Really Bad Arguments Against Repealing Drug Prohibition

This will not be a comprehensive argument in favor of drug legalization, just a list of really bad whoppers I have heard and my responses to them.

“There will be a huge surge in drug use.”

This is the most obvious objection, and it’s wrong for a number of reasons. In historical cases where the legal status of a drug has been changed, you just don’t see that large a demand response. In the United States most recreational drugs have been illegal for a very long time, so it's hard to say what demand was "before" and "after." But use rates have failed to respond to massive shifts in drug enforcement efforts. Also, massive changes in use rates of any particular drug have fluctuated wildly despite there not being any change in enforcement effort. In other words, neither the legal status nor the intensity of enforcement appears to affect usage rates by much. (The empirical evidence for this is fully fleshed out in Jeffrey Miron's Drug War Crimes and also in Matthew Robinson's Lies, Damned Lies, and Drug War Statistics. I'll stop there, because I don't want to list every book on my "drug policy" shelf.)

I think the people who say this are implicitly assuming that the only thing holding people back from drug use is the legal status of the drug, which is a very absurd assumption once you say it out loud. The main thing keeping people away from dangerous drugs are the inherent risks of addiction, social dysfunction, drug-related health problems, and overdose. People who are willing to endure these risks are not much affected by adding legal risks on top of these. The people who want do use these substances are already doing them. It is absurd to think that people are undeterred by the pharmacological risks of drug use but then respond strongly to the legal risks of drug use. (Remove the words "pharmacological" and "legal" from that sentence to see the absurdity. To make drug prohibition sound like a good idea, someone has to actually square this circle.) There isn’t an enormous pent-up demand that will surge forth if the dam of drug prohibition bursts.

“Bad guys will just find something else to do.”

I first heard this one at a debate on drug legalization at my undergraduate university, and I’ve heard it a few times since. This is the kind of thing that people can only say if they have not incorporated any economics into their worldview. Proponents of drug legalization often argue that much of the violence in society is due to black market crime. (Again, see Drug War Crimes, which has an entire chapter devoted to this topic.) Drug dealers killing each other over territory, killing witnesses, killing or beating subordinates, drug users retaliating against a dealer who ripped them off, etc. There really is quite a lot of this kind of violence. It makes up a significant fraction of total murders and assaults. This becomes very clear if you look at countries like Mexico or Columbia, where the violence is almost noticeable in everyday life. It exists in the United States, too, even if to a lesser degree.  

When you make something illegal, you don’t actually stop people from producing and selling it. All you do is ensure that the most violent individuals will be in charge of production and distribution. Simply put, there are more bad guys in the world because drug prohibition has made it more lucrative to be a bad-guy. The proponents of this argument are making some kind of daffy assumption that there is a fixed number of wrong-doers, regardless of the relative costs or rewards to being a wrong-doer. Most of these people are “law-and-order” types who love heavy criminal penalties, so it is truly stunning to hear them argue that the bad guys don’t actually respond to incentives.

To anyone who is committed to this viewpoint, we legalizers happily accept your surrender. If, by your own admission, bad guys will do bad regardless of the rewards or penalties they face, legalization is a no-brainer.

I suspect that this argument is simply an ad hoc attempt to deny one of the major benefits of drug legalization, given that it’s (usually) contrary to the speaker’s actual worldview. It’s the kind of argument you get when people try to “wrack up bullet-points” rather than actually think about what they are saying.

“Drug prices won’t fall much, so you’ll still have all the economic crimes by drug users trying to finance their habit.”

I heard this one recently, and it’s new to me. It’s another ad hoc attempt to dismiss an argument in favor of drug legalization, but in fact someone who takes this position seriously is actually making an incredibly strong case for legalizing drugs. The whole purpose of drug prohibition is to make drugs so expensive (in monetary and other costs) that people stop using them. If the drug warriors are ready to admit failure on this front, once again I’d happily accept their surrender. I don’t understand how someone could still favor drug prohibition after insisting that prohibition has failed to achieve its one true objective. Nevertheless, I have heard this claim more than once, and by people who put drug "offenders" in prison. Legalizers like me sometimes make the argument that if drug prices are allowed to fall to their true market value, there will be far less property crime from addicts trying to support a habit. These people can find real jobs and live lives with normal schedules, rather than constantly seeking their next fix and stealing or "hustling" to finance it. I view the "drugs won't get cheaper" argument as a pathetic attempt to deny this benefit. 

In actual fact, drug prohibition has increased the market price of drugs. The black-market markup has been exaggerated by some writers; it’s not in the “factor of 100” range that you sometimes hear. In “The Effect of Drug Prohibition on Drug Prices: Evidence from the Markets for Cocaine and Heroin”, Jeffrey Miron concludes that the black market price of cocaine is 2-4 times the legal price and heroin is 6-19 times the legal price. Not exactly a “factor of 100” (an extreme claim that Jeffrey Miron is attempting to tone down) but still a significant financial relief for the severe addicts who spend most of their resources feeding an expensive habit.

“Drug laws are a good way to arrest real criminals when those crimes are hard to prove.”

This one is shocking to the conscience. It is pretty disturbing to hear law-and-order types suggest that drug laws allow an end-run around the constitution, and that this is a feature rather than a bug. I’m sure they have a point. If you “know” someone is a criminal, it’s probably easier to pat them down and find a baggy of drugs than to actually discover evidence of a real crime. That being said, I’m always disturbed by the confidence that law enforcement types have in their own estimates of who is or isn’t guilty. 

I dearly hope that proponents of this argument aren’t actually saying that we should make something arbitrarily illegal just so the police and prosecutors can arrest and imprison whoever they want to. I suspect this is just a throw-away, “Oh, by the way…” kind of argument. Perhaps it doesn’t, on its own, support the policy of drug prohibition, but is in some sense a mitigating factor to an otherwise bad policy. I don’t approve of this viewpoint at all. In fact, I think that too many resources are diverted from policing real crimes to policing drug crimes, and that’s part of the reason for social decay in some neighborhoods. If not for drug prohibition, there wouldn’t be so many missing young men spending time in prison, there wouldn’t be as many shattered families, and there wouldn’t be so much distrust of the police. Under those circumstances, maybe the communities could actually forge some kind of relationship with the police, and real crimes would actually get solved because of the resulting cooperation.

That's it for now. I hate to do these "fish-in-a-barrel" responses to really stupid things that I've heard. I like Scott Alexander's concept of steel-manning an argument, as in "making the argument under scrutiny as strong as possible, even if the person delivering it wasn't very articulate or reasonable." But I've heard these silly claims so I might as well respond to them and say why they're wrong. I plan to eventually do a long round-up post that unifies arguments in favor of drug legalization made in several earlier posts. 

Welcome New Readers!

A recent post of mine got picked up by Scott Alexander in a link roundup. I was astonished to see the amount of traffic that came to my blog via that one link. I shudder to think what an entire Slate Star Codex post dedicated to the the topic might have done. I rarely get comments, but I got a few on the post. And I could tell that people were skimming my older posts, and even commenting on a few. Lurkers are of course perfectly welcome, but I appreciate any feedback I can get. I want to welcome new readers I've picked up in the past week or so.

I'm sure curious readers have perused my previous posts. If you're reading this on a computer or tablet, you should see my most-read posts on the right-hand side. I have a large number of posts arguing against drug prohibition starting around February 2016. I have a couple of posts about what thoughtful comments do and don't look like, here and here. I have a few scattered posts about so-called "inequality", how health insurance should work, and "moral outrage" as a debating tactic (one that I am finding increasingly obnoxious).

A few things I noticed.

Most people don't read all that carefully. That post, which attempts to debunk the standard narrative of the opioid epidemic, had at least a dozen links to prior posts by me which contained supporting information. Fewer than 10% of readers clicked on any of those. I'd hope that a larger share of readers would think, "Huh, is that really true? Why does he think that's true? Oh, there's a link arguing that this is true." Of course, many of those links were to places other than by own blog, and maybe people were scrupulously checking the various government documents and other articles I linked to. I promise that I'm doing my best and will never deliberately bend the truth, but I also sincerely hope nobody ever simply takes my word for anything I claim on this blog.

Some of the comments I got were great. And some were terrible. I made a couple of edits on my post after reading those comments (some here and some at SSC). One was to correct an error (one that I thought was not material, even to the very narrow argument in that particular paragraph). One was to clarify something that was not an error. (I called meditation "basically a placebo treatment", which should not be construed to mean I think meditation isn't effective for pain management. Just that I have an expansive definition of "placebo." After all, imagine doing an experiment where one group gets "real" meditation and the other gets "placebo" meditation as the treatment...) One thing I didn't care for was how easily people will conclude that you're deliberately lying. One comment, if I'm reading it correctly, implied that I was "lying about" a statistic cited in the Vox paper. Another implied that one of my claims was "dishonest." Is this how the rationalist community points out mistakes, and even disagreements that can't really be called "mistakes"? Mostly not, but it was a little bit grating to get this treatment over immaterial details. To say that somebody is "lying" implies something about their motives, which usually the accuser doesn't know. Anyway, the good comments outweighed the bad ones, and even the bad ones forced me to think harder about my arguments. (Bad commenters sometimes improve your understanding in the same way as a small child who keeps asking "Why?" to each successive answer.)

There were some excellent comments at Slate Star Codex about how people are actually using opioids. Consider it a small, random sample, but it's still illuminating. Considering the examples given (a broken arm, skin scraped to the bone, oral surgery), I'm very glad these people got powerful painkillers. I really hope that Vox does not have the effect on health policy that it wants to have, which would probably deny a few of these acute pain sufferers the relief they seek.

Free Medicine Doesn't Make People Healthier

This is from Free For All? Lessons from the RAND Health Insurance Experiment by Joseph Newhouse. It's not exactly a page-turner. It's more of an eat-your-vegetables kind of book. I've been thumbing through it recently. I am familiar with the conclusions (which I'll share below) because of the classic article Cut Medicine In Half by Robin Hanson. That piece was the lead essay in a Cato Unbound forum. I had thought that maybe Hanson drew some weird contrarian conclusions from the study. Indeed three other health policy wonks disagreed with him (err...without actually disagreeing with him; you'll have to see what they say and how they fail to meaningfully respond to Hanson).  Not contrarian at all, actually. Hanson was pretty much drawing the most straightforward possible conclusion from the RAND study. This slays some political sacred cows, but people should face the information with their eyes wide open. They shouldn't be engaging in casuistry to avoid the obvious. It's fine to speculate that "The effect of free medicine is clinically important, but it's hard to see in small datasets because of 'statistical significance' issues." But people who take such positions should admit that they are speculating beyond a straightforward interpretation of the best data we have on this question.

 Here's the relevant part (starting on page 201; emphasis mine):

For the average person there were no substantial benefits from free care (Table 6.6). There are beneficial effects for blood pressure and corrected vision only; ignoring the issue of multiple comparisons, we can reject at the 5 percent level the hypothesis that these two effects arose by chance, but we do not believe the caveat about multiple comparisons to be important in this case. We investigate below the mechanisms by which these differences might have arisen; the results from these further analyses strongly suggest that the results did not occur by chance.

For most health status measures the difference between the means for those enrolled in the free plan and those enrolled in the cost-sharing plan did not differ at conventional levels. Many of these conditions are rather rare, however, raising the possibility that free care might have had an undetected beneficial effect on several of them. To determine whether this was the case we conducted an omnibus test, the results of which make it unlikely that free care had any beneficial effect on several conditions as a group that we failed to detect when we considered the conditions one at a time. 

If the various conditions are independent and if free care were, for example, one standard error better than cost sharing for each measure, then of the 23 psychologic measures in Table 6.6 we would expect to see four measures significantly better on the free plan (at the 5 percent level using a two-tailed test), and none significantly worse. Among the insignificant comparisons, 15 would favor free care and only 4 would favor cost sharing. In fact three measures are significantly better on the free plan and none is significantly worse, but 13 of the 23 measures rather than the predicted 4 favor the cost-sharing plan. Hence it is very unlikely that free care causes one standard error of difference in each measure. If the independence assumption is violated, the violation is probably in the direction of positive dependence, in which case accounting for such dependencies would only strengthen our conclusion. Moreover, one standard error of difference is not a very large difference -- about half of the 95 percent confidence interval shown in the fourth column of Table 6 (equal, for example, to one milligram per deciliter of cholesterol). 

The same qualitative conclusions hold for persons at elevated risk (table 6.7). In this group, those on the free plan had nominally significantly higher hemoglobin but worse hearing in the left ear. Again outcomes on 13 of 23 measures favored cost sharing.

Staring at the top of page 204:

Hypertension and vision. Further examination shows that the improvements for hypertension and far vision are concentrated among those low-income enrollees at elevated risk (Table 6.8). Indeed, there was virtually no difference in diastolic blood pressure readings across the plans for those at elevated risk who were in the upper 40 percent of the income distribution. 

Because the low-income elevated risk group is small (usually between 5 and 10 percent of the original sample depending on the health status measure), the outcome differences for that group between the free and cost-sharing groups have relatively large standard errors. These results might be taken to mean that we missed beneficial effects for the low-income, elevated risk group for certain measures. But although this might be the case for a small number of measures, it is unlikely to be generally true. If we apply the same omnibus test just described to the low- and high-income groups shown in Table 6.8, we would expect that if there were a true one standard error favorable difference for the free plan for each measure, 2 of the 13 comparisons in Table 6.8 would be significantly positive and 2 would be negative, but none would be significantly negative. Of the 9 that would be insignificantly positive at the 5 percent level, 6 would have values of significance between 5 and 20 percent. The data in Table 6.8 show that for the low-income group, none (rather than 2) of the 13 comparisons is significantly positive at the 5 percent level; 4 (rather than 6) are significant at the 20 percent level; and 4 (rather than 2) are negative, one (acne) significantly so. For the high-income group, 7 of the 13 results favor the free-care plan, and the results are even "less significant" than one would expect at random (that is, one would have expected 2 or 3 differences "significant" at the 20 percent level among 13 comparisons, even if there were no true differences, whereas only one comparison was significant at this level).

Sorry, you'll need to get the book to see the actual charts. (I typed this while looking at my copy of the book and double-checked it. I sincerely apologize if I mistyped something, but on a double-check what I type matches what's in my book.) I like this concept of an "omnibus test." Note that the question isn't exactly "What dimensions of health improve when we give people free medicine," but rather a much more modest "Does free medicine improve health at all?" I like this exercise of saying, "What would I expect to see if free medicine had a significant effect on health?", comparing that to the observation, and concluding "What we predicted did not match what we observed." Keep in mind that the people with free care consumed something like 30-40% more medicine, apparently to no effect.

There is much more in the book, all in a similar vein. Giving people free medicine, even at-risk, low-income people, doesn't seem to make them any healthier. If someone want to take issue because the sample size is too small, I will join them in asking the RAND study to be redone with a much larger sample size. I won't stand for someone insisting that no data whatsoever, however carefully collected, can ever have policy implications that they don't approve of. That seems to be most of what I get from the popular media. Whenever there is a proposal to change health policy, there is a lot of shrill doom-saying by the proponents of socialized medicine. They speak as if any reductions made to the medical welfare state represent a lethal threat to people in poverty. I get the sense that they don't even realize they're making empirical claims. Well, we have the RAND study, and more recently the Oregon Medicaid Experiment. We have two randomized controlled experiments demonstrating that free medicine just doesn't seem to have health benefits, and we have tons of observational studies coming to the same conclusion.

The Proper Role of Legislature In Society

Most days I'm an anarchocapitalist. On my off days I'm an extreme minarchist. I've been thinking about what the proper role of a legislature is in society, including whether there is a place for such a thing in a world of zero or near-zero government. There probably is, but the role is a much smaller and more circumscribed role than the one played by the legislature in most modern democracies.

"But in anarchocapitalism," the naive response might begin, "don't you simply contract for everything? Isn't the argument that you don't need government because everything is spelled out in contractual agreements between individuals?" This is wrong, because there are bound to be disputes in any society under any conceivable system of government. Contractual language is bound to be ambiguous, leading to disputes between contracting parties. In a nation state, there are also disputes about what "the law" actually means, and citizens must occasionally sue their governments to assert (or at least clarify) their rights. So that's the first point: under any system of government, you need lawyers, arbitration, litigation, courts and judges to resolve disputes. You need someone who can bang a gavel and say, "Pay him back his $200, or you'll be marked a scoundrel." Anarchocapitalist writers, like David Friedman, Bruce Benson, and Peter Leeson, have quite a lot to say about dispute resolution in the absence of government. You might even say it's the focus of anarchocapitalist literature. Any boob can say, "This all works out fine, because there are prior agreements and the rules are spelled out plainly." But disputes are inevitable. The interesting stuff happens when there are disagreements about the rules and contracts that have been written.

Suppose you have commonly-occurring disputes that are resolved in different ways in different regions. But some firms operate across these different regions, so they need to be compliant with various inconsistent judicial rulings. This could end up being incredibly stifling, because the rule of law is not clear. It differs from one city to the next, because one judge zigs while the other zags. It might be desirable to impose some consistency such that people know the rules ahead of time and can plan accordingly. This is the proper role for a legislature. It should be to clarify the law and resolve opposing judicial decisions regarding similar cases, not to invent new law out of whole cloth. Some amount of pure policy-making might be unavoidable. Maybe your minarchy needs to go to war with a neighboring state, or maybe you face some internal crisis of the kind that was constantly plaguing the United States early in its history. Perhaps there are a few coordination problems too large to be solved privately. We need a canal dug or highway built, so we need an elegant way to secure easements across many thousands of properties. Or we need a unified system of intellectual property rights so that innovators with very high research costs can recoup their investments. I'm sympathetic to the idea that some projects are rendered incredibly difficult, even unfeasible, without a central government overseeing it. Mostly, the legislature should see its role as clarifying existing law, not changing the law to something that some central planner deems desirable. Inventing penalties for the use and sale of drugs, limiting immigration into the country, constraining the allowable range of labor contract provisions, and redistributing wealth are not the proper purview of the legislature. We need to be a lot more humble about our ability to reshape society to make the unpleasant things go away. Legislatures should get out of the business of banning things. But it's probably useful to have groups of representatives assemble and review the existing law to see if it makes sense.

(Great podcast on law versus legislation on Econtalk here, with Don Boudreaux as the guest. "The law" is the set of rules we all implicitly follow. "Legislation" is the set of dictated rules made by fiat. "The law" says you may speed up to about 5 over the speed limit, while "legislation" restricts you to the number posted on the sign. At least in Boudreaux' usage. At any rate this is a very useful concept.)

I'll take an example I've used before: a careless employee who can easily lose his employer a lot of money. The employee takes a call, mishears an order, and upon delivery the customer says, "That's not what I ordered." The employer, who can't tolerate money-losing misplaced orders, fills the correct order and makes the employee pay for the cost of the misplaced one. The employee says, "No fair! Occasional wrong orders are a cost of doing business. It doesn't say anything in my contract about having to pay for a misplaced order. This eats up an hour's worth of my five-hour shift!" The employer says, "This is your fourth misplaced order this week. You are costing me money, so you're going to have to pay for your mistakes." Here there is a legitimate dispute over who should pay. If the employer is wrong and withholds a misplaced-order's worth of wages, he is stealing from his employee. If the employee is wrong, he is insisting on the right to injure his employer with impunity. Someone will have to step in and resolve the conflict. You want to make sure similar cases are resolved in similar ways such that everybody knows the rules ahead of time.

The anarchocapitalist has an answer to this. Judicial decisions can set the default rules, but parties can contract around these rules by explicitly specifying the details. But even here, maybe a judge rules that some obscure provision was buried in the fine print of a simple low-skilled labor contract, and such a person can't be expected to read and understand such provisions. Maybe these kinds of contract provisions get thrown out, and to my point get thrown out inconsistently across regions. Such a society might want something that functions like a legislature, clarifying the law by fiat. Another anarchocapitalist answer is that the contracting parties can specify ahead of time which judge (or which dispute resolution firm) will solve any disputes. (David Friedman describes this kind of arrangement frequently in his talks and (I think) in his excellent book The Machinery of Freedom.) But then I can imagine a class-action suit in which a large number of employees cry foul. "No fair. You stacked the deck against us, so we're suing you in another court." Dispute resolution is hard. It's a little bit question-begging to say, "All potential disputes will be specified ahead of time in the contract," and it's just further question-begging to say, "Methods for resolving disputes will be determined ahead of time in the contract." There can be legitimate disputes over any of the details in a contract, including details about how disputes will be resolved. Once again, this kind of society might want a legislature that clarifies the rules.

Of course, legislation can also be confusing. An attempt to clarify can confuse. "Hmm...the law says: If X, then Y. It also says: If A, then B. Wait, does the condition X apply here? Or condition A? Judges?" So this needs to be done carefully. The inefficiencies of inconsistent judicial rulings might be too small to justify the drawbacks of having a legislature that rules by fiat. Don't mistake me as arguing that an initially anarchocapitalist society will inevitably institute some form of central government. I just want to modestly suggest that dispute resolution is really hard. It's going to suck. Even if anarchocapitalism is better than having a central government, these painful disputes over the rules of the game will arise now and then.

Cycling Caffeine

I wanted to share my experiences with caffeine because it might be helpful to someone with a similar problem.

For a while I was a daily coffee drinker. I would have a 16-ounce cup in the morning and another one at lunch. I love the taste of coffee and the mild buzz from a low dose of caffeine. (A high dose is extremely unpleasant.) But this started to cause problems. I was fine for the morning and after lunch, but after my lunchtime coffee I would be miserable. As my caffeine levels dropped, I would get pretty severe withdrawal symptoms. Tension headaches. Fatigue. An all-around miserable feeling. Even an irregular heartbeat, which can be incredibly jarring. I even wore a heart monitor once. My doctor reassured me it was nothing to worry about, but it was still an incredibly unpleasant sensation. I thought there was something really wrong with me.

I knew my heart was healthy enough. I do a pretty extreme martial arts/gymnastics workout every day. I essentially never get physically tired from this. Still, like I said, jarring.

Just over a year ago, I got my own coffee thermos and started brewing my own mix. It would always be some combination of regular grounds plus some decaf grounds. I love the taste of dark coffee but don’t always want all the caffeine. So one day I had only a single cup of low-caffeine coffee in my thermos. That was all I had that day. I got all the symptoms. Fatigue. Headaches. Heart palpitations. It was an “Ah ha!” moment for me. This was what was making me miserable. I suspected that too much caffeine might have caused my occasional irregular heartbeat (and drinking too much coffee definitely sometimes has this effect on me), but I never suspected that caffeine withdrawal was the culprit. I decided I would tough it out. Rather than “cure” myself by drinking some coffee, I decided I’d just take the discomfort. If this fixed my feeling awful every day, it would be worth it. So I went off coffee for a few weeks. (A week into my caffeine withdrawals, Scott Alexander posted this wonderful piece about drug tolerance. Good timing, Scott.)

Like I said, I love coffee. I didn’t want to give it up forever. I made the conscious decision to start drinking coffee again, but this time I’d be careful with it. No more day-long tension headaches and heart palpitations. I decided I’d drink it twice a week. This works well for me. On Saturdays and Wednesdays I’ll mix a strong brew of coffee. Sundays, Tuesdays, and Thursdays I mix a tiny volume of regular coffee with a lot of decaf (which actually does contain small amounts of caffeine, BTW). I’ll have a single caffeinated soda on Mondays and Fridays if I feel like I need it. I tried doing coffee every other day, but my withdrawal symptoms came back. Twice a week at most is apparently all this delicate snowflake can handle without acquiring a real physical dependence. Cycling on and off caffeine has been a lot better than having it every day. I pretty much never have withdrawal symptoms, unless I cheat and drink coffee several days in a row. (I have done this just a couple of times on weeks when I was traveling and out of my normal routine.)

___________________________________________________

Yes, I know it's dangerous to draw any conclusions based on anecdotes. Yes, I know the "treatment" and the outcome can be a coincidence. 

Dark Text on Light Background Or Vice Versa?

Should I keep with the light text on a dark background? Switch to dark text on light background? No preference? I'm not seeing any convincing evidence that either one is inherently preferable to the other.

Prescription Opioid Abuse Is Declining

And the government failing to disclose it. I wrote about this in my previous post, but I think this is important enough to give it its own post.  The two graphs below are from page 7 and 26 of the SAMHSA's Behavioral Health Trends in the United States: Results from the 2014 National Survey on Drug Use and Health (here).

The top chart plainly shows that past month prescription opioid abuse is flat over the past decade or so, the era in which we supposedly saw an exploding opioid epidemic due to "over"-prescription of opioids (in some observers' estimations). The second chart shows that prescription opioid-related substance abuse disorders are also flat over the same period, even decreasing for some age demographics. 

In the 2016 version of this document, both of those charts go missing, even though the report shows similar graphics for all the other drug categories covered (cocaine, heroin, alcohol, marijuana, tobacco...). Why suddenly remove this information? I'd think the readers of this document would want to know that this trend is flat, particularly since they're hearing elsewhere that there's an "opioid epidemic" in this country. Like I say in my earlier piece, this is probably due to a methodology change in 2015 in which they started asking about "opioid misuse" and "any opioid use", which might make the numbers not directly comparable. But the question about "opioid misuse" is basically the same as the question from prior years, so I think they should have included it. It's not like adding the question about "any opioid use" dramatically changed the number of reported illicit opioid users. You can look at comparable sections of the text of both the 2014 and 2016 version. Here, once again, is my previous post:

[T]hat report says: "In 2016, an estimated 1.8 million people aged 12 or older had a pain reliever use disorder, which represents 0.7 percent of people aged 12 or older." That report, which I hadn't seen until just today, actually does not include the charts displaying the trend in prescription painkiller misuse and substance use disorders from 2002 to present (the charts shown above in this post). Why not? Why weren't those charts updated for the most recent report. Well, the 2014 version says, "The estimated 1.9 million people aged 12 or older in 2014 who had a pain reliever use disorder (Figure 31) represent 0.7 percent of the people aged 12 or older." The number of people with a substance abuse disorder regarding painkillers decreased by 100,000 people in the last two years. Is SAMHSA trying to disguise a decline in a widely publicized problem? Shame on them if they are.

I can find a similar duo of quotes about declining "past month use". The 2014 report says: "The estimated 4.3 million people aged 12 or older in 2014 who were current nonmedical users of pain relievers represent 1.6 percent of the population aged 12 or older." The 2016 report says: "An estimated 3.3 million people aged 12 or older in 2016 were current misusers of pain relievers, which represents 1.2 percent of the population aged 12 or older." Once again the chart is missing from the 2016 version of the report; if it were there it would show a sharp decline in past month painkiller misuse in 2016. Past month recreational use of prescription painkillers decreased by a million people, and the government is disguising this decline? My best non-cynical explanation for removing the charts is that 2015 was the first year that they started asking about "illicit painkiller use" and "any painkiller use" (previously they had just asked about illicit use). But then they should show the graph but have a footnote about the methodology change, like the Monitoring the Future report does.

And I include the following chart from the MTF report, showing what an appropriately-disclosed methodology change looks like:

I don't think there's some massive conspiracy to disguise a flat or declining trend here. In fact, I'd think the government would want to advertise its "success" in turning around a social problem. (Scare quotes around "success" because prescription opioid overdoses haven't declined, and any causal connection between the decline and some government policy would be suspect.) An editorial decision to remove that chart was made for some reason, though. This is pretty sloppy work, in my opinion.