Biomedical subjects

J P Caulkins

Publications and source records attributed to J P Caulkins.

7 recordsLinked to original sources

PubMed2001

Drug prices and emergency department mentions for cocaine and heroin.

OBJECTIVES: In this report, the author illustrates the historic relation between retail drug prices and emergency department mentions for cocaine and heroin. METHODS: Price series based on the Drug Enforcement Administration's System to Retrieve Information From Drug Evidence database were correlated with data on emergency department mentions from the DrugAbuse Warning Network for cocaine (1978-1996) and heroin (1981-1996). RESULTS: A simple model in which emergency department mentions are driven by only prices explains more than 95% of the variation in emergency department mentions. CONCLUSIONS: Fluctuations in prices are an important determinant of adverse health outcomes associated with drugs.

Cocaine-Related Disorders↗

PubMed1999

A dynamic model of drug initiation: implications for treatment and drug control.

We set up a time-continuous version of the first-order difference equation model of cocaine use introduced by Everingham and Rydell [S.S. Everingham, C.P. Rydell, Modeling the Demand for Cocaine, MR-332-ONDCP/A/DPRC, RAND, Santa Monica, CA, 1994] and extend it by making initiation an endogenous function of prevalence. This function reflects both the epidemic spread of drug use as users 'infect' non-users and Musto's [D.F. Musto, The American Disease: Origins of Narcotic Control, Oxford University, New York, 1987] hypothesis that drug epidemics die out when a new generation is deterred from initiating drug use by observing the ill effects manifest among heavy users. Analyzing the model's dynamics suggests that drug prevention can temper drug prevalence and consumption, but that drug treatment's effectiveness depends critically on the stage in the epidemic in which it is employed. Reducing the number of heavy users in the early stages of an epidemic can be counter-productive if it masks the risks of drug use and, thereby, removes a disincentive to initiation. This strong dependence of an intervention's effectiveness on the state of the dynamic system illustrates the pitfalls of applying a static control policy in a dynamic context.

Cocaine-Related Disorders↗

PubMed1997

Setting goals for drug policy: harm reduction or use reduction?

Historically, United States drug policy has focused on use reduction; harm reduction is a prominent alternative. This paper aims to provoke and inform more debate about the relative merits of these two. Since harm is not necessarily proportional to use, use reduction and harm reduction differ. Both terms are somewhat ambiguous; precisely defining them clarifies thinking and policy implications. Measures associated with use reduction goals are poor; those associated with harm reduction are even worse. National goals influence the many decentralized individuals who collectively make drug policy; clearly enunciating goals makes some policy choices transparent and goals serve a variety of purposes besides guiding programmatic decisions. We recommend that the overall objective be to minimize the total harm associated with drug production, distribution, consumption and control. Reducing use should be seen as a principal means of attaining that end.

Decision Making↗

PubMed1997

Is crack cheaper than (powder) cocaine?

AIMS: To compare the prices of cocaine powder and crack cocaine in the United States. DESIGN: Retail prices for crack and powder cocaine are compared for 14 US cities between 1986 and 1991 using regression analysis and t-tests. MEASUREMENTS: Prices are estimated from the United States Drug Enforcement Administration's System to Retrieve Information from Drug Evidence (STRIDE) database. FINDINGS: On average, crack is neither more nor less expensive per pure unit than powder cocaine. Prices are not equal in every city in every year, but crack is equally likely to be more or less expensive, and the differences are not large relative to variation in prices of both forms of cocaine between cities and over time. CONCLUSIONS: Crack has been widely believed to be cheaper than powder cocaine, and this "fact" has been used to help explain why US drug problems worsened in the 1980s. However, crack is not, in fact, cheaper per pure unit than powder cocaine. Other explanations must be sought for why crack spread so rapidly relative to powder cocaine.

Cocaine↗

PubMed1996

What does mathematical modeling tell us about harm reduction?

This paper argues, primarily by example, that mathematical modeling can contribute to harm reduction-orientated drug policy making in three ways: by contributing to quantitative evaluations of effectiveness, by improving data and understanding of the underlying drug-related phenomena, and by encouraging precise thinking about the goals and objectives of harm reduction.

Journal Article↗

PubMed1995

Redefining the goals of national drug policy: recommendations from a working group.

This paper discusses what the goals of national drug policy have been and suggests an alternative set of goals. The past emphasis on use reduction is found wanting. Total harm related to drugs can be viewed as the product of use and harm per use. Thus, reducing use usually serves to reduce harm. However, in some cases, use reduction programs may increase harm per use so much that they increase overall harm even as they succeed in reducing use. Hence, use reduction goals can be usefully augmented with the explicit objective of reducing the total harm created by the production, distribution, consumption, and control of drugs. Numerous programmatic recommendations flow from this approach.

Alcohol Drinking↗

PubMed1994

What is the average price of an illicit drug?

Estimates of the total dollar value of the markets for illicit drugs are valuable for policy making. Such estimates are usually produced by multiplying estimated consumption by price. This paper argues that the relevant price for such calculations is not simply the price of one standard unit. There are substantial quantity discounts for illicit drugs, and there is a distribution of retail purchase sizes. Hence, the average price paid per gram need not equal the price of one gram. This concept is illustrated with calculations for heroin and cocaine.

Cocaine↗