July 10, 2005

The Meth Epidemic

A lot of reports have been coming out lately on how methamphetamines are the newest drug plaguing the nation. Expect a Time cover story soon; War on Drugs to follow, etc. Awesome. Anyway, it's clearly the case that less attention should be paid to kids smoking pot in high school and much more on the meth problem creeping across the Southwest. And because that's so obvious, it probably won't happen. So it goes. What would be interesting, though, is to figure out how this sort of "plague" actually spreads. Is it linear? Does use keep spreading and spreading without bound until someone does something about it? Or maybe not. Maybe it's more like the Game of Life.

For instance, in the 1970s, cocaine use picked up around the country, became widely popular in the mid-1980s, and then dropped off. Of course, this "drop-off" is deceiving—in the late 1980s the total number of cocaine users fell, but the quantity consumed stayed constant, indicating that there were more heavy users out there. Since heavy users are the bulk of the problem—they overdose the most, they're most likely to be unproductive at their job or commit crimes—that means the problems haven't really subsided, even if the "plague" has. Now that drop in total users is often chalked up to the success of the "War on Drugs". And indeed, the percentage of young adults reporting cocaine use in the past 30 days dropped considerably in the 1980s. (It rose in the late 1990s, but not close to its previous levels.)

But what if drug epidemics follow their own natural tide and ebb? Since we know that drug use is spread primarily through social contacts, it may not follow a linear pattern. Perhaps it goes something like this: light drug use spreads through social networks. Soon the drug becomes popular. More heavy users start to appear, and the media starts picking up horror stories—like one that came out a few weeks ago about "meth mouth". New and widely-publicized research brings the bad effects of drugs to light. (Or those bad effects become apparent among friends, people you know, etc.) Eventually the social networks are all tapped out—drug use has spread to as many of your friends as it's going to spread to—and light use starts to decline, leaving only the heavy users. Plus aging probably has much to do with it. But anyway, this rise and fall might have nothing whatsoever to do with government policy.

So that's one problem with measuring the success of the "War on Drugs." Perhaps cocaine use would have fallen on its own in the mid-1980s no matter what. Alternatively—perhaps the epidemic was just picking up momentum, and use would have been even more widespread in the absence of Reagan's "War on Drugs." Who knows? Cause and effect becomes pretty difficult to untangle. Meanwhile, critics note that the price of drugs fell dramatically over the past decade, as "proof" that policy has failed. But a hundred different factors could account for this: advances in communications and shipping technology, port security weakened by the rise in global trade, a more sophisticated international market. Again, it's possible that in the absence of the War on Drugs, drugs would have been even more available. (As it happens, I do think the war on drugs is a wretched failure; just not for these reasons.)

Anyway, back to meth: The problem here, I think, is that if drug epidemics do have a natural ebb and tide, that seems like a big deal, and something you want to tailor drug policy around. For instance, law enforcement strategies—which make up the bulk of the War on Drugs budget—would be far more effective early on, when there are fewer dealers. On the other hand, treatment isn't very effective at reducing consumption early in the cycle because there aren't many heavy drug users. Later on, it's the reverse—treatment's vastly more effective, law enforcement less so. Likewise, if an epidemic's already peaked, then prevention strategies—like D.A.R.E. in schools or TV ads—are sort of a waste of money, whereas they seem to be fairly cost-effective early on. (That is, they're somewhat useless, but also incredibly cheap.)

Now the problem is this: Looking at the White House's National Drug Control Strategy budgets, the three big drug policy measures—law enforcement, treatment, prevention—always seem to take a more or less constant share of the budget over time. More to the point, the proportions here seem to be roughly the same as they were back in 1996. Now maybe this is all well and good. Still, if we're in the midst of an epidemic featuring, as one sheriff puts it, "absolutely the worst kind of drug the nation has ever seen," and if drug use has its own natural cycle, then we should see these proportions change quite dramatically over time, no? But that doesn't seem to be the strategy here.

Anyway, I find drug policy pretty fascinating, though it would be depressing to study or research this stuff full-time: In no other area of government do the facts matter so incredibly little when setting policy.
-- Brad Plumer 3:20 PM || ||