Twenty-One Debunked Opposes Most Drug Testing

In light of recent reports of student drug testing now including nicotine in some schools due to the moral panic over vaping, Twenty-One Debunked needs to reiterate our general opposition to such testing:

• We oppose any drug testing that is not strictly to determine current impairment or "fitness for duty" in cases of driving, operating machinery, or working at safety-sensitive jobs.
• We oppose any drug testing that privileges or excludes some people over others, whether by age, socioeconomic status, race, or any other suspect or quasi-suspect classification.
• We oppose schools and employers having any jurisdiction whatsoever over what students and employees do to their own bodies off the clock and off the premises, as long as it does not unduly adversely affect their job or school performance and behavior.
• Even if the above criteria are satisfied, we still oppose any drug testing method that has detection times longer than a day or two at the cutoff used, and/or uses inactive metabolites as a proxy for the main substances being tested.  That excludes essentially everything except blood and saliva tests for most substances.  (Note that SCRAM bracelets and sweat testing for offenders in the 24/7 Program are an exception to this rule.)

Twenty-One Debunked, therefore, opposes the vast majority of drug testing done in this country.  We are the supposed land of the free, it's time to start acting like it!

The Latest Moral Panic: Juuling in the Classroom

Those who are old enough to remember the 1973 song "Smokin' in the Boys' Room" by Brownsville Station (and/or it's 1985 Motley Crue cover version) would certainly remember that there was a whole lot of actual smoking going on in school or at least on school grounds back then.  Since then, in part because of the declining popularity of tobacco in general and in part due to today's stricter rules and laws governing smoking in and around schools, such conduct has declined considerably.

But now, there seems to be a new moral panic du jour taking hold lately:  Juuling.  What's that, you ask?  Well, JUUL is a fairly new brand of e-cigarette (vaping device) that was first launched in 2015 and really took off in 2017 in terms of popularity.  As for why it is so popular, it probably has something to do with the appealing fruity flavors and the fact that it is very easy to conceal since it literally looks just like a USB flash drive and doesn't smell like tobacco.  High school (and younger) students apparently even sometimes sneak using it in class, thus if one were to ever do an updated cover version of the aforementioned song for 2018, it might as well be called "Juuling in the Classroom".

So what should we make of all this?  First, don't panic, lest we continue to fuel a deviancy amplification spiral rather than let this fad burn out on its own.  The good news is that combustible tobacco consumption is now at a record low among young people, and still falling.  Vaping is actually rarely used by teens who have never also tried combustible cigarettes.  If anything, vaping in general (including, but not limited to, Juuling) is displacing combustible cigarettes on balance, and is significantly safer as well--perhaps even 95% safer by some estimates.  The bad news?  Vaping is, of course, not completely safe, as most vape juices (including all JUUL brand ones, even if its users don't realize it) do contain nicotine, which is highly addictive and is even a known neurotoxin, particularly for the developing early adolescent brain.  Other concerns include the relative lack of regulation as to how these things are made and what sort of contaminants may be lurking inside, but again, it still pales in comparison to the dangers of combustible tobacco cigarettes, which contain literally thousands of other nasty chemicals as well as nicotine, including many known carcinogens, mutagens, and teratogens.  So insofar as vaping displaces smoking, it is a net win for public health.

Secondly, we should note that this apparent fad exists even in states and localities where the age limit is 21 for both smoking and vaping (or at least for buying these things), including New Jersey.  Thus, raising the age limit is unlikely to solve anything in that regard compared with keeping it 18 and enforcing it on vendors the same as with combustible tobacco products.  Keep in mind that until fairly recently there was no age limit at all for vaping devices and liquids/pods in many states and localities.

And finally, there are practical ways of reducing any potential harm from all of this:

• Regulate vaping devices and juices/pods the same as combustible cigarettes (but no stricter), and require strong quality control standards and testing
• Warning labels alerting users about the fact that they contain the addictive drug nicotine
• Tax nicotine-containing vape juices/pods by weight or volume adjusted for nicotine content (but much lower than combustible cigarettes)
• Increase the number of nicotine-free vape juices, particularly for Juul brand ones which currently lacks such options 
• Consider banning or phasing out any vape juices/pods that have fruity, floral, or any other non-neutral or non-tobacco-style flavors unless they are completely nicotine-free ones
• Educate the public, especially young people, on the truth about vaping, particularly with an eye towards preventing accidental addiction to something they may not even realize contains nicotine at all
• Social norms marketing to help defuse any deviancy amplification spiral

Most importantly, we need to see the forest for the trees, and stop tilting at windmills already. 

The Kids Are (Mostly) Alright

The results of the annual Monitoring the Future survey of middle and high school students for 2014 were primarily good news overall.  Alcohol and tobacco use both dropped to record 40-year lows, and cannabis use saw the first decrease in years after steadily increasing since 2007.  Other drugs, both illicit and prescription, saw either decreases or no significant change in 2014, and most of those remained well below their most recent peaks.  Dangerous quasi-legal synthetic "designer drugs", such as "K2" (synthetic cannabis) and "bath salts", have plummeted to the lowest levels since they have first been measured.  And there was no substance that saw any significant increases in 2014.

One thing that makes such results remarkable is that 2014 was the first year that cannabis was fully legalized in Colorado and Washington, with a few more states on the way as well.  And there is currently zero evidence that any of the prohibitionists' fears have actually materialized.  Another remarkable observation is the fact that "extreme binge drinking" (i.e. 10+ drinks in the same occasion at least once in the past two weeks) among high school seniors has finally dropped to the lowest level since it was first recorded in 2005.  For example, from 2005-2011, it remained flat at 11%, and from 2011-2014 it had dropped by more than a third to 7%.  And lest you erroneously think that the longstanding 21 drinking age (or tougher enforcement thereof) is somehow the cause of that drop, significant decreases in teen drinking have also occurred in other countries where the drinking age is still 18.

But don't expect to hear such good news from the fearmongering mainstream media, of course.

Extreme Binge Drinking Revisited

The latest news on extreme binge drinking is in.  Apparently, a new study of Monitoring the Future (MTF) survey data from 2005-2011 found that about one in ten high school seniors have engaged in "extreme" drinking, defined as 10 or more drinks in the same occasion at least once in the past two weeks.  And about one in twenty have consumed 15+ drinks (!) in the same timeframe.  Rates were highest in the Midwest and in rural areas (i.e. so-called "blue-collar America"), and more common among males than females.  We have already noted similar findings four years ago.

While clearly only a small minority in engaging in such truly dangerous drinking, it is not a trivial fraction either, and is probably an underestimate.  And, most relevant to the drinking age debate, these numbers have not changed significantly since MTF began following them in 2005, despite ever-intensifying enforcement of the 21 drinking age and its ancillary laws.  So recent declines in prevalence of 5+ drinks in a row appear to be somewhat misleading, especially since underage drinkers tend to undercount their drinks.  Lying (or exaggerating or minimizing) is also fairly common in teen drug and alcohol surveys.

For what it's worth, according to the same surveys about 25% of seniors and 18% of sophomores admit to having had 5+ in a row in the past two weeks, and these numbers are leveling off after a decade-and-a-half-long decline.  It seems that fewer teens are drinking, but the more they do when they do.  That may explain why in emergency rooms in several cities across the country, admissions related to teen binge drinking increased in recent years in spite of surveys showing that teen drinking and "binge" drinking are both at record lows.

Tracking this highly dangerous behavior is long overdue.  We already know that among college freshmen, 20% of males and 8% of females have done extreme drinking (10+ males, 8+ females) in the past two weeks.  But that was a one-semester snapshot in the fall of 2003, with no other years for comparison.  The rate of "binge" drinking (using the 5/4 definition) in the past two weeks was 41% for males and 34% for females, which does jibe well with known statistics (roughly 40%) that use that definition.  But one must wonder if there is even any relationship at all between the rates of drinking, "binge" drinking, and "extreme" drinking.  And it is an important distinction to draw, as studies show that a higher cutoff (e.g. 7/6 or 8/6) has better predictive value for the more serious alcohol-related problems than the rather unscientific 5/4 definition.

Indeed, from 1993 to 2005, the percentage of college students who "binge" drank (5/4 definition) in the past two weeks has not changed a whole lot, but the percentage who do so three more times in the past two weeks ("frequent binging") has gone up significantly.  And since the aforementioned study found that extreme drinking was strongly correlated with frequent "binging," the former most likely rose as well.  Further evidence comes from another study that found that the number of alcohol poisoning deaths (a good indicator of truly dangerous drinking) among college students nearly tripled from 1998 to 2005. 

Bottom line:  when you criminalize normative drinking, you inevitably normalize truly dangerous drinking.  We saw the same thing during Prohibition.  And we all pay a heavy price for it.

How Common is Extreme Binge Drinking? Now We Know

We at 21 Debunked have repeatedly voiced disapproval at those who insist on calling 5 drinks a "binge," as well as noting the dearth of longitudinal data concerning the practice of imbibing 10 or more drinks in an evening, sometimes called "extreme" drinking or "extreme binge" drinking.  The Monitoring the Future (MTF) survey of middle and high school students has not been gathering data on this truly dangerous activity, so we have been left in the dark about its true prevalence.  Until now. 

Lloyd Johnston, the overseer of the survey, has recently been asking high school seniors whether they have had 10+ drinks or more in at least one occasion in the past 2 weeks.  The most recent data say 11% have done so, and 6% have had 15+ drinks in a row.  While clearly a small minority, it is not a trivial fraction either, and is probably an underestimate.  And, most relevant to the drinking age debate, these numbers have not changed significantly since Johnston began following them, despite ever-intensifying enforcement.  So recent declines in prevalence of 5+ drinks in a row appear to be somewhat misleading, especially since underage drinkers tend to undercount their drinks.  Lying (or exaggerating or minimizing) is also fairly common in teen surveys.

For what it's worth, according to the same surveys 25% of seniors and 18% of sophomores admit to having had 5+ in a row in the past two weeks, and these numbers are leveling off after a decade-long decline.  It seems that fewer teens are drinking, but the more they do when they do.  That may explain why in emergency rooms in several cities across the country, admissions related to teen binge drinking increased in recent years in spite of surveys showing less drinking.

Tracking this dangerous behavior is long overdue.  We already know that among college freshmen, 20% of males and 8% of females have done extreme drinking (10+ males, 8+ females) in the past two weeks.  But that was a one-semester snapshot in the fall of 2003, with no other years for comparison.  The rate of "binge" drinking (using the 5/4 definition) in the past two weeks was 41% for males and 34% for females, which does jibe well with known statistics (roughly 40%) that use that definition.  But one must wonder if there is even any relationship at all between the rates of drinking, "binge" drinking, and "extreme" drinking.

Indeed, from 1993 to 2005, the percentage of college students who "binge" drank (5/4 definition) in the past two weeks has not changed a whole lot, but the percentage who do so three more times in the past two weeks ("frequent binging") has gone up significantly.  And since the aforementioned study found that extreme drinking was strongly correlated with frequent "binging," the former most likely rose as well.  Further evidence comes from another study that found that the number of alcohol poisoning deaths (a good indicator of truly dangerous drinking) among college students nearly tripled from 1998 to 2005. 

Bottom line:  when you criminalize normative drinking, you inevitably normalize truly dangerous drinking.  We saw the same thing during Prohibition.  And we all pay a heavy price for it.

Would you drive a car knowing its brakes would fail 11% of the time?  Didn't think so.