More Reaction to Sun's Light on Buprenorphine
A few days ago Vice Squad mentioned the Baltimore Sun's investigative reporting on buprenorphine, an opioid commonly used to treat heroin addiction (which is rife in Baltimore). One part of the series concerns France, where buprenorphine is widely prescribed to addicts. This part of the series, like other parts, has attracted critical commentary from the treatment community. Today's letter (scroll down a bit) from two French addiction workers expresses dismay about both the story and the Sun's Public Editor's tepid endorsement. Their letter points out some information that did not appear in the Sun story:
Causality is always tricky, but it does seem that buprenorphine has been a very successful treatment for heroin addicts in France. Incidentally, much of the Sun's concern about buprenorphine "abuse" draws upon heroin addicts who purchase street bupe to stave off withdrawal when they cannot afford or access heroin. This use may not be undertaken under a physician's care, but it is far from clear that it constitutes "abuse" in the usual sense. (Though in the drug policy world, the abuse of "abuse" is common.)
Opioid substitution treatment now covers about 70 percent of drug users in France, and most receive buprenorphine. This change in policy has achieved:
• An 80 percent reduction in heroin overdose deaths (from 500 to 100 per
• A 75 percent reduction in HIV prevalence among drug users (from 40
percent in 1995 to 11 percent in 2004).
• A 75 percent reduction in drug-related crimes.
New York Times on Vice Policy
A friend of Vice Squad brings our attention to yesterday's and today's business sections in the New York Times. Yesterday, Times economics writer David Leonhardt called for higher taxes on beer and wine. Today, we learn about the state of Texas's intention to introduce a $50 scratch-off lottery ticket, on the heels of other high-priced varieties that cost up to $30 each. The articles share a certain affinity for Vice Squad-style policy directions -- higher alcohol taxes and concerns about the under-regulation of gambling being venerable Vice Squad topics -- but more importantly, they share a reliance upon the ideas of friend of Vice Squad Phil Cook. Phil is both source and part-subject for the alcohol tax article, and his recent alcohol-policy tome, Paying the Tab, is described as "a wonderful little book". (Little? OK, the text per se is "only" about 200 pages, but I never viewed the book as little in terms of length or depth.) For the lottery article, Phil gets a reduced role of providing a short quote.
The lottery article notes that "traditional" lotto has been declining in popularity in Texas -- a "problem" that besets many state lotteries. Further, it provides some demographic statistics on lottery players, with yet more evidence that poorer people tend to spend more money, in absolute terms, on the lottery than do richer individuals:
In 2006, according to a University of North Texas survey commissioned by
state lottery officials, the typical black player spent $70 a month on the
lottery, compared with $47 for Hispanics and $20 for whites.
The demographic differences were especially sharp when it came to
scratch-offs. Players with a high school degree or less typically buy $20 a
month worth of scratch-off tickets, compared with $10 for college graduates. Similarly, players with an annual income of less than $12,000 spent 33 percent more a month than those with incomes above $100,000.
A Letter from a Drug Enforcement Agent
The letter appeared one week ago in the Washington Times. The author indicated that he "served almost 30 years as a federal drug enforcement agent." He was writing to express support for the recent Supreme Court decision that allows judges to depart from the sentencing guidelines for cocaine offenses. In the course of the letter, this drug war veteran avers: "If the U.S. government wishes to continue its futile and counterproductive crusade against illegal drug use, it should regard all illegal drug trafficking and use as equally deserving of punishment." (While I do not think the drug war is futile, I do think it is counterproductive.) Speaking of law enforcers questioning the drug war...
Sun Sets on Bupe
Just a quick note from Baltimore, where the Baltimore Sun recently has featured an investigative series of articles (first installment here) on the opioid agonist buprenorphine, a drug frequently used to treat heroin addicts. Sometimes buprenorphine itself is abused, and it is this possibility that garners the bulk of the Sun's attention. The Sun's Public Editor explains the coverage, and some of the fallout, here, without offering much of an assessment beyond a sort of tepid endorsement. A letter from a medical professional (with experience in the area) that appeared in today's issue of the Sun is illuminating:
It is telling that despite months of reporting and thousands of words, The Sun
did not find a single person in Baltimore whose life has been ruined by
Yet just walk the streets in East or West Baltimore and you
can find scores of people whose lives are being ravaged by the condition that
buprenorphine treats effectively.
Beer Like You Have Never Seen It
In October the Guardian launched a three-year project devoted to the development of Katine, a village area in Uganda. In concert with this program is a series of short video reports. The latest concerns the local beer, ajon, made from locally-grown millet. It is consumed in a hut that serves as a pub, and drinkers use long "straws" to imbibe out of a communal pot. What to do about those who overindulge? According to the pubman, "If you get too much drunk they say 'you go home now, you're tired'; the rest can continue."
The video is pretty fascinating. (I can only watch Guardian videos using Internet Explorer, not Firefox, however.) The other Katine videos repay the watching, too; here's a short one on the barber whose visit with a car battery once per week is a major source of electricity in the village -- look at all the cell phones that take advantage of his visit for a re-charge. Here's another video on the backbreaking work conducted with only the most primitive tools in the local quarry.
Speeding Along the Demise of French Home Distilling
There is a rural tradition in France of orchard owners distilling high-alcohol fruit brandies, eaux de vie. But these home distillers are in serious decline, as the French government has been restricting the right to make tax-free distillations. Those whose production right -- it only amounts to 20 litres of 50 percent alcohol per rightholder -- was grandfathered in decades ago have not been allowed to bequeath that right, so many of the distillers are literal grandfathers. Nevertheless, French law is set to change on January 1, and the aged alcohol producers will either have to pay a 7.25 euro per bottle tax, or give up their traditional hobby. Seems a bit heavy-handed.
Here are some photos of the production technique for eau de vie, along with some commentary on the fear instilled by the French alcohol tax collection authorities.
Checking in From Kyiv
The stop in London on the way to Kyiv afforded an opportunity to scour British papers for vice policy stories. The Guardian more than met its responsibility, in part through this offering concerning an alcohol harm reduction program in Kenya. The idea is to fight alcohol problems by ensuring a steady supply of, well, cheap beer. Yes, a major alcohol producing firm is a proponent of the idea, but it is far from crazy. The underlying notion is that many alcohol problems come from informally produced (hence untaxed) high-potency alcohol, which when consumed can both bring on drunkenness quickly and (through adulterants) wreak havoc upon drinkers. Kenya has engaged in what appears to have been a successful experiment of providing a cheap (untaxed but formally produced) beer, "Senator Keg". The beer is available only in kegs, so is sold by the glass, not in bottles or cans. And it has established itself in the Kenyan marketplace; whether this establishment has come at the cost (or benefit) of reduced hooch consumption is not really addressed in the article.
Some policy pundits, particularly those who (unlike Vice Squad) oppose higher alcohol taxes (in the US, that is), like to quote Thomas Jefferson: "No nation is drunken where wine is cheap." Adam Smith expressed similar sentiments.
Coffee in Kyiv
Vice Squad is relocating today, first to London and then to Kyiv. The loyal Vice Squad reader is concerned that sans Starbucks, it might be hard to stay properly caffeinated in Ukraine. Fear no more, comrade: Gloria Jean's has come to Kyiv.
Actually, one of the more obvious changes in Kyiv in recent years has been the burgeoning of coffee shops, as the linked article mentions. The Coffee House and Coffee Time chains are particularly prominent, and at least one of them (Coffee House, if memory serves) has pretty good food, too. One thing that is glaringly absent is a public smoking ban. While Vice Squad does not support such a ban, as the bans proliferate, those places that do not have them do begin to stand out.
The temporary relocation will lead to even less frequent blogging through the end of 2007, alas.
A New British Lottery?
No, not that one to pay for the London Olympics (later complemented by a more straightforward raid on National Lottery proceeds). This lottery is proposed to get people to vote -- or as those wacky Brits say, to "incentivise" voting. The suggestion to use gambling to lure punters to the polls survived a filter that screened out the possibility of doughnut giveaways because -- I am not making this up -- of concerns about obesity.
The linked Guardian article doesn't mention that the Yanks had the lottery idea first (though California's primacy in doughnut distribution merits notice); Arizona voters, uncompensated, didn't care for the idea.
Britain's Alcohol Disorder Zones Still Under Wraps
You might think that Britain already has plenty of Alcohol Disorder Zones (ADZs), but strictly speaking, no. The official version of ADZs are actually anti-alcohol disorder zones, and they were pledged by the Labour government years ago. The idea is that alcohol licensed businesses within an ADZ would have to pay for the extra public services that stem from concentrated drinking. But so far, they have remained on the back burner. On the front burner is fiery rhetoric aimed at supermarkets (and their owners) that sell alcohol for prices that really are astonishingly low, given the significant taxes on alcohol in Britain. For instance, a one-litre bottle of Smirnoff Red Label Vodka sells for ten pounds at some British supermarkets, despite a tax of, oh, 8.83 pounds. (Read about it in the Daily Telegraph here.)
Vice Squad's Britain obsession is fueled this week by the prospect of stopping off in London on the way to a workshop in Kyiv. And did I mention that Regulating Vice is published by Cambridge University Press?
Regulating Vice: Chapter 2, "Addiction: Rational and Otherwise"
Chapter 2 of Regulating Vice starts by describing addiction, while noting the myriad definitions of addiction and dependence that previously have been offered. (In The Addiction Concept, Glenn D. Walters writes: "After reviewing the addiction literature, one might be inclined to conclude that there are as many definitions of addiction as there are investigators conducting research in the area.") Reinforcement, tolerance, and withdrawal are generally part of the mix, but not all vicious compulsions that people would likely term "addiction" demonstrate all three of these traits. Nevertheless, the chapter moves ahead with a description of rational addiction theory, as developed by two University of Chicago economists, Gary Becker and Kevin Murphy:
A capsule summary of rational addiction theory begins with the description of a potentially addictive good (a drug, say) as having the quality that the consumer’s current satisfaction from the drug depends on the extent of previous drug consumption. Other factors such as price will also influence current drug use, but the amount of past consumption plays a key role in generating today’s demand for the drug. In keeping with the notion that addiction involves reinforcement, the more you have consumed in the past, the more that you will choose to consume now, holding all other factors constant.Rational addiction theory, it turns out, provides a solid underpinning for much addiction-related behavior, and also gains support from empirical tests when it is compared to addiction models where consumers lack foresight. One type of behavior that rational addiction cannot easily explain, however, is the costs that some people impose on themselves to try to commit to reduced future consumption. [Stomach reduction surgeries are one example.] In its pure form, rational addiction theory suggests that public policies that try to make drugs (or whatever) harder to obtain cannot make anyone, even addicts, better off (at least directly); private policies adopted towards the same end also would not make sense -- and yet such private policies are commonly undertaken.
What separates rational addiction theory from most other approaches is that the basic description just provided is understood by the consumer as well as by the armchair addiction theorist. So when you make a choice to consume an addictive drug today, you recognize that today’s consumption will increase your desire for the drug tomorrow.
Robust to What?
One of the participants in the George Mason workshop yesterday asked why I focused on policies that are robust to the amount of rationality or self-control shortcomings among vice participants, when there are many other dimensions along which we might want robustness. For instance, we might want regulations that are robust to potential capture attempts by the regulated, or are robust to government empire-building. Once again, I did not have much in the way of ready response. Now, I think, I would mention that these other sorts of robustness, which may well be important, apply to essentially all areas of regulation. Self-control problems are central to the "traditional vices" -- a phrase itself that rightly came under some scrutiny -- and so it makes sense to reflect this centrality in thinking about desirable vice policies. One and one-third of the standard three and one-third vice concerns are addiction and "internalities," and these are largely missing from most other policy areas, such as antitrust or environmental policy. The robustness principle is aimed directly at these one and one-third concerns.
What I did mention is that while I am confident that attention to "robustness to rationality shortfalls" is essential to desirable vice policies, I often find myself less certain about the importance of some of the other purported problems. For instance, some people argue against a special sin tax on alcohol because once you start taxing alcohol in an exceptional manner, you will pave the way for higher and higher taxes and eventually serve a neo-prohibitionist agenda. But other people worry about a nearly opposite problem, that any special regulations will be undermined by moneyed alcohol interests. Which way do these political economy arguments cut, that sin taxes tend to rise, or to fall?
Regulating Vice at George Mason
Thanks to Pete Boettke, I was able to give a talk (or participate in a discussion, rather -- the majority of my talk outline was skipped entirely) at George Mason University today, in the Philosophy, Politics and Economics workshop. My negligible sleep Monday night was poorly compensated for by lots of caffeine, but I managed to learn a lot and to enjoy the experience (which might make me unique among today's workshop participants). I'd say the most recurrent issue with my general approach to vice was a concern that my embrace of regulations might lead to all sorts of matters being declared to be vices, whereupon government would generate tons of new, counterproductive controls. [I am tempted to make a bad historical pun by saying that George Mason was constitutionally opposed to my approach to vice.]
My general response to the potential overinclusiveness of the definition of vice was along the lines of, "Maybe, but the robustness principle ensures that the costs of taking the notion of vice too far will not be very high. Further, even without the robustness principle, your favorite activity could be declared to be a vice, and then it might even be banned." (Ask the folks who enjoy alcohol inhalers, or marijuana.) [I should mention, though, that one friend in the audience reported that after an hour and a half, he still didn't really understand this robustness principle, so I must have been pretty incoherent -- maybe I shouldn't have skipped most of the outline?]
There was more at GMU, of course, and perhaps I will blog again as I process it. But one point that I find interesting is how different audiences respond in such varied ways to the robustness principle. Non-academics (or perhaps non-economists) focus on the fact that I would allow legal (though regulated) markets for heroin and adult prostitution; economists typically don't bat an eye at the legal heroin, but are concerned that my approach might be used to tax fatty or sugary foods. There's something to be said for perturbing everyone, no?
George Mason, of course, is (among other things) ground zero for econoblogs, and Pete's workshop has a very nice vibe.
Hand Rub as a Beverage Alcohol Surrogate
Back in May Vice Squad noted the frequency with which surrogates -- substances containing alcohol but not intended for ingestion -- are consumed in Russia. On Friday the BBC reported that alcohol-based hand rubs, placed near patient beds in hospitals to help fight against the spread of germs, have become a surrogate in NHS facilities. Sometimes the rubs are drunk by confused patients, but some ingestions are motivated by alcohol cravings. As terrible as the hand rub consumption sounds, at least it is unlikely to lead to one possible, dire health hazard of binge drinking, as reported by the BBC earlier in November.
A Euro 2000 Hooliganism Tale
It has been a while since Vice Squad drew upon Paying the Tab, Phil Cook's alcohol control monograph. On page 151, Phil recounts the story of the Euro 2000 soccer tournament, which was hosted by Belgium and the Netherlands. The Dutch city of Eindhoven elected to combat British soccer hooliganism by reducing the alcohol content of beer sold during the tournament ("Festival Beer") to 2.5 percent, about half or less of the standard beer alcohol content. (Phil doesn't mention it, but Eindhoven also chose to further liberalize the rules surrounding cannabis, hoping to entice visiting soccer tourists out of the bars and into the coffee shops.) At any rate, the low-alcohol gambit seemed to work, as the England supporters were fairly well-behaved in the Netherlands, especially relative to their comportment in Belgium. Less successful was an attempt in Rome this year to ban alcohol sales for 24-hours around an important football match involving Manchester United; a cannabis tolerance in Portugal for Euro 2004 worked out fine, it seems -- the main violence around the tournament emanated not from the host country, but from a Portuguese-owned pub in England.