Tuesday, August 20, 2019
The title of this post is the title of this remarkable new RAND report authored by Gregory Midgette, Steven Davenport, Jonathan Caulkins and Beau Kilmer. This webpage provides this account of what appears in the nearly 100-page full report:
Substance use and drug policy are clearly in the national spotlight. Provisional data from the Centers for Disease Control and Prevention suggest that drug overdose deaths in 2018 exceeded 68,000, of which more than 47,000 involved opioids. Although heroin, prescription opioids, and synthetic opioids (such as fentanyl) receive most of the attention, deaths involving methamphetamine and cocaine are both on the rise. In addition, more than 25 percent of the U.S. population lives in states that have passed laws that allow for-profit firms to produce and sell marijuana for nonmedical purposes to adults ages 21 and older.
To better understand changes in drug use outcomes and policies, policymakers need to know what is happening in the markets for these substances. This report updates and extends estimates of the number of users, retail expenditures, and amount consumed from 2006 to 2016 for cocaine (including crack), heroin, marijuana, and methamphetamine in the United States, based on a methodology developed by the RAND Corporation for the Office of National Drug Control Policy. The report also includes a discussion of what additional types of data would help quantify the scale of these markets in the future, including the new types of information produced by the legalization of marijuana at the state level.
- People who use drugs in the United States spent on the order of $150 billion on cocaine, heroin, marijuana, and methamphetamine in 2016. The marijuana market is roughly the size of the cocaine and methamphetamine markets combined, and the size of the retail heroin market is now closer to the size of the marijuana market than it is to the other drugs.
- After falling precipitously from 2006 to 2010, cocaine consumption's decline slowed by 2015. Results suggest there were 2.4 million individuals who used cocaine on four or more days in the past month in 2015 and 2016. Results also suggest that consumption grew in 2016 among a stable number of users as price per pure gram declined.
- Heroin consumption increased 10 percent per year between 2010 and 2016. The introduction of fentanyl into heroin markets has increased the risk of using heroin.
- From 2010 to 2016, the number of individuals who used marijuana in the past month increased nearly 30 percent, from 25 million to 32 million. The authors estimate a 24 percent increase in marijuana spending over the same period, from $42 billion to $52 billion.
- Methamphetamine estimates are subject to the greatest uncertainty because national data sets do not do a good job of capturing its use. There was a steady increase in the amount of methamphetamine seized within the United States and at the southwest border from 2007 through 2016, and a commensurate increase in use over the 2010–2016 period.
- For marijuana, household and student surveys could be updated to collect more information about the type and quantity of products consumed. Legalization is producing new types of information through state "seed-to-sale" tracking systems, market surveys, delivery services, loyalty card programs, and other sources. Figuring out how data from these new sources can be mined to develop insights about the markets should be a priority.
- With respect to the other drugs, bringing back the Arrestee Drug Abuse Monitoring program or some version of it would be enormously useful, particularly if it included objective (biological) consumption measures. For example, it is possible to detect fentanyl in urine specimens even if the user did not know he or she had consumed fentanyl because it appeared as an adulterant in some other drug.
- Wastewater testing is another approach for estimating consumption that has received much more attention outside of the United States. Although the utility of this method will depend on the type of substance examined, the science is advancing, is readily scalable, and could provide insights about drug consumption at the local level.
Notably, Chapter 5 is devoted to a discussion of marijuana use.