The War on Drugs: Methamphetamine, Public Health and Crime

The War on Drugs: Methamphetamine, Public Health and Crime

Carlos Dobkin, Nancy Nicosia

Background on Methamphetamine

• Methamphetamine is typically sold in powdered form. It is usually inhaled, but may also be ingested orally or injected.

• Slows dopamine uptake and creates a euphoric state• Some users experience violent and psychotic episodes

– Hallucinations, paranoia, depression

• Some users experience adverse physical symptoms– Chest pains, headaches

• Users surveyed in Queensland reported committing both property and violent crimes.

Methamphetamine Abuse Is a Growing Problem in the U.S.

• In the 1980s methamphetamine was used primarily by adult white males in western states– Use is increasing among minorities, women and high

school students– Nearly one-third of state and local enforcement

agencies surveyed in 2003 rated methamphetamine as one of the greatest drug threats in their area (NDIC 2003)

• There has been lots of attention to the methamphetamine problem in the press. (e.g. NYTimes 2/10/2005)

Drug Treatment Admissions in the United States - Amphetamines, Cocaine and Heroin

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The Government Has Three Strategies to Curb Illegal Drug Use

• Prevention: Education and community action – Discourage people from starting to use drugs– $2B budget in 2005– Demand side intervention

• Treatment: Programs for drug users– Get people who use drugs to stop– $4B budget in 2005– Demand side intervention

• Enforcement: Reduce Availability– $6B budget in 2005– Supply side intervention– Unlike treatment and prevention experimental evaluation is not

feasible

Goals of this Study

• Examine the impact of an extremely successful DEA enforcement effort in the methamphetamine precursor market on:– Price and purity of methamphetamine– Hospitalizations and drug treatment admissions for

methamphetamine– Property crime, violent crime and drug crime

Evidence of the Effect of Reducing Methamphetamine Supply

• Cunningham and Liu (2003) find that regulation of precursors reduces methamphetamine hospitalizations.

• Abt Associates (2000) find that a 1% increase in methamphetamine prices reduces consumption by 1.48%

• Numerous studies of price elasticity of cocaine and heroin in U.S. (DiNardo 1993, Yuan and Caulkins 1998, Caulkins 2000 …)

• These studies have some limitations– They are identified of changes in price with unknown sources.– They typically use data aggregated to the year and state level

potentially masking temporary or local changes.– They do not examine the direct effect of enforcement on

outcomes of interest such as crime and adverse health events.

Methamphetamine Production Is Dependent on Precursor Availability

• Methamphetamine is “cooked” in illegal drug labs using either ephedrine or pseudoephedrine as a precursor

• Ephedrine or pseudoephedrine have many legal uses.– Over the counter medicine such as Sudafed and Tylenol Cold

contain pseudophedrine

• The DEA works to keep these chemicals from getting diverted to illegal uses

Significant Precursor Legislation (1989-2000)

• October 1989: Chemical Diversion and Trafficking Act– Regulated bulk ephedrine and pseudoephedrine

• August 1995: Domestic Chemical Diversion Control Act (DCDCA) – Removes the record keeping and reporting exemption for single

entity ephedrine products.• October 1996: Methamphetamine Control Act

– Regulates access to over the counter medicines containing ephedrine.

• October 1997: Methamphetamine Control Act – Regulates products containing pseudoephedrine or

phenylpropanolamine• July 2000: The Methamphetamine Anti-Proliferation Act

– Establishes thresholds for pseudoephedrine drug products.

Significant Precursor Interventions Resulted from the DCDCA

• Two large interventions occurred in May 1995 – Clifton Pharmaceuticals: 25 metric tons of ephedrine and

pseudoephedrine– Xpressive Looks International: Distributed about 830 million

ephedrine tablets (over 18 months)

• Scale of two interventions is enormous– Production potential was 29 metric tons of methamphetamine– DEA seized only 762 kilograms of methamphetamine in 1994

(DEA STRIDE)– ONDCP estimated total methamphetamine consumption was

34.1 metric tons in 1994

Our Analysis Relies on Detailed Data from a Variety of Sources

• Census of DEA seizures & purchases• Census of California hospitalizations• Census of drug treatment admissions in California• Survey and drug test of a non random sample of

arrestees for three California cities • Monthly reported crimes and arrests in California by

jurisdiction

Figure 2A: Methamphetamine Price and Purity in California

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Figure 2B: Methamphetamine Price in California by Size of Purchase

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Figure 2C: Methamphetamine Purity in California by Size of Purchase

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Figure 3: Methamphetamine Related Hospital and Drug Treatment Center Admissions

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Amphetamine Cocaine Opioid All AdmissionsPsychoses 0.219 0.209 0.089 0.045Alcohol/drug abuse or dependence, detoxification or treatment 0.163 0.150 0.184 0.010Delivery of Baby 0.112 0.070 0.029 0.148Alcohol/drug abuse or dependence, left against medical advice 0.033 0.043 0.067 0.002Depressive neuroses 0.041 0.022 0.016 0.005Poisoning & toxic effects of drugs age >17 with complications, comorbidities 0.037 0.037 0.033 0.004Alcohol/drug dependence, combined rehabilitation & detoxification therapy 0.034 0.050 0.048 0.002Other 0.361 0.419 0.533 0.784Observations 72,229 92,036 97,896 10,383,151

Diagnosis Related Group of Admissions for People With Amphetamine, Cocaine or Opioids Mentioned on the Admission Record

Notes: This for hospital admissions among people older than 8 in California for the 1994-1997 period. Not all admissions are tested for drug use.

California Hospital Admissions with Amphetamine Mentioned on Record by Diagnosis Related Group

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Figure 4A: Drug Treatment Admissions in California by Referral Route

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Figure 4B: Drug Treatment Admissions in California by Treatment Type

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Figure 5A: Cocaine Price and Purity in California

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Figure 5B: Heroin Price and Purity in California

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Figure 6B: Regional Cocaine Purity

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Figure 7: Hospital and Drug Treatment Admissions in California

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The Interventions Resulted in Temporary Changes in Prices, Purity, and Adverse

Health Outcomes• There was a large though temporary increase in prices

– Price increased from $30 to $100 – Prices returned to pre-intervention levels within four months

• There was an enormous and longer-lasting impact on purity – Purity declined from 90% to 20%– Purity required 18 months to recover to near pre-intervention

levels• There was a substantial decline in adverse health

outcomes associated with methamphetamine– Amphetamine-related hospitalizations declined by 50%– Methamphetamine-related treatment admissions declined by

35%– Changes in health outcomes track the purity rather than prices

Drug Testing Revealed All Arrests Property Crime Violent Crime Drug Arrests Marijuana 0.34 0.36 0.32 0.36 Cocaine 0.26 0.29 0.17 0.41 Opiates 0.07 0.08 0.03 0.10 Methamphetamine 0.17 0.14 0.12 0.32Survey Reported Methamphetamine Use Last 72 Hours 0.09 0.07 0.05 0.20 Last 30 Days 0.15 0.12 0.10 0.28 Have used ever 0.30 0.26 0.23 0.44 Times in Last Month if > 0 11.03 11.31 9.04 12.54Spent Some Money on Drugs in Last Month 0.32 0.35 0.21 0.49At Time of Arrest Under Influence of Drugs or Alcohol 0.28 0.23 0.27 0.36 Need Drugs or Alcohol 0.08 0.09 0.04 0.12Monthly Income and Spending Percent Reporting Legal Income 0.73 0.71 0.81 0.79 Percent Reporting Illegal Income 0.15 0.19 0.07 0.22 Legal Income 771 647 1,073 696 Illegal Income 275 343 123 416 Money Spent on Drugs 124 167 53 152Observations 16,584 6,231 3,838 2,998

Table 1A: Drug Use and Sources of Income by Type of Crime in San Diego, Los Angeles and San Jose 1994-1997

Note: The drug test used is EMIT screening which is known to be sensitive to false positives. Positive methamphetamine tests are confirmed using gas chromatography. Tests will pick up cocaine, heroin and methamphetamine use in the 3-5 days prior to the test. Arrestees are tested within 48 hours of arrest.

Figure 8A: Methamphetamine Use Among Arrestees in San Diego, Los Angeles and San Jose (Smoothed with a Moving Average)

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Figure 8B: Positive Methamphetamine Test Among Arrestees in San Diego, Los Angeles and San Jose by Crime Type (Smoothed with a Moving Average)

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Figure 8C: Proportion of Arrestees Reporting Ever Having Used Methamphetamine in San Diego, Los Angeles and San Jose by Crime Type (Smoothed with a Moving Average)

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Reported Ever Using

Methamphetamine

Reported Using Methamphetamine in the Last Month

Positive Urine Test for

MethamphetaminePositive Urine Test Marijuana 0.34 0.36 0.36 0.34 Methamphetamine 0.17 0.42 0.68 1.00 Cocaine 0.26 0.21 0.14 0.13 Opiates 0.07 0.09 0.06 0.06Reported Use in Last Month Marijuana 0.41 0.57 0.67 0.56 Methamphetamine 0.15 0.50 1.00 0.59 Cocaine 0.10 0.14 0.15 0.09 Opiates 0.04 0.08 0.07 0.04Reported Ever Using Marijuana 0.77 0.97 0.96 0.93 Methamphetamine 0.30 1.00 1.00 0.75 Cocaine 0.40 0.72 0.71 0.62 Opiates 0.12 0.26 0.24 0.18Arrestees 16,584 4,971 2,462 2,799

Table 3: Poly Drug Use Among Methamphetamine Users

Notes: These are computed from a sample of arrestees in San Diego, Los Angeles and San Jose for the 1994 to 1997 period

Figure 8D: Positive Drug Test Among Arrestees in San Diego, Los Angeles and San Jose Who Report Ever Having Used Methamphetamine (Smoothed with a Moving Average)

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Some Evidence of Substitution to Other Drugs

• Poly drug use is high among arrestees– Methamphetamine users also use cocaine, heroin and marijuana

• There is some evidence that some methamphetamine users are switching to cocaine and heroin – Decline in cocaine purity– Increase in positive cocaine and heroin tests among arrestees

who reported ever using methamphetamine

• Still a very large overall reduction in drug use

There is Evidence of an Association Between Methamphetamine Use and Crime

• Drug use is common among people arrested for property crimes, violent crimes and drug crimes

• Proportion of arrestees testing positive for methamphetamine for all three crime categories drops as a result of the intervention.

• How a reduction in methamphetamine supply might impact crime rates is not clear– Property crime may rise or fall depending on the price elasticity

of consumption– Violent crime due to the pharmacological effects of

methamphetamine may fall– Violent crime due to the enforcement of property rights may fall– Drug crime: arrests for possession and sale are likely to fall as

there are fewer transactions to conduct

Figure 9: Reported Property Crime in California

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Figure 11A: Felony Drug Arrests in California

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Figure 11B: Misdemeanor Drug Arrests in California

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Figure 12: Amphetamine Hospitalizations Rate by Amphetamine Hospitalization Rate of County

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0 - 0.33 Admissions Per Month Per 10K Residents

0.33 - 0.51 Admissions Per Month Per 10K Residents


More than 1.15 Admissions Per Month Per 10K Residents

Figure 13A: Homicide Rate by Amphetamine Related Hospitalization Rate of County

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Figure 13B: Larceny Rate by Amphetamine Related Hospitalization Rate of County

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Burglary Larceny MV Theft Rape Robbery Homicide Assaults2.270 4.327 2.714 0.070 0.226 0.005 0.979

[0.782] [2.101] [1.042] [0.030] [0.214] [0.007] [0.371]

Observations 2,784 2,784 2,784 2,784 2,784 2,784 2,784R-squared 0.720 0.570 0.530 0.260 0.860 0.460 0.540Dep. Var. Mean 16.065 39.326 12.857 0.449 4.581 0.149 7.957

Table 2A: Cross-Sectional Regression of County Level Reported Crime Rates on County Level Amphetamine Hospital Admissions Rates

Rate Amphetamine Admissions

Notes: All regressions are at the county level by month. The regressions include year effects, month dummies, proportion black and Hispanic in county and the proportion of the population in various age categories. The regressions are weighted by county population age 15 to 44. The regressions include all California counties between 1994 and 1997. The mean amphetamine admission rate is 0.7246. The means of the dependent variables are calculated from January 1994 - June 1995.

Felony Narcotics

Felony Dangerous

DrugsFelony Other

Drugs Felony MJ

Misdemeanor Dangerous

Drugs

Misdemeanor Other Drug

LawsMisdemeanor Glue Sniffing


0.028 1.693 0.071 0.105 -0.050 0.562 -0.038 -0.054[0.138] [0.201] [0.042] [0.066] [0.040] [0.339] [0.021] [0.180]

Observations 2,784 2,784 2,784 2,784 2,784 2,784 2,784 2,784R-squared 0.830 0.710 0.250 0.410 0.310 0.320 0.130 0.320Dep. Var. Mean 2.939 2.943 0.118 0.615 0.104 3.575 0.062 1.382

Notes: All regressions are at the county level by month. The regressions include year effects, month dummies, proportion black and Hispanic in county and the proportion of the population in various age categories. The regressions are weighted by county population age 15 to 44. The regressions include all California counties between 1994 and 1997. The mean amphetamine admission rate is 0.7246. The means of the dependent variables are calculated from January 1994 - June 1995.

Table 2B: Cross-Sectional Regression of County Level Drug Arrest Rates on County Level Hospital Amphetamine Admissions Rates


Burglary Larceny MV Theft Rape Robbery Homicide Assaults0.379 1.095 0.402 -0.008 -0.032 0.008 -0.071

[0.244] [0.518] [0.212] [0.016] [0.077] [0.005] [0.179]

Observations 2,784 2,784 2,784 2,784 2,784 2,784 2,784R-squared 0.91 0.93 0.90 0.44 0.96 0.57 0.84Dep. Var. Mean 16.065 39.326 12.857 0.449 4.581 0.149 7.957

Table 3A: County Level Fixed Effect Regressions of Reported Crime Rates on County Level Hospital Amphetamine Admissions Rates

Notes: All regressions are at the county level by month. The regressions include county fixed effects, year effects, month dummies, proportion black and Hispanic in county and the proportion in various age categories. The regressions are weighted by county population age 15 to 44. The regressions include all California counties between 1994 and 1997. The mean amphetamine admission rate is 0.7246. The means of the dependent variables are calculated from January 1994 - June 1995.


Felony Narcotics

Felony Dangerous

DrugsFelony Other

Drugs Felony MJ


Drugs




0.019 0.740 -0.010 -0.020 -0.007 0.554 -0.023 -0.102[0.051] [0.102] [0.020] [0.028] [0.012] [0.131] [0.015] [0.042]

Observations 2,784 2,784 2,784 2,784 2,784 2,784 2,784 2,784R-squared 0.91 0.84 0.71 0.68 0.65 0.80 0.45 0.58Dep. Var. Mean 2.939 2.943 0.118 0.615 0.104 3.575 0.062 1.382

Table 3B: County Level Fixed Effect Regressions of Drug Arrest Rates on County Level Hospital Amphetamine Admissions Rates

Notes: All regressions are at the county level by month. The regressions include county fixed effects, year effects, month dummies, proportion black and Hispanic in county and the proportion in various age categories. The regressions are weighted by county population age 15 to 44. The regressions include all California counties between 1994 and 1997. The mean amphetamine admission rate is 0.7246. The means of the dependent variables are calculated from January 1994 - June 1995.


Burglary Larceny MV Theft Rape Robbery Homicide Assaults0.174 1.845 0.133 -0.01 -0.25 -0.001 -0.211

[0.644] [0.837] [0.351] [0.036] [0.093] [0.019] [0.284]

Observations 348 348 348 348 348 348 348R-squared 0.95 0.95 0.96 0.58 0.98 0.65 0.85Dep. Var. Mean 16.065 39.326 12.857 0.449 4.581 0.149 7.957

Table 4A: Pre Post Regressions of County Level Reported Crime Rates on County Level Hospital Amphetamine Admissions Rates


Notes: All regressions are at the county level by month. The regressions include county fixed effects, year effects, month dummies, proportion black and Hispanic in county and the proportion in various age categories. The regressions are weighted by county population age 15 to 44. The regressions include all California counties between April and June of 1995 and October and December of 1995. The mean amphetamine admission rate is 0.7246. The means of the dependent variables are calculated from January 1994 - June 1995.

Felony Narcotics

Felony Dangerous

DrugsFelony Other

Drugs Felony MJ


Drugs




-0.15 1.028 -0.056 -0.058 0.011 0.532 -0.057 -0.23[0.127] [0.195] [0.048] [0.082] [0.022] [0.291] [0.037] [0.134]

Observations 348 348 348 348 348 348 348 348R-squared 0.97 0.91 0.8 0.72 0.83 0.85 0.37 0.74Dep. Var. Mean 2.939 2.943 0.118 0.615 0.104 3.575 0.062 1.382Notes: All regressions are at the county level by month. The regressions include county fixed effects, year effects, month dummies, proportion black and Hispanic in county and the proportion in various age categories. The regressions are weighted by county population age 15 to 44. The regressions include all California counties between April and June of 1995 and October and December of 1995. The mean amphetamine admission rate is 0.7246. The means of the dependent variables are calculated from January 1994 - June 1995.

Table 4B: Pre Post Regressions of County Level Drug Arrest Rates on County Level Hospital Amphetamine Admissions Rates


Burglary Larceny MV Theft Rape Robbery Homicide Assaults-0.88 2.273 1.199 -0.118 -1.199 -0.048 -2.063

[2.298] [3.549] [1.976] [0.119] [0.720] [0.050] [1.415]

Observations 2784 2784 2784 2784 2784 2784 2784R-squared 0.91 0.93 0.9 0.43 0.96 0.56 0.82Dep. Var. Mean 16.065 39.326 12.857 0.449 4.581 0.149 7.957

Notes: All regressions are at the county level by month. The regressions include county fixed effects, year effects, month dummies, proportion black and Hispanic in county and the proportion in various age categories. The regressions are weighted by county population age 15 to 44. The instrument takes on a value of 1 between September 1995 and June 1996. The mean amphetamine admission rate is 0.7246. The means of the dependent variables are calculated from January 1994 - June 1995.

Table 7A: IV Regressions of County Level Crime Rates Regressed on County Level Hospital Amphetamine Admissions Rates


Felony Narcotics

Felony Dangerous

DrugsFelony Other

Drugs Felony MJ


Drugs




1.305 4.805 0.047 -0.488 -0.04 2.276 -0.038 -0.61[0.827] [0.795] [0.106] [0.129] [0.089] [0.829] [0.064] [0.304]

Observations 2784 2784 2784 2784 2784 2784 2784 2784R-squared 0.89 0.59 0.71 0.64 0.65 0.75 0.45 0.57Dep. Var. Mean 2.939 2.943 0.118 0.615 0.104 3.575 0.062 1.382Notes: All regressions are at the county level by month. The regressions include county fixed effects, year effects, month dummies, proportion black and Hispanic in county and the proportion in various age categories. The regressions are weighted by county population age 15 to 44. The instrument takes on a value of 1 between September 1995 and June 1996. The mean amphetamine admission rate is 0.7246. The means of the dependent variables are calculated from January 1994 - June 1995.

Table 7B: IV Regressions of County Level Crime Rates Regressed on County Level Hospital Amphetamine Admissions Rates


Figure 14: Purity and Health and Crime Outcomes

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Treatment Admissions

Hospital Admissions

Felony Dangerous Drugs

Misdemeanor Other Drug Laws

Arrestee Positive Test

Purity

The 1995 DEA Intervention Had a Large, Temporary Impact on Adverse Outcomes

• Price jumped from $30 per gram to $100 per gram and Purity declined from 90% to 20%

• Hospital admissions for methamphetamine declined by 50%

• Treatment admissions for methamphetamine declined by 35%

• Methamphetamine use declined by 55% among arrestees and some arrestees switched to cocaine and heroin.

• Felony arrests for “Dangerous Drugs” declined by 50%• Misdemeanor arrests for “Other Drug Laws” declined by

25%• The decrease in methamphetamine availability may have

slightly reduced larcenies and motor vehicle thefts• No discernable reduction in violent crime

Conclusions

• Supply interdictions can reduce the rates of adverse health outcomes

• A reduction in drug supply will result in a reduction in the number of drug arrests

• Supply interdictions may reduce some property crimes – specifically larceny and motor vehicle thefts.

• Lack of a large impact on violent crime or property crime suggests either: – Methamphetamine consumption does not cause large amounts

of these crimes or– Interdiction may not be an effective way of reducing the crime

caused by methamphetamine use• Despite this enormous success on the part of DEA the

supply of methamphetamine recovered fairly rapidly.

Documents

The War on Drugs: Methamphetamine, Public Health and Crime