Association for Public Policy Analysis & Management

Panel: Substance Use and Regulation: New Policy-Relevant Evidence Using Innovative Methods and Samples

(Health Policy)

The misuse of substances imposes substantial costs on the U.S. as it is linked with morbidity, mortality, healthcare use, impaired driving, and reduced labor market productivity. Indeed, alcohol, illicit drugs, and tobacco misuse costs the U.S. over $700 billion annually. Moreover, the specific types of substance misused and the regulatory environment have recently undergone substantial changes. Important trends include the emergence of e-cigarettes in tobacco markets, eroding of the historic prohibition on marijuana through state legalization of this product for medical and recreational use, and large-scale transformation of the healthcare system currently ongoing with the implementation of the Affordable Care Act (ACA). Given these remarkable changes and the high costs substance misuse imposes on individuals and society, policy makers at all levels require a solid evidence base on which to optimally regulate substances, whether these decisions involve new regulations or modifications of existing regulations. This panel attempts to provide such evidence. The panel includes four papers that use rigorous methods and novel data sources to study pressing substance misuse questions. The panel also includes two discussants with substantial expertise in substance misuse and regulation. Paper one directly addresses the FDA’s current proposal to i) regulate e-cigarette flavors and ii) require government approval for modified risk descriptors on e-cigarette packaging suggesting that these products are less harmful than tobacco cigarettes. Specifically, the paper examines how e-cigarette potential for addiction varies by flavor and the extent to which modified risk messages impact smokers likelihood of using e-cigarettes. To study these questions, the authors conduct two revealed preference studies. The second paper explores how medical marijuana laws (MMLs) impact physician prescribing patterns within the Medicaid program. To study this question, the authors utilize data on all prescriptions paid for by Medicaid programs 2000-2014. Differences-in-difference models are applied to determine whether Medicaid enrollees in states with an MML have different overall, on-label, and off-label prescription drug use than their counterparts in non-MML states. Paper three provides new evidence on the extent to e-cigarette minimum purchase ages impact teen pregnancy outcomes through substitutability between e-cigarettes and tobacco cigarettes. The authors couple rich birth record data 2010-2014 with triple differences methods to provide new estimates on potential unintended consequences of tighter e-cigarette regulation: increases in teen tobacco cigarette use and, in turn, worse birth outcomes. The final paper investigates the effect of state health insurance parity mandates for substance use treatment on traffic fatalities using data from the Fatal Accident Reporting System 1988- 2009. Differences-in-differences methods are used to uncover the causal effect of mandates on fatalities attributable to substance use. Findings can help predict the impacts of ACA provisions which require most insurers to cover substance use treatment at parity with medical treatment. All four papers in this panel provide timely and policy relevant information. The findings have direct implications for policymakers who seek to address the consequences of substance use through government regulation. As such, the panel’s focus directly overlaps with the 2016 conference theme “The Role of Research in Making Government More Effective.”