Euphoriant substitution: a small step towards a much better world.

People want to have a good time; that much is a given. More stringently, we may argue that man is a pleasure-seeking animal and for this very reason, he will go to great lengths to achieve this pleasure. One of the ways is through the use of euphoriants (broadly construed), that is, chemicals used with the purpose of inducing pleasure. This much seems to be a given across cultures: if there is access to euphoriants, people will use them – and they will even incur great disutility to enable this use (case in point: “prison wine“, a truly horrible concoction brewed in prisons).

 

However, these euphoriants affect the body differently. They induce different highs, and some do great harm to the organism, while others are less harmful. They also differ in price. These differences form the basis for substitution in euphoriant use: I might choose to smoke a joint instead of drinking a pair of pints with a friend, because I have work tomorrow and know from experience that I tolerate cannabis much better than alcohol, etc.* This forms the basis of the utilitarian argument for marijuana reform: that because some people tolerate cannabis better, do less harm to their environment when using cannabis instead of alcohol, etc., they should be allowed to partake in the use of this. Simply put, cannabis is harmful, but if it is less harmful than alcohol in typical use, people substituting into cannabis use would be a societal good.

 

What I find interesting is that while pharmaceutical innovation is generally high, we have seen very little innovation from pharma companies when it comes to euphoriants. Certainly, there is black market innovation, which has led to the so-called “designer drugs”, but these drugs are plagued by the normal problems with drugs: no follow-up on effects, no testing prior to release, etc. The reason for this lack of corporate innovation when it comes to euphoriants is certainly not due to low ROI; the drug market is a large a market as ever. Rather, it is due to the fact that in many legal frameworks, it is the very capacity of inducing euphoria that is illegal, not the adverse effects – for example, in the Danish Law on Euphoriants (§1, link in Danish).

 

It is well-known that MDMA (ecstasy) has very few adverse effects, compared with other euphoriants**. For this reason, one could argue that MDMA should be legalised to allow more efficient substitution into this drug from more harmful drugs such as alcohol. However, my main point is that pharma companies should be able to develop varieties of, say, MDMA, which reduces the adverse effects even further and allows substitution into these drugs, reducing adverse effects much more. This would be a small, but important step, towards a better world. However, as long as it is the very ability to induce euphoria that is illegal, we will not see progress in this area.

*) This blog does not endorse the use of any euphoriant except mathematics.
**) Of course, the only euphoriant truly free of adverse effects is this.

What’s your implicit model?

I recently read this article (nb: in Danish), where the pediatrician Morten Staberg argues against the legality of circumcision from a medical perspective. I’m not going to address his points, because I doubt that I’ll be able to offer valid points on the medical aspects per se.

Rather, I’d like to focus on one point, where I’m disagreeing with him: what’s the comparison model? He is (implicitly) comparing the current practice of circumcision in Denmark with a state of no circumcision – which is wrong! If you criminalize circumcision, you’ll reduce the number of circumcisions, but you won’t eradicate it. And those who illegally continue to perform circumcision on children will do so in worse sanitary conditions for being forced underground and will be more reluctant to seek out medical advice if adverse effects arise.

In this aspect, it ties in with the prostitution debate: making prostitution illegal won’t eradicate it, but it will lead to some bad effects for the persons involved. We shouldn’t compare the current legal state of prostitution with a state wherein nobody is a prostitute, because that’s not what will result from a ban. The same goes for circumcision.

It’s all about living in the real world.

Accept no substitutes? Vol. II

The city I grew up in – Aalborg in Northern Jutland – recently passed a resolution by the city council, which meant that e-cigarettes are subject to the same regulations in terms of smoking on public property as regular cigarettes. I believe this is a bad idea – and I’d like to explain why, as this underscores how one should think about substitution in terms of public policy.

Background
The e-cigarette is technically a vaporiser, in which a fluid containing nicotine and aromatic components are vaporised with the purpose of inhalation. The base of this fluid is propylene glycerol and vegetable glycerin – common food additives. 

Over the last ten years, more and more restriction on tobacco smoking has come into place in Denmark, including municipalities regulating the smoking of tobacco on municipal grounds – even outside. Recently, the Aalborg City Council stipulated that this ban extends to the e-cigaretes mentioned above (nb: link in Danish).

 

Externalities
One of the main arguments presented is the fact that second-hand vapor might have adverse effects, i.e. that there might be carcinogenic or otherwise adverse effects of second-hand inhalation, akin to the well-documented risk from second-hand smoke. This is a serious risk that needs to be assessed, since nicotine itself might be carcinogenic (Toxicol. Sci. 2004). As such, there might be a valid argument from externalities that such products should be regulated. However, very little research exists on this topic. One might then prefer to err on the side of caution.

Substitution effect
What the city council and others, who argue for the regulation of e-cigarettes haven’t considered properly, is the effect of regulation on consumption substitution. People who smoke e-cigarettes tend to use them primarily as substitutes for regular cigarettes, and this substitution was prompted, in part, by the smoking regulations enacted. When it was illegal to smoke a cigarette, but legal to smoke an e-cigarette at a bar or restaurant, the “cost” of the e-cigarette went down compared to the ordinary cigarette, while utility was held constant – leading people to switch consumption to e-cigarettes (i). Increasing the cost of e-cigarettes by subjecting it to the same legal constraints as ordinary cigarettes then decreases the marginal benefit of using an e-cigarette instead of an ordinary cigarette – which should inhibit the substitution rate and might even lead to people switching back to the ordinary cigarette!

While both the short-term and long-term health effects of e-cigarette smoking is relatively unknown, I would venture the guess that they’re milder than those of ordinary cigarettes, since there is no tar, benzene etc. in the vapour inhaled. This means that people substituting e-cigarettes for cigarette consumption is reducing their own risk of disease, and indirectly following from this, e-cigarette substitution has positive externalities under a regimen of socialised medicine.

The point
The point of this post is not to argue in favor of e-cigarettes or whether or not one should ban them or their use in public facilities. Rather, the problem is that when you’re raising the cost of them without raising the cost on ordinary cigarettes at the same time, you’re making it less attractive to take up e-cigarettes instead of ordinary smoking. The analysis of the City Council and the sources they cite is not technically wrong, but they consider the wrong comparison: one should not consider e-cigarettes against tobacco abstention, but against smoking ordinary cigarettes, because that’s the usage frame indicated by actual human behaviour. 

This is exactly what ties this discussion in with the one about cannabis legalisation: people are comparing the use of cannabis to not using euphoriants, when they should actually compare it to using alcohol and evaluate those two scenarios against each other.

 

(i) One could argue that substitution should be much more rapid and wide-spread, considering the adverse long-term health effects of tobacco smoking. However, there is some empirical research indicating that smoking behaviour might be the result of greater time discounting, which would diminish the influence of long-term effects on substitution behaviour (see for example Kamijo et al. 2011)

Accept no substitutes?

Tonight, I saw a BBC programme, broadcast through Danish National Television on cannabis consumption. The programme must be applauded for it’s open-mindedness and fairness to the facts – with regards to both the benefits and hazards of cannabis use. However, one thing about it annoyed me: the host ended the programme with a remark about the hazards of cannabis use, and was keen to emphasise that cannabis (or rather, THC, the main psycho-active component of cannabis) has no place in a developing brain.
Of course I agree. No euphoriant is appropriate for developing brains or minds. But what does that really tell us about cannabis, per se? Not very much, I think.

One interesting thing about the debate on cannabis is that people tend to emphasise additional consumption, both in terms of consumer groups and consumptive behaviour and to de-emphasise substitution. If we are to have a real idea of the health effects of legalizing cannabis, we need to consider that people might drink a smaller amount of alcohol, because they’re supplementing with a joint. Or – similarly – kids shouldn’t smoke marijuana, just as they shouldn’t drink. But is cannabis a good or bad substitute for alcohol, when considering the impact on a developing brain?

There is some empirical evidence that people substitute cannabis for alcohol under liberalization, based on American data (Anderson, Hansen & Rees, hattip: Marginal Revolution). There is at least one positive health effect directly from this substitution, directly adressed in the paper through reduction of DUIs.

The total health effects of alcohol is the well known J-shape: moderate consumption (1-2 glasses of wine a day) is associated with lower risk than abstention, while consumption in excess of this amount leads to higher risk than either abstention or moderate consumption. Additionally, several clusters of adverse results from alcohol consumption is primarily associated with excessive intake – this goes primarily for accidents, etc.

What is interesting about the Hansen, Andersen & Rees paper is that they show that people substitute most heavily in these circumstances, i.e. by reducing binge drinking. In other words, they smoke cannabis when they would otherwise have gotten pissed, not (to the same extent) when they would have had a glass of Cabernet with the missus. This should inform our decision about legalisation in important ways.