Sunday, January 04, 2004
Alcohol Harm Reduction?
Ever-vigilant Vice Squad friend Dima Masterov brings us this word on a pill (officially, a dietary supplement) that seems to serve as a hangover preventative. Marketed under the name RU-21 (get it?), the pill is taken (perhaps multiple times) during an evening's drinking, and is claimed by some to remove the usual next-day ill effects. There's a legend tying the invention of the pill to the old Soviet KGB.
The author of the linked article attempts a controlled self-experiment, and proclaims that the pill worked as advertised for him. But his final take is far from an unqualified endorsement: "Over the course of my highly unscientific experiment, RU-21 had indeed made an impressive showing. I marvelled at the possibility of a world without hangovers, a world in which pleasure need not be counterbalanced by pain. After some consideration, however, the idea struck me as hollow. I hate hangovers as much as the next man, but as crazy as this may sound, they may be a necessary evil, the thing that keeps consumption reasonable and, by extension, fun. Maybe the smart thing would be to learn to regard throbbing heads and churning stomachs, once our mortal enemies, as our friends..."
Economists like to distinguish between "internal" and "external" costs of drug use. Internal costs are those that accrue to those who are deciding about drug consumption; external costs are those costs that one's drug use imposes upon others. In the case of alcohol, the major external costs are injuries and deaths to others from drunk driving, and violence. If RU-21 works as advertised, it presumably lowers the internal costs of getting drunk (and hence, as the author speculates, should raise consumption), without reducing most forms of the external costs. So the author's concerns about the pill leading to more immoderate (and hence, as he writes, less fun) drinking might even be magnified when the external effects are considered.
How does this rather negative assessment jibe with Vice Squad's often enthusiastic endorsement of harm reduction measures? In the case of heroin addiction, the main harm reduction strategies are needle exchange and methadone (or heroin) maintenance. Much of the rationale behind these measures is to reduce the incidence of communicable diseases, chiefly AIDS and hepatitis C. But reducing the probability that a drug user will become infected with such a disease has not only a large "internal" benefit, but an external benefit, as having fewer "infecteds" helps to slow the spread of the diseases to others. Further, maintenance can help reduce the petty crimes that addicts frequently engage in to hustle their way to their next hit. So in general, I believe the case for these types of harm reduction is stronger than for RU-21. Nonetheless, I don't favor a ban on this supplement, or anything of the sort. But we might have to direct more resources into severing (or reducing) the link between drinking and violence and drinking and driving if RU-21 works as advertised. (Incidentally, this post should not be taken as an endorsement of RU-21 -- indeed I would be wary of any relatively untested substance that has profound physical effects. Who knows what the long-term consequences of RU-21 use are? More generally, Vice Squad concerns public policy, and is not intended (nor should be used) to alter the private vice policy of the loyal Vice Squad reader.)