to be deterred by criminal prohibition (certainly less than the recreational user). Demand-side options (treatment, education) are much more likely to impact the problem user, while any actual gains from supply side/enforcement/prohibition are much less likely to affect the abuser.
Posted by: Pete Guither | July 22, 2008 12:23 AM
Polls of teenagers are meaningless data.
Why do you not plot street prices in constant dollar terms? That is the best measure of the success of attempting to stop the availability of illegal drugs
For example look here:
http://www.unodc.org/pdf/WDR_2004/Chap5_coca.pdf
According to the UN, the inflation-adjusted street price of a gram of cocaine fell from $260 to $92 between 1990 and 2003
Posted by: bwv | July 22, 2008 12:26 AM
bwv,
A fall in price simply means that demand has fallen faster than supply. You could interpret this as evidence that education is more effective than intervention. But because both education and interdiction are tactics used in the war, it doesn't tell you much about the success of the war overall.
Incidentally, the Australia heroin price does just the opposite over the past 15 years, showing that interdiction has been slowing the supply faster than education and treatment reduced demand.
Posted by: Lab Lemming | July 22, 2008 12:43 AM
I agree with the previous poster. Imposing a prohibition on any substance and you'll see a decline in it's users. If you go back to the days old prohibition in the 30's in the US I'm sure you'll see a decline in the numbers of alcohol users. Or maybe people are just getting sneakier. I live in Canada, here we don't expect every potential employee to take a drug test for every job they apply for.
(At least not yet anyway) From what I understand there's a booming industry for those who can provide drug-free pee for testing. And like everything, drugs follow trends. I don't think coke is as popluar a recreational drugs as it use to be. I've noticed that you don't mention any declines in heroin or MDMA. Those are depressingly popular drugs where I live (Vancouver). I think all the statistics show is that the more law-abiding don't use drugs as much leaving more and more people on the margins. With "three strikes" laws in many US states causing poor teenaged pot heads to go to jail for years on end I guess some places have succeeded in scaring some kids into not using pot. So bravo! Statistics aside I think Pot growing was THE biggest cash industry here in my home province of British Columbia for at least a few years now. And we ain't smokin' it all ourselves.
Posted by: Susan | July 22, 2008 1:00 AM
I don't know crap, but hey, it's a blog.
Hypothesis: trends in drug use are determined solely by monetary cost.
If the WoD makes a bunch of stuff illegal, it gets more expensive (on the black market). To see if the WoD is working, you'd have to normalize for price, to see whether or not things like threat of punishment and education about negative effects are having any effect at all.
For example, if you want to reduce teen smoking, boosting the tax per legal pack to price smokes out of the typical start-to-smoke teen economic range works great. Didn't New Jersey come up with some good data on this recently?
Posted by: whimple | July 22, 2008 1:15 AM
It would be interesting to see corresponding data from countries that don't wage a war on drugs. E.g. Swiss and the Netherlands.
Posted by: tk | July 22, 2008 1:18 AM
As an epidemiologists I've heard of a lot of different baises but what the hell is a "Len Bias"?
Posted by: NM | July 22, 2008 1:39 AM
Erghh!
*epidemiologist*
Posted by: NM | July 22, 2008 1:40 AM
To Pete's list of costs of the war we should add the exceptionally high proportion of US citizens that are imprisoned. (Per 100 000: US: 715 , Switzerland: 72, Sweden: 75, the Netherlands: 112, according to Nationmaster.com)
Posted by: tk | July 22, 2008 1:57 AM
Interesting question. I think it is very possible that the vast amounts of money spent by our government on destroying cocaine production in South America really did lead to a drop off in cocaine use in the U.S. But mostly I think it was the rise of cheap methamphetamine that killed it. Cheap and homegrown, with very little risk to the manufactures. Marijuana use has dropped off from the 60's and 70's I am sure, as that time probably represents an abnormality in normal usage levels.
I think the best way to judge the War on Drugs is to determine whether our society in general is suffering less damage from drug use and addiction. Polls of high school students won't capture this -- instead we would need to look at the number of people per capita whose lives are negatively affected by drug use. But this is difficult to count (in California anyway), because all the prisons, drug treatment centers, etc are so overcrowded, drug abuse, except in the most difficult cases, it pretty much ignored now.
I am going to weigh in that the War was a failure. My personal experience with drugs in the society around me has remained unchanged in the last 40 years.
Posted by: R.C. Moore | July 22, 2008 2:25 AM
It does seem to me also that we're looking at a graph is the powder cocaine/crack trends changing rather than a true decrease.
Is there any significant decrease in heroin use? I'd doubt that..
Posted by: Kitt | July 22, 2008 5:02 AM
The war on drugs has vastly improved the variety and quality of illegal drugs at the cost of corrupting the courts and the police, putting us far in the lead in incarcerating our own people, while inflating the price of those drugs so that those who cannot afford them must turn to illegal uses of legal substances, such as huffing gasoline fumes from a paper bag. Nobody is going to huff his way to mental health.
If the war on drugs was a deliberate attempt to destroy our nation, then it has failed. Still, it has made serious inroads. And, if you've noticed, we are no longer a nation, we're now a homeland.
Posted by: Rose Colored Glasses | July 22, 2008 5:39 AM
I was stunned and amazed to discover, in the process of researching a recent article, that the United States "Justice" system accounts for a quarter of the world's prisoners. How on Earth have you guys allowed your government to get so far out of control? Surely even right-wingers with their emphasis on small government should be against the bloating of the prison service?
Also I feel the need to quote Bill Hicks:
"George Bush says we're losing the war on drugs. You know what that implies? There's a war going on, and people on drugs are winning it!"
Posted by: Martin Robbins | July 22, 2008 6:23 AM
On the wider point, the analysis in the post above is irrelevent. You've selected three drugs out of a shit-load. Individual drugs come and fade over time. What would have made more sense is to look at overall trends - emergency room admissions, street prices, total drug use counts.
You've also not looked at the U.S. in comparison with other nations, or the cost. How many drug users are simply locked up in your ridiculously over-populated prison system? Is that an outcome beneficial to society? Not only that but a bunch of drug-users are deporting, thus exporting the problem elsewhere.
Finally, it's well documented that prohibitive tactics often result in a short term drop in use, followed by a rise over time.
Anyway, in summary, you can't just chuck out three random excel graphs and go "explain!!".
Posted by: Martin | July 22, 2008 6:34 AM
"The trends for 5-drinks-in-a-row (currently the definition of a "binge") in the past two week interval were very stable from 1978-1983 and thereafter exhibited a slow decline until the early 1990s. Very reminiscent of the above mentioned drugs."
If that's true, then I can't see it being the WoD that started the decline, since it wasn't the War on Drugs and Alcohol. More likely, it is simple public awareness that some drugs are just stupid (notice the drastic increase in MJ use once it was discovered that it wasn't all that harmful) The WoD, the money spent trying to keep it out of the country, the prosecutions, arrests, lives ruined because drug use is against the law.... THAT's what hasn't worked. Understanding drug use, the good drugs and the bad ones, has done more than law enforcement ever has.
Anyway, that's just my humble opinion.
Posted by: Will Grant | July 22, 2008 7:23 AM
I'm pretty sure I'm the only person on the internet who doesn't want drugs legalized. Of all social and political questions, drug legalization is the one with the biggest disconnect between the internet and the real world. In the real world, there is no groundswell for legalization (or against the War on Drugs). On the internet, it seems everyone wants drugs legalized.
I've been reading your blog for months now DrugMonkey and appreciate your work.
Posted by: Mike | July 22, 2008 8:48 AM
Posted by: Matt Hussein Platte | July 22, 2008 8:56 AM
Long ago in a history class in college I had a professor who gave us an assignment about Europe's historic climate. We were to analyze three data points (I believe a famine from the 1300's, a drought in France from the 1400s, and a normal year from Germany in the 1600s) and write about what we could infer about the average climate of Europe during the Middle Ages. If I remember correctly I was the only one to write that you couldn't determine anything about the climate from such scattered and uncommon data points.
Breaking: selectively picking bits of data proves hypothesis (as long as you ignore all other data) that the Drug War has 'worked' (for a given value of 'worked').
For anyone who thinks there is not support for legalization in the real world I'd recommend you start with LEAP (http://www.leap.cc/cms/index.php) and go from there.
Posted by: Bob | July 22, 2008 9:06 AM
You know, I bet they have reduced rates of civil unrest in China, since they prohibit freedom of speech and firewall the hell of out of their internet. Does this make it right? No. Does the decrease in drug use justify the war on drugs? Hell no. I guess I'm speaking just for pot, since anything harder would require more thought than I am willing to go into right now. I have no new arguments to add here that haven't been reiterated ad nasuem , but I'm coming from a freedom standpoint. Why can I get blacked out drunk on vodka from the grocery store, but I can't catch a smooth buzz from sharing a joint with a few friends? I think as long as booze and tobacco are legal, there isn't an argument on this planet to justify the criminalization of marijuana. On what grounds, exactly, is pot any 'worse' than alcohol? Allow me to play the 'how many people die each year' card, if you will. How many people ended up in jail for marijuana possession in 2006? 829,625? Almost a million people? Really? You explain to me how this is a good thing. It's not keeping criminals off the street. It's not preventing any crime. It's creating a mess and filling our jails with non-violent offenders.
I'm gonna go out on a limb here and say "Let the punishment fit the crime." If the drug you possess doesn't have the ability to kill, why are people being arrested and charged with hard time? Why sentence patients and providers to decades of jail time? Simply put, why, other than for arbitrary morals, do we legalize one intoxicant and not another?
To what end do we persecute others to feel 'safe'? Do you feel any safer knowing that I could be locked up at any time, simply because of the methods I choose to relax? The next time you drink a beer, image if you could be locked away and have your possessions confiscated for simply winding down.
Yes, tell the teens and everyone the consequences, just as we do for alcohol and tobacco use. Education is what works, not prohibition. IMHO, 'drug use has gone down' does NOT mean the drug war is working. By your logic, the 'War on Terror' must be won, since there has been a steep decline of terrorist attacks on this country since 9/11. It's a good thing we don't have any other problems we could be spending this money on in this country.
Posted by: Twi | July 22, 2008 9:20 AM
Like many other posters, I have repeatedly pointed out the distinction between a policy aimed at reducing drug use per se, and one aimed at reducing drug related harms, so I won't go over it again - I'm sick of banging my head against that particular ideological wall (for the moment).
However, even accepting (purely for the sake of argument) that the objective of policy should be to reduce drug use per se, it is not sufficient to demonstrate that the current policies have done this. There are at least three further questions which need to be addressed before you can conclude that a policy of prohibition is the best choice:
1. Does prohibition reduce drug use at least as effectively as other policy responses?
2. Does prohibition represent the best available cost / benefit trade-off?
3. Does prohibition have other undesirable side-effects not shared by other policy responses?
To draw a parallel with testing of medications, it's not enough to demonstrate that a given option works to some extent - you have to demonstrate that it works better than the alternatives. Given the choice between two options, would you go for the one that is more expensive, less effective, and has more serious side-effects?
Posted by: Dunc | July 22, 2008 9:48 AM
Yeah, forget Len Bias and look at selection bias. This selection of graphs ignores all changes in "drugs of choice" over the years. For example, the graph you've chosen for cocaine is just for powdered cocaine and ignores the advent of crack cocaine use, and the graph for amphetamine does not include methamphetamine use (you know, the meth epidemic?), and so on. And where does the massive upswing in prescription opiate abuse fall in your charts? Heard of oxycontin? Or ketamine? Hell, I knew a guy who had three different doctors prescribing him Xanax, which he powdered and snorted!
I'm not saying that I know with any certainty whether there has or has not been a fall in the usage of drugs in general among teens (or any other demographic). But I am certain about one thing: You can't draw any legitimate conclusions from such egregiously cherry-picked data.
Posted by: G Felis | July 22, 2008 9:51 AM
Several people seem not to know who Len Bias was so I'll give some background. Bias was an outstanding college basketball player who was set to become one of the great power forwards in the history of NBA basketball. He played for University of Maryland and was tall and graceful, could play inside and out and had incredible leaping ability. He was drafted by the Boston Celtics in 1986. Although the Celtics had won the championship in the previous year it was clear that they were on the tail end of their run because Larry Bird and Kevin McHale were both aging and nearing retirement. Along with the LA Lakers, the Celtics were likely the most popular team in the US. At that time it seemed that most NBA fans were either Laker or Celtic fans and whichever team you favored, you hated the other.
2 days after being drafted, Bias died of a cocaine overdose. Although I was relatively young when it happened, the event had a lasting effect on me and nearly everyone else that I knew. Why? As far as I knew Bias represented the first instance of someone with seemingly limitless potential having their life cut short by a chance exposure to an illegal drug. His death stood out as an example of the dangers of cocaine use and the anti-drug campaigns that followed his death strongly reinforced that idea (at least for cocaine). It is also worth remembering that the NBA had a real problem with cocaine use at that time and this problem soon came to be on full display (again) with the events that led to the downfall of Roy Tarpley's career with the Mavericks (and his lifetime ban from the NBA in 1991).
Posted by: juniorprof | July 22, 2008 9:51 AM
It's just occurred to me that I have seen this approach to proof of efficacy somewhere before - it is identical to that used by homoeopaths, and other assorted alt-med cranks. No control group? Check. No comparison to alternative treatments? Check.
Seriously, with this approach, you would have to conclude the homoeopathy, reiki and acupuncture all work, because they all appear to reduce symptoms.
Posted by: Dunc | July 22, 2008 10:22 AM
I have just one question. I had never heard of Len Bias before today. I am 34. How old do you need to be to know who the heck Len Bias was?
Posted by: llewelly | July 22, 2008 10:25 AM
I'm 35 and I knew who Len Bias was. Maybe some/all of you (who have never heard of Len Bias) are not sports fans. I echo the "crack cocaine" comments as well.
Posted by: TomJoe | July 22, 2008 10:58 AM
"I have just one question. I had never heard of Len Bias before today. I am 34. How old do you need to be to know who the heck Len Bias was?"
Arrgh, you're such a bunch of science geeks! :) I'm 35, and I vividly remember the whole Len Bias affair. Its a matter of your interests as much as age. I'd wager most of you were playing with your chemistry sets back then and were paying no attention to sports. To give perspective, Bias was considered on par with Michael Jordan at that time (they were both in college). Had he lived, he may have been one of the greatest basketball players of all time. A modern day comparison, in terms of popularity, would be LeBron James, had he overdosed from cocaine shortly after being drafted.
Posted by: Bill | July 22, 2008 11:12 AM
wow, touched a nerve on that one, eh?
I'll pick through as I get to them but yo! D00ds! For the "selective presentation" critiques. I linked the MtF site and the two critical monographs for a reason! Go. Get.
The. FREELY. AVAILABLE. PDFs! Start readin! If you have a point about crack, meth and heroin, drag out the numbers and share with the group, please.
In the case of crack and "other cocaine" these categories were only added to the survey at about the same time. One thing I might be overlooking is that previously all cocaine was grouped but I haven't found the footnote for that yet if so. This would only explain the timing (rejecting the H:LenBias) but not the trend. Interestingly, crack and 'other cocaine' was also at peak prevalence when the survey added these items and subsequently declined to the same early 1990s nadir.
Regarding Len Bias, becca's comment and some others...it is not strictly necessary that youngun's know who he was to be relevant. I am not arguing that it is a direct effect that keeps current cocaine use where it is! The other thing I didn't highlight here (but I may have in the prior post on this) is that in the perspective of how 'risky' people think a given drug is (another MtF item) cocaine enjoyed an unusually 'safe' reputation and then came down to about the average for most drugs around the same time. MDMA is another drug that (more recently) shows similar trends of a 'safe' reputation and high prevalence, followed by a rapid (over 1-2 yrs) change in both numbers, btw. This was more recently, of course, circa 2002-2004.
Posted by: DrugMonkey | July 22, 2008 11:58 AM
DM, I think you may need to look at data for drugs other than the ones you've presented (http://www.alternet.org/drugreporter/80448/).
Dying of a oxycontin overdose sure strikes me as what any sane War on Drugs should be aiming to minimize (I am less convinced we really care how many kids have been using marijuana).
Also, @twi, where on earth did you pull that number from?
Does anyone know how I can find out the number of people incarcerated for trafficking of marijuana and LSD (and other drugs where death is an unlikely outcome)?
Btw, I'm not trying to imply there aren't very negative consequences of drug use that have nothing to do with oversdose- just that overdose is an endpoint I'd want to look at.
Posted by: Becca | July 22, 2008 12:11 PM
The "Len Bias Hypothesis" is a good start. I would add to that "Legalized Abortion and Crime Effect" ala Levitt and Donohue. If one buys into the idea that teenagers begin crime sprees in their teen age years (15 or there-abouts), then the late 1980's would be a good place to show a drop in ilicit activities of all sorts, including drug usage, correlated to the availability to safe and legal abortions 15 years earlier.
I am not arguing cause and effect, but there are many paths that led to the drop in drug use and one single hypothesis is not going to win the day. It was most likely a combination of education (with Len Bias as an example of what not to do), Just Say No, abortions, peer-pressure, and other things. You're delving into sociology here, not real science :).
Posted by: JimNorth | July 22, 2008 12:16 PM
Dying of a oxycontin overdose sure strikes me as what any sane War on Drugs should be aiming to minimize (I am less convinced we really care how many kids have been using marijuana).
Totally and completely agreed. Actually, I have a followup to that dinky little post on the prescription opiate issue in the draft stage, gotta get back to that one of these days.
Prescription opiate incidence and prevalence is going though a bit of a boom cycle- question is, can we learn anything from the cocaine story of the 70s and 80s that helps to reduce prevalence and therefore overdose?
This brings us to PeteG's point @#3. Yes, I agree that abuse and dependence stats are important and I've posted on issues of conditional dependence risk and likely will again. I do not share PeteG's apparent confidence (citations?) that the abuser population has no relationship to the population prevalence numbers.
Posted by: DrugMonkey | July 22, 2008 12:22 PM
G Felis @#23: Hell, I knew a guy who had three different doctors prescribing him Xanax, which he powdered and snorted!
I'm not saying that I know with any certainty whether there has or has not been a fall in the usage of drugs in general among teens (or any other demographic). But I am certain about one thing: You can't draw any legitimate conclusions from such egregiously cherry-picked data.
Because your anecdote is so much more satisfying?
At any rate, my so called cherry picking is for some of the most prevalent substances. The ones people are mentioning as being suspiciously overlooked are in fact quite unpopular in population terms and in many cases are not represented in the MtF survey until recently. For the same reason- focus was on the most-prevalent substances.
The most-recent numbers which include a greater diversity of drugs are a topic for another post, frankly I can't believe nobody picked up on the 800lb gorilla. What in the heck happened after the early 1990s nadir for most drugs?
Personally, I blame Snoop Dog and Dr. Dre for "The Chronic"...
/ducks
Posted by: DrugMonkey | July 22, 2008 12:40 PM
Can you show the corresponding plots for ecstasy? Meth?
Posted by: Pablo | July 22, 2008 12:56 PM
Agreeing with above posters, but could use reiterating:
1. Polling teenagers about their illegal behavior is a pretty unreliable way to determine whether or not they are actually engaging in that behavior. The war on drugs' anti-drug campaigning may well have had an effect on how many teenagers admit to having tried drugs. This doesn't mean they're not trying them.
2. The fall in use of many of the drugs you did provide data for coincided almost directly with the emergence of the so-called designer drugs market: ecstasy, 2ct7, 2cb, ketamine, etc etc etc. Also, prescription drug abuse in recent years has certainly spiked. Agreeing with poster #23, you can't draw conclusions from such spotty data.
Posted by: Shannon Murphy | July 22, 2008 1:03 PM
Shannon @#35 and others: First the survey methodology is a bit more involved than "polling". By all means give us some references to data showing the disconnect between surveys such as this and the 'real' data. Here's a hint, there are real critiques about the methods available, this does tend to undersample at risk youth and thus probably undercounts. What you have to show though is that this problem is relevant to the specific discussion at hand, i.e., that such problems account for the long trend for decreasing drug use. It is science denialist to simply throw up chaff that has nothing to do with the points at hand. Even absent cites you should be able to connect the dots between your critique and the points I am making.
The fall in use of many of the drugs you did provide data for coincided almost directly with the emergence of the so-called designer drugs market
Most evidence I've seen suggests that users of the designer drugs are also concurrent users of marijuana at the least. Also, once again (and for Pable@#34) go read the reports yourselves. You will find that these trends observed in the 1980s generalize quite well across drug classes and for the bulk of the rest, use was stable but not increasing. MDMA and prescription opiates being recent exceptions but then again this is in the context of a generalized rebound from the early 90s nadir in prevalence.
Posted by: DrugMonkey | July 22, 2008 1:30 PM
What disturbs me about this study is that it apparently has enjoyed R01 funding for nearly 20 years. Talk about pissing money down a rathole...
The MADD campaign has been going on for the same length. Have incidents of teenage drunk driving decreased by the same rate? Ditto for the safe and sane driving, have the rates of teenage driving incidents (tickets for speeding, accidents, etc.) declined? IMO, that would be a more reliable indicator of whether education is an effective deterrent to risky behavior in adolescents and young adults then some quackery survey.
Posted by: Onkel Bob | July 22, 2008 1:47 PM
Being snarky little bastards, we claimed to do every drug listed.
and no survey scientists ever thought of this? it isn't my area but I've had enough brush with it to know that they work at multiple validations of their methods. is there going to be some variance from omnipotent 'truth'? sure. Systematic problems that change in precise register with a given argument being advanced? Not too likely. Again, connect the dots. What change in "snarky little bastard" rate is coincident with the trends observed?
Wasn't that the point of this snarky disingenuous post? If you wonder why people distrust you, it's your Machiavellian "the ends justify the means" approach to the discourse.
'disingenuous'? 'Machiavellian'? really, do tell...
With respect to the 'ends' and 'means' it is you that is being disingenuous. I am quite clear to say that I am not talking about the means one bit. It is the ends that I am discussing here, which frankly should delight you. Are we achieving any ends whatsoever? The supposition that we are not is a common refrain, as I outline in the opening. If we are not achieving any 'ends', that makes the 'means' discussion a slam dunk, does it not?
Ummm, is it me or are you relying on the same anecdotal experience that you immediately throw at others who question your arguments?
It's you. Right in front of that part you quoted, what did I say? '(another MtF item)', meaning it is in the report. go read.
What disturbs me about this study is that it apparently has enjoyed R01 funding for nearly 20 years. Talk about pissing money down a rathole...
Please. If the NIH did not collect data on the scope of drug use you all advocates would be screaming bloody murder that the entire NIDA budget was being pissed down a rathole of "problem? what problem?".
Posted by: DrugMonkey | July 22, 2008 2:11 PM
OK, here's one reason the war on drugs was a failure despite lowered use among teens or whatever: so many people's lives ruined, turned to other criminality by exposure to prison, money wasted, etc. by having a punitive approach rather than a treatment/rational interdiction approach. And, how do you know the usage bubble wouldn't have gone down anyway, considering that most social fads/trends are inherently up and down in nature anyway?
Posted by: Neil B. ♪ ♪ ♪ | July 22, 2008 2:54 PM
I'm not one who says that the war on drugs doesn't work. But I do think one has to consider what is included in the "war on drugs", and also demographic trends, before declaring that it works.
Education (if honest), in particular, has not been opposed by those who oppose the "war on drugs". Most who are against making drugs illegal are convinced that education is the way to go, that most people try to avoid highly dangerous drugs (the meth fad might tell against this idea--or for it, considering how many people eventually decided that meth is not for them), and that it is interdiction and prosecution of users that doesn't work well (true, it likely decreases use, but at a high cost).
So if the message is that education works, it might be an argument against the "rest of the war on drugs."
Then too, probably the biggest single weapon against drug use has been drug testing, and prohibition of smoking at work. Is workplace testing a part of the "war on drugs"? If so, fine, that does work, but it doesn't obviously justify the intrusion into personal life, nor does it inform us of the value of more traditional criminalization of drug use and enforcement of drug laws.
Demographics ought also to be considered. The high point of drug use appears to be when the boomers were still young(ish), beginning to make good money and spending it to get high. While education and drug testing may have had some effect on boomers, surely the simple fact that they got older and more concerned about losing what they had obtained made a significant impact on their reduction in drug use.
I would say that the statistics suggest that workplace drug tests and education do work. Whether or not traditional methods of criminalizing drugs reduces their use any more than alcohol prohibition did (and it did reduce use, and at least initially, crime rates) remains in doubt.
It seems, too, that alcohol use ought to factor into any discussion of a "war on drugs" and its effects. Boomers switching from pot to alcohol (for instance) is not likely to make society less violent, although using alcohol instead of crack presumably would.
Glen D
http://tinyurl.com/2kxyc7
Posted by: Glen Davidson | July 22, 2008 3:01 PM
Interesting how you display the charts for everything but alcohol, which you note also declined. This is a classic post hoc ergo prompter hoc fallacy. Although it may seem plausible that the drug education worked, marijuana increased in use during the time this movement was strongest, and I would say that most kids today use it much more than they did in the 70s, when they may have been more likely to try it.
With that said, a more effective policy could work. If the gov't were to cite studies and point to actual science, rather than use unconvincing rhetoric, the results will be better. Unfortunately for concerned parents, the science on marijuana doesn't suggest terrible health effects -- although it does suggest impaired short-term memory, drastically decreased learning potential (while high), and perhaps increased risk for psychological disorders. Which is why I haven't smoked pot in over a month (after smoking way too much since the age of 16; currently 22).
Posted by: kurvmax | July 22, 2008 3:05 PM
Based on the images included in your post I was going to write something broadly acknowledging your point, while emphasising the need to contrast with the amount of money spent on the WoD over the same time in order to see if it's actually the spending that's working. I know from my own field of narcotics research that drug use is not decreasing but in fact steadily increasing and becoming more mainstream from things such as oxy abuse, but I figured hey, maybe narcotics are an outlier.
I then took the time to look at the rest of the drug use trends and saw that at best with this you are being disingenuous and at worst dishonest. It's not hard to tell why you led with an image of the graph from powder cocaine use rather than the more eminently suitable "all illicit substances", and you chose it as the only one a casual visitor to the site would see under the bold title of "SUCK ON THIS DATA, LEGALIZO-NUTS!". It's pretty much the only one in the entire paper that shows a convincing decrease. And it's also the only one which shows such a large decrease since the 80s that it masks the continuing increase at the start of the '90s.
I then looked at the amount of money spent on the drug war over the same period of time, and took a guess as to why you didn't compare the two. Clearly the drug war was in your mind while writing the post, but for some reason looking at the drug war itself rather than drug use somehow slipped your mind, and it's not hard to see why. Spending has ballooned over the same period when most if not every single drug apart from powder cocaine and amphetamine has either shown no decrease or has in fact increased. This is damning condemnation of the drug war, not the vindication of it you snarkily imply with the title and misleading leader image. If it's working, why has the budget doubled since the end of the 80s to less than no effect? I wouldn't publish in j.med.hypotheses if I was trying to tell a story like this one. And consider that last sentence written in trademark Snarky Bold Formatting, for effect!
Posted by: Jamie | July 22, 2008 4:12 PM
I then took the time to look at the rest of the drug use trends and saw that at best with this you are being disingenuous and at worst dishonest. It's not hard to tell why you led with an image of the graph from powder cocaine use rather than the more eminently suitable "all illicit substances", and you chose it as the only one a casual visitor to the site would see under the bold title of "SUCK ON THIS DATA, LEGALIZO-NUTS!". It's pretty much the only one in the entire paper that shows a convincing decrease.
This is complete and utter bollocks. Figures 5-1 - 5-3 of Vol I are the relevant ones, for those playing along at home. They show exactly the same long sustained declines in lifetime and annual use of illicit drugs that is represented by the individual drug prevalences, with or without marijuana (a possible big-daddy confounder) included.
I know from my own field of narcotics research that drug use is not decreasing but in fact steadily increasing and becoming more mainstream from things such as oxy abuse
Indeed prescription narcotic use has been on the increase of late. Actually, as I'm trying to allude to by using the term 'nadir', the rebound for most drugs of abuse has been obvious from the early 90s onward. Prescription narcotics are an impressive contribution but not the exclusive answer.
So what is your point here?
If it's working, why has the budget doubled since the end of the 80s to less than no effect?
ah. The question of what has been going on since the early 90s is a good one and perhaps an analysis of the overall character of the drug war (again, I'm including the overall perspective of the PR campaign, foreign and local interdiction efforts, escalating legal penalties, etc) would lend some clues.
Me, I happen to favor looking into hypotheses related to the PR campaign because I think that 1) alterations in demand are possible and related to PR and education efforts, 2) alterations in demand are the part of the puzzle that is my closest professional and personal interest, 3) alterations in demand have downstream beneficial effects on the rest of the puzzle.
Posted by: DrugMonkey | July 22, 2008 5:07 PM
DM -
The problem with this data, is that it is far from the whole story of the public health impact of the War on Drugs (or War on Vice, as I prefer to lump it). It is all fine and good that actual use is down. But what about the other problems with prohibition and the WoD?
Prohibition and the draconian WoD is largely responsible for the violent crime in neighborhoods like mine. Since the first of the year there have been fourteen shootings and twelve reports of brandished guns, in a five block radius of my apartment. Of the nine shootings where motive was established, all of them were related to the illicit drug trade. Last year all but one of the shootings in the same area where motive was determined, were also illicit drug related (the other involved the illicit sex trade).
Violent crime is an inherent aspect of the WoD. Prohibition created the black market and the WoD then made it extremely lucrative. Far more dangerous yes, but with that danger comes exponentially higher profits making it worth while. The higher potential profit margins also make it worth playing games wherein death, maiming and/or life in prison are considered acceptable risk. When you also consider that there are no legal protections to govern even simple business disputes, much less outright theft or fraud, disputes are often going be settled with violence.
Prohibition and the WoD have also drastically swelled our prison populations. Prisons are a major detraction to health. Communicable diseases run rampant through prison populations at rates that are exponentially higher than that of the general population. Mental illness and violent conditioning of previously non-violent offenders is also very prevalent. More prisoners is bad for public health.
The actual drugs being used are also a danger to public health (or at least the health of the user). Many illicit drugs are made poorly, with chemicals intended for very different purposes - often industrial. Even when they start out relatively "clean" they still get stepped on by any of hundreds of different products, ranging from benign to extremely toxic. Then you have the question of strength. Without regulated controls, the quantity of active drug can fluctuate wildly easily leading to accidental overdoses.
If we are going to look at the impact on public health, we really need to pay attention to the whole story. Too, we need to look at the pre-prohibition, pre-WoD public impact of currently illicit drugs to get a reasonable comparison. While I tend to make a distinction between them, it's really more a case of one begetting the other. I.e. without prohibition, the WoD would be redundant. So what exactly were the usage rates before those various drugs were made illegal? Excepting amphetimines, the drugs listed were all legal and available in the U.S. at one point.
Finally, there is little to show that the decreased rates of use are actually the result of the WoD and not the result of improved education. I would also theorize that at least of portion of this can be attributed to rather sweeping changes in mainstream parenting techniques over the last thirty years. Gone is the idiot notion that coddling and loving on children is a bad idea. Kids are growing up with healthier interpersonal relationships.
Posted by: DuWayne | July 22, 2008 5:12 PM
Oy, having an ADHD moment (I tend to write every paragraph simultaniously) and forgot to finish a couple of paras, the worse being the last. It should have continued;
Healthier relationships lends itself to happier kids and more secure, self-confident adults. I.e. people who are less likely to turn to recreational drug use.
I would also like to note that this is far from a comprehensive argument for legalization. There are many more reasons for legalization, this is just my argument for the failure of the WoD from a purely public health perspective.
Posted by: DuWayne | July 22, 2008 5:19 PM
My message was apparently unclear, I'll attempt to clarify it.
As for the comments of Machiavelliean disingenuousness, it was directed at your baiting of opponents to reply, then engaging in your usual snark and dismissal. The ends which I speak of is that "you win" the argument, the means, being the belittling and sarcasm you direct at those who disagree with you. Whether this WoD is successful cannot be determined by a "study" or report. You place a great deal of confidence in the report and their methodology. I do not share that same confidence. Knowing more than a few research scientists (the frau is a Dev Bio professor in an ivy league institution) I have an innate distrust for your profession. Chalk it up to the "familiarity breeds contempt" syndrome. Your writing and communication style have engendered that same contempt to such a point I would not trust you if you said the sky is blue. It's not enough to be right, one must listen to you and must understand your argument.
As for the NIDA and its existence, a funny thing happen during the nascent years of the USA. There was a surplus of grain produced in the Ohio Valley that could not be shipped eastward in an efficient manner. To overcome that problem, much of the harvest was distilled into whiskey. So much whisky was produced that it is estimated that nearly a quart was consumed on a daily basis by the working class. Granted this stuff couldn't have been the 80 proof rotgut we see today, still that quantity is alarming. Yet somehow, some way, this country survived without a war on whisky. The "advocates" simply look at the situation and believe this is a solution seeking a problem. Unfortunately, as the mohair and honey subsidies prove - once a the US government opens the taxpayer funded spigot, closing it is an impossible task. That is especially true if the justification is as emotionally charged as this one.
Posted by: Onkel Bob | July 22, 2008 6:01 PM
A lot of pro-drug monkeys have been suggesting cost comparisons with European countries with laxer drug laws. But if you're doing comparisons, it wouldn't hurt to also compare the costs of the US war with those in countries like Singapore, Malaysia, and Indonesia, which have much harsher penalties.
Posted by: Lab Lemming | July 22, 2008 6:31 PM
I was referring to the data from 18-45 year olds, since I'm sure you'll agree any comment on the success or otherwise of the drug war can't be restricted to 1/4 of the population. Especially when a lot of people are introduced to many drugs in college, at 18 or later. An apparent decrease in use from schoolchildren isn't much use if it doesn't change the level of use in the same children when they become legal adults a few years later, and from data like figure 5.1 in volume 2 it looks like drug abuse has remained steady or even increased DESPITE continued massive increases in investment in the drug war. In short, it hasn't. The age at which people begin to take illegal drugs has been increased by a couple of years, which is commendable, but the prevalence has not changed significantly since 1990 and for many drugs has increased and is continuing to increase.
Ignoring the social costs of inadequate treatment for recovering addicts, ignoring the social costs of giving people criminal records for ingesting certain substances and for keeping them in jail, ignoring the costs of giving organised crime their biggest cash crop... Ignoring, to cut myself short, every single one of the other deletrious effects that the drug war has had on society, drug war funding has gone up exponentially since 1990, and for what effect? Overall drug use has not dropped in adults since 1990, and for several drugs it is increasing. This money has been flushed down the toilet, and for the debatable benefit of a small delay of abuse onset in a small number of people.
If you want people to start praising the drug war, and not raising issues of disingenuousness over titles like "haha, explain this data you NORML drones! the drug war is working!", explain where this money is going and what it is doing. Because the only drops in drug use these data are showing are when funding for the drug war was at its lowest, and a system that is burning money for no apparent gain is not what I would call "working".
Posted by: Jamie | July 22, 2008 6:42 PM
DuWayne, again, I'll point to the above exchange about means and ends. It would be best to figure out if the intentional upside ends were being accomplished (to any extent) first, would it not? Then we can move to the downside results and ask if it is worth it. But as you know, you won't find me delving into that with any depth any time soon- it is very far from anything like my area of knowledge or expertise.
So what exactly were the usage rates before those various drugs were made illegal? Excepting amphetimines, the drugs listed were all legal and available in the U.S. at one point.
That would be prior to the Harrison Narcotics act of 1914, no? a considerably different economic and social environment. I think you would be hard pressed to make comparisons.
Posted by: DrugMonkey | July 22, 2008 7:01 PM
I was referring to the data from 18-45 year olds, since I'm sure you'll agree any comment on the success or otherwise of the drug war can't be restricted to 1/4 of the population. Especially when a lot of people are introduced to many drugs in college, at 18 or later. An apparent decrease in use from schoolchildren isn't much use if it doesn't change the level of use in the same children when they become legal adults a few years later, and from data like figure 5.1 in volume 2 it looks like drug abuse has remained steady or even increased DESPITE continued massive increases in investment in the drug war.
Again, completely wrong description. The trends look very similar to the cocaine figure in the original post! Drug use peaked in the late 70s, or very early 80s. Thereupon it began a decade long decrease in population prevalence to a nadir in the early 90s. That's all I've had to say about any of the above data.
but the prevalence has not changed significantly since 1990 and for many drugs has increased and is continuing to increase.
Again, I. Am. NOT. Talking. About. Post-1990. Data. I am talking about the interval relevant to the full court press 'war on drugs' episode identified with the Reagan administration. Including the huge uptick in the Just-Say-No and D.A.R.E. and all that PR stuff.
Don't get me wrong, I'm very much interested in the post-1990 stuff. But looking at current levels versus 1980 and saying "look, no effect" when there are very clear trend involved, one downward and then one going back up again, is being a bit silly. Understanding of why prevalence went down, and why it started coming back up again is critical to evaluating what parts of the War on Drugs may or may not have worked is it not?
Posted by: DrugMonkey | July 22, 2008 7:58 PM
DM -- No, I don't have citations regarding trends in abuse (as opposed to use), and quite frankly, that's a major concern to me. The government has tended to avoid recognizing any distinction (under the guise that merely using an illegal substance qualifies as abuse) but that is disingenuous and unhelpful. I'm not aware of existence of solid data in this area, and would love to see it. I imagine collecting it would be difficult at best (it appears to be easier to find such data on legal drugs).
Even if that data collection was possible, I suspect that few in government would want it known.
So what do I have to go on? Logic, reason, and anecdotal data. If large numbers of casual recreational users of drugs continue to purchase them despite onerous criminal penalties, potential loss of jobs, children, etc., then what possible reason do we have to believe that criminal penalties will stop an addict/abuser?
So, if, in fact, there are different types of individuals as they relate to drugs, which appears to be the case... Let's posit Group A is interested in trying a drug on occasion but don't really care one way or another. Group B likes the drug a lot and would like to do it regularly. Group C is addicted or otherwise has a problem related to drug use. It seems likely that supply-side/enforcement prohibition would, if it affected use, first whittle away from Group A, then Group B, before ever affecting Group C. Which is exactly the wrong way to go.
So basically, once a drug use population exists, enforcement is no longer a viable option for deterring abuse in that population. That's a huge point.
That leaves two possible ways of affecting abuse through enforcement: 1. preventing abuse through discouraging use, and 2. forced treatment.
The first method assumes that there is no predilection for abuse/addiction and that the future abuser can be aborted easily (ie, stop a Group A member from becoming a Group C member). Yet it seems to me that there is plenty of evidence that says that some people are more susceptible to abuse than others (and thus would be likely to go directly to Group C).
The second method can reduce the number of abusers somewhat, by essentially casting a very wide net and hoping that buried within the catch are some abusers that will either be removed through incarceration, or helped through treatment. It's an extremely inefficient system, identifying users to find abusers, rather than identifying abusers in a legal system (such as with alcohol).
Again, if you have any data regarding abuse (as opposed to use), I'd love to see it.
It should be disturbing to anyone that we've been fighting this war for decades at extreme cost without anyone coming up with that seemingly critical "justification."
Posted by: Pete Guither | July 23, 2008 1:32 AM
I was probably one of the commentors you mentioned from the first part of this discussion. This thread is one of the best discussions I have read on the issue, actually. We seemed to have gotten past the knee-jerk reactions and heavy righteousness that characterized the first discussion.
To clarify where O stand, I want to say that I am FOR education about drugs.
I think the "prohibition" style approach, where you lock up a bunch of casual users and first time offenders and throw away the key, and spend the public resources building prisons and housing the new "criminals" is a failure.
If there is an aspect of the WoD that has worked, it has probably been the educational arm (including the controversial DARE program in the schools).
I remember the first time I saw photos of brain cross-sections of longtime crack users. That's a pretty good deterrent.
Educating young people about what drugs actually are, what the active ingredients are and how they can damage or adversely affect the body (everything from blood pressure, sugar-balance, to rotting your teeth out) I think is good.
And different for different substances. Many pot smokers are actually people who take pretty good care of them selves. Most of my pot smoking acquaintances take care to eat healthy food, don't abuse alcohol or any or the hard drugs, and are generally good citizens with productive lives.
This might not be true of the crackheads and needle-users, however.
So drug users are a pretty diverse population and there is also wide diversity in the types and amounts of drugs being used or abused, and the physiological effects of those drugs spans a wide range of symptoms.
I am against punishing people just out of righteous vigilante mentality, and against stupid wasting of taxpayers money.
But I think that educating yourself about the nature and potentials of substances that can have a profound effect on your well-being (or even end your well-being, for that matter) is the right thing to do.
I support an education and rehabilitation based approach to reducing drug abuse in society, as opposed to a draconian prohibition/punishment approach.
Posted by: yogi-one | July 23, 2008 3:15 AM
Accepting that the "war on drugs" (including the overall perspective of the PR campaign, foreign and local interdiction efforts, escalating legal penalties, etc) can affect rates of actual usage, is it really that much of a stretch to think that it might also affect reporting biases? It is, after all, a change in the "economic and social environment".
Posted by: Dunc | July 23, 2008 4:48 AM