Source: Dissertation Abstracts International, Volume: 78-07(E), Section: B.

Adviser: Jody L. Sindelar.

Drug abuse imposes a substantial burden on public health. Over 20 million Americans have a substance use disorder, with over 7 million meeting DSM-IV criteria for abuse or dependence attributable to prescription or illicit drugs. Two policies could worsen this problem: marijuana legalization and policies intended to reduce non-medical use of prescription opioids (NMU), which can have the unintended effect of encouraging heroin use. This dissertation presents three empirical studies intended to inform future policy by addressing gaps in current knowledge about these two important policies.

Chapters 1 and 2 consider marijuana legalization. As of August, 2016, Colorado, Washington, Alaska, and Oregon have laws that make the production, sale, and use of marijuana legal for all adults over 21. Similar laws will likely pass in the near future. Scholars have noted these laws do more than repeal existing penalties; they set the regulatory framework for how legal marijuana may be produced, sold, and used (i.e., these laws have design).

In chapter 1, I consider the impact of policy design on the demand for legalized marijuana. Because legalization is relatively new, it is difficult to use standard data sources to predict how differences in these designs will impact demand. Instead, I use a discrete choice experiment to consider these relationships. My results provide novel predictions about the effect of design on individual intentions to use, and highlight segments of the population that vary in their sensitivity to design choices.

Chapter 2 examines a different factor related to design-the public's preferences for design choices. There is a small literature that examines preferences for legalization in the abstract. However, recent failed legalization initiatives suggest the public may say they prefer legalization in the abstract, but will not vote for a policy if they object to elements of its design. Policymakers could benefit from better knowledge of the public's preferences for design, yet to my knowledge no study has attempted to systematically examine these preferences. The results of chapter 2 therefore expand on prior work by providing the first estimates of Americans' preferences for the design of marijuana legalization policies.

Chapter 3 examines a separate topic: whether policies intended to reduce non-medical use of prescription pain relievers (NMU) have the unintended effect of encouraging heroin use. In 2014, almost 1 million Americans reported they used heroin in the past year, an increase of 130% since 2004. During the same time, many states passed policies intended to reduce the prevalence of NMU. Because of this association, some have suggested that policies intended to reduce prescription drug abuse have unintentionally encouraged individuals to engage in newly incident (i.e., first time) heroin use. However, evidence to support this claim is limited. To address this issue, chapter 3 examines whether prescription drug monitoring programs (PDMPs) - state-level policies meant to ensure that controlled substances are appropriately dispensed - have inadvertently encouraged newly incident heroin use among those with a history of NMU. Findings suggest that PDMPs may encourage heroin use among individuals who engage in "high risk" use; specifically, those who self-report NMU on 200 or more days in the past year, or who meet DSM-IV criteria for opioid abuse or dependence. Although no evidence is found to support the belief that PDMPs encourage heroin use among the larger population of individuals who engage in NMU infrequently.