Lithuania Study Finds Raising Drinking Age Did Not Save Lives After All

Lest anyone speciously claim that Lithuania's raising of the their drinking age from 18 to 20 effective January 1, 2018 somehow saved lives, keep in mind that in 2017 they also greatly raised their alcohol taxes, banned alcohol advertising, and greatly cut trading hours for alcohol sales in 2018.  So once again, we see a great deal of confounding here.  

In fact, one recent study found that once such confounders were adjusted for, any supposed lifesaving effect of the drinking age hike itself on 18-19 year olds disappeared, implying that it was a spurious effect.  The study looked at all-cause deaths, which is probably the most bias-free measurement of the "final bill".  And the drop in deaths was actually larger in 20-21 year olds (who were already too old to have been affected at that time*) than for 18-19 year olds or 15-17 year olds. Relative to the former group, the effect was null, and interestingly no "trickle-down" effect was observed for 15-17 year olds either.  And controlling for alcohol taxes and GDP also rendered the net effect null as well.

Thus, raising the drinking age any higher than 18 is very unlikely to save lives on balance.  But raising alcohol taxes, etc. is very likely to do so, for all ages.

QED

*NOTE:  If many years of post-hike data were observed, it would probably have been better to use a slightly older age group (e.g. 22-23, 23-24, or 24-25 year olds) instead as the control group, since previous studies have found that mortality is often shifted to the age group just above the new drinking age.  However, since just one year of post-hike data was included, the choice of control group remains largely appropriate for such short-term effects, and in any case the relative results were in the "wrong" direction even if mortality were displaced as such.

About That Finland Study

This year, a new study came out in The Lancet that looked at the long-term differences in alcohol-related morbidity and mortality between birth cohorts in Finland that either were or were exposed to the lowering of their legal drinking age from 21 to 18 on January 1, 1969.  That is, based on how old they were when the drinking age was changed.  The study and its interpretation had a clear pro-21 bias. 

While the results did show that, exposed cohorts did have higher morbidity and mortality later in life relative to the unexposed cohorts, the results were ultimately inconclusive since several other changes happened at the same time. For example, the lowering of the drinking age occurred in tandem with other alcohol liberalization policies (in a previously very stringent policy regime with fairly low alcohol consumption) that greatly increased alcohol availability in general and thus consumption in a short period of time.  Urbanization also increased rapidly as well.  Culture changes (especially of the drinking culture) also inevitably occurred as well against a backdrop of increasing general alcohol consumption, and those who came of age during or right after the change would logically have been more affected than those who already came of age just before it, regardless of the legal age limit.  So teasing out the specific effects of the legal drinking age change is really practically impossible in this case.

A cursory reading of the Wikipedia article about Finnish drinking culture will tell you all you need to know about why the age limit is largely irrelevant.

Previous studies on the very long-term effects of the 21 drinking age in the USA and elsewhere have been very scarce and ultimately inconclusive at best as well.  (At least one Swedish study seems to suggest a null effect though.)  And this new Finland study, quite frankly, adds very little.  Causation can thus neither be confirmed nor ruled out, in other words.

Regardless, in any case, even if it were partly causal, using a study like this to justify the ageist abomination that is the 21 drinking age is mission creep at best, and grasping at straws at worst, given that the original justifications for it are either debunked, obsolete, or both.  The idea that some vague conception of "public health", especially theoretically in the distant future, somehow trumps civil rights (and selectively for only one demographic group, no less) is the very worst of utilitarianism and health fascism, and has no place in a free society.

And as long as we are on the subject of Finland, that same country has also since shown us what can be done to rapidly decrease alcohol-related mortality and morbidity at very little cost to society at large and without trampling civil rights:  raising the tax/price of alcohol.  Even the pro-21 crowd, including the authors of the aforementioned study, seem to be willing to concede that.  But apparently that doesn't satisfy the ageists' desire for power and control.  Their libido dominandi seems to know no bounds in that regard.

QED

UPDATE:  And while we are at it, lest anyone speciously claim that Lithuania's raising of the their drinking age from 18 to 20 effective January 1, 2018 somehow saved lives, keep in mind that in 2017 they also greatly raised their alcohol taxes, banned alcohol advertising, and greatly cut trading hours for alcohol sales in 2018.  So once again, we see confounding.  In fact, one study found that once such confounders were adjusted for, any supposed lifesaving effect of the drinking age hike on 18-19 year olds disappeared, implying that it was a spurious effect.

What Reactionaries Get Wrong About Drugs, Decriminalization, And Homelessness

Twenty-One Debunked does not take an official position on hard drugs (i.e. illicit drugs other than cannabis and some psychedelics) or the question of their legalization, but we generally lean more towards the decriminalization and harm reduction side of the spectrum as opposed to the War on (people who use a few particular) Drugs.  There is a lot of nuance that tends to get glossed over in debates that are, more often than not, typically dominated by hysterics.

Reactionaries have lately been giving some red-hot takes about the supposed perils of decriminalization and harm reduction, and often pointing fingers at Oregon for their decriminalization policy causing or exacerbating homelessness, crime, and overdose deaths.  However, such hot takes are typically completely devoid of nuance, and thus conflate correlation with causation.  Such nuances include the role of super-deadly fentanyl and its variation over time and geography, the role of the pandemic and lockdowns and their aftermath, the still-growing housing crisis, the inherent pitfalls of forced treatment, and so on.  Better articles about such nuances can be found here and here, for starters.

Those who have the GALL to oppose basic and increasingly necessary lifesaving harm reduction measures like making naloxone (Narcan) and fentanyl test strips readily available are, to put it mildly, murderously stupid.  Fentanyl often gets mixed into other drugs and can make the drug supply much deadlier than it would otherwise be.  While treatment and recovery are no doubt important goals, we also still need to meet people where they are as well.

Of course, the reactionaries do get one thing partially right, as a stopped clock always does twice a day.  There has been a general breakdown of law and order in most major North American cities in recent years due to a combination of general policy changes, anti-police sentiment, catch and release, political ideology, political correctness, and perhaps even deliberate chaos manufacture by various agents provocateur.  Of course, they should shut down and clear out the sprawling homeless encampments on the city streets and sidewalks and the open-air drug scenes that all too often go along with them.  End catch and release.  Re-criminalize theft.  Crack down on violence of all kinds.  Bring back "focused deterrence" policing, and take the classic "broken windows" theory literally.  All of these things are really just common sense, and none of them require ending harm reduction or reversing Oregon's decriminalization of simple possession of small amounts of illicit drugs.

In other words, simply enforce existing laws, and repeal bad or counterproductive ones.  But please, do it ethically, and don't let it be a springboard for an illiberal reactionary agenda.  If you feel the urge to show "tough love", look to Portugal or Alberta, not the current or historical drug warrior nations.

That said, we should always keep in mind that hard drugs called "hard" for a reason, as they are a different beast from alcohol, tobacco, and cannabis.  They may not be quite a million miles away from the latter ones, but they clearly don't belong in the same category either.  While illiberal drug policy clearly makes them much more dangerous than they have to be, they are also pretty inherently dangerous, deadly, and highly addictive in their own right as well regardless.  This is especially true for opioids in particular, as there is really no such thing as a truly safe opioid.  And we have also long known that "speed kills" and "meth is death".  And yet, unfortunately these things are still not going anywhere either.  Policymakers need to handle these things with great care as they should with any wicked problem.  And consumers would be wise to avoid these substances like the plague, especially in the age of fentanyl. 

As for the perennial wicked problem of homelessness, the housing crisis still needs to be solved before there is any hope of ending it for good.  Artificial scarcity of housing needs to end, yesterday.  And a recent study found that some form of UBI can also play a net positive role in the solution as well.  Contrary to popular opinion, spending on "temptation goods" did not actually increase for such recipients.  But good luck convincing the reactionaries of that!

Yet Another Myth Bites The Dust

Last month, another study came out that debunks yet another cannabis prohibitionist myth.  The study found that cannabis use during off-hours does NOT result in an increased risk of workplace accidents.  Therefore, there is no good reason to test workers for cannabis any more than there is a reason to test for alcohol, and no good reason to punish employees for their off-hours cannabis use any more so than for off-hours alcohol use.  Which is to say, there is no good reason, period.  Anything else is serfdom. 

Twenty-One Debunked has always opposed the use of drug testing for cannabis except to determine actual impairment at the time, and even then only when truly necessary.  Urine and hair testing only detect past use (days or even weeks ago), not actual impairment at the time, and thus serve no useful purpose whatsoever.  The only chemical test for cannabis (and most other substances) that could possibly serve as a "fitness for duty" test would be saliva (oral fluid) testing, which despite its flaws we grudgingly support for "safety sensitive" jobs, much like breathalyzers for alcohol.  And even better still would be non-chemical tests like the DRUID app and AlertMeter that detect any kind of impairment regardless of the cause.

The study was done in Canada where cannabis has been legal since 2018 for everyone over 18 at the federal level (18 in Alberta, 18 in Quebec until 2020 when it was raised to 21, and 19 in all other provinces and territories).  So this study also puts the lie to the tired, old canard that legalization itself will somehow make workplace accidents worse or more likely.

(Mic drop)

Remove Cannabis From The Federal Controlled Substances Act

With all the recent talk about removing cannabis from the most stringent Schedule I (the same category as heroin) of the federal Controlled Substances Act (CSA), we at Twenty-One Debunked believe that the best thing to do is to remove it from the Controlled Substances Act entirely (that is, "deschedule" it).  Merely reducing it to a lower schedule ("rescheduling") or creating a new schedule would not have nearly the same benefits as removing it from the CSA entirely and treating it no more stringently than alcohol and tobacco are currently treated.

As Ricardo Baca of Salon so elegantly and eloquently writes:

But rescheduling cannabis under the CSA, rather than descheduling it completely, doesn't address the underlying issue: The cannabis plant shouldn't be a controlled substance under federal law. Period. Alcohol isn't a controlled substance. Tobacco isn't a controlled substance. Not even caffeine is a controlled substance. Cannabis shouldn't be a controlled substance either. 

Indeed.  And to that we would add, there is also no good or rational reason to set a federal age limit any higher than 18 either.

(Mic drop)

Cannabis Legalization Does NOT Increase Tobacco Use

A recent study pours cold water on another prohibitionist fear, namely that legalizing cannabis for recreational use will lead to more tobacco use via a "reverse gateway" effect.  Well, the study found the opposite:  a slight decrease in tobacco use as well as e-cigarette use.  While the decrease did not quite reach statistical significance, it was lagged and perhaps builds over time.  And at the very least, it certainly puts the lie to the tired old "reverse gateway" theory.

Thus, another myth bites the dust.

If The 21 Drinking Age Really Saves Lives In The Long Run, Then Explain This

Sometimes the truth is literally hiding in plain sight.  A good, bias-free way to examine the supposed lifesaving effects of a policy would be to look at excess all-cause mortality or its inverse, life expectancy.  That gives a clear picture of the "final bill" of net effects, regardless of the "why" behind it.

For example, a recent article notes how life expectancy in the USA has lagged behind that of practically every comparable country in the world, in both absolute AND relative terms.  America is clearly an outlier, and not in a good way, despite being the richest and most powerful country on Earth.  

So what gives?

Is it Covid?  The collateral damage from lockdowns?  Or the vaccines?  While things clearly deteriorated further during the pandemic, and especially after the vaccines were introduced, the diverging trend in life expectancy began well before that.  

Is it fentanyl, or the opioid crisis more generally?  That's a big part of it, and something you really don't see nearly as bad anywhere else in the world, but the trend pre-dates even that by quite a while.

Is it illicit drugs in general?  Partly, but those "epidemics" ebbed and flowed repeatedly while the divergence continued regardless.

Is it tobacco? Well, as deadly as it is, given how Americans generally smoke less than Europeans, and always have, that cannot be a significant reason for the divergence. 

Is it obesity?  Partly, but several other countries are also catching up to us in that regard, so that only explains a fraction of it.  (And why are we so fat in the first place?)

Is it poverty?  Lack of healthcare?  Inequality?  Or any other adverse effect of neoliberalism?  Very likely at least part of it. After all, the American life expectancy began diverging from peer countries in the early 1980s during the "Reagan Revolution".  Before that, it was well within the normal range of wealthy countries.  But not even the UK under Margaret Thatcher could deteriorate quite like we did.

Is it guns?  Partly, but again that only explains a fraction of the trend, and there were already plenty of guns in the USA well before the divergence.

Is it traffic deaths?  Getting even warmer.  Traffic safety has clearly lagged behind the rest of the developed world indeed, and it's not only because we have more cars either.

Or is it perhaps the pink elephant in the room?  That is, Americans drowning themselves in the bottom of the bottle?  Yes, and we are paying a heavy price for it:  alcohol is indeed one of the largest contributors, that actually kills more Americans than opioids and all illicit drugs combined.  Let that sink in. 

Along with suicide and drug overdoses, alcohol-related deaths are in fact one of the most common types of "deaths of despair" in this country.

So to those who support the 21 drinking age, riddle me this:  if your beloved policy saved so many lives on balance like you claim, why did America's life expectancy lag behind all of our peer countries that generally did NOT raise their drinking ages any higher than 18?  And why are alcohol and traffic deaths such large contributors to the divergence?

Take as long as you like with your answer.

And bonus points for those who loudly cry "think of the children!" when it comes to public policies they dislike, and are still able to somehow explain why American infant and child mortality is so much worse than peer countries as well.

(Mic drop)

UPDATE:  But don't European countries supposedly have higher liver cirrhosis death rates than the USA?  Well, some do, but many countries are the same or lower.  The UK, for example, used to be higher, but by 2016 it was lower.  Canada, Australia, and New Zealand also have lower cirrhosis death rates as well.

One Silver Lining Of The Pandemic And Its Aftermath

As the rolling three-year ordeal of the pandemic and its illiberal restrictions has drawn to a close, one can observe that one particular and very platitudinous phrase seems to have vanished entirely from our lexicon.  It was a phrase that long predated the pandemic, and first became common about 40 years ago, which was used to cover any number of illiberal policies, most notably the 21 drinking age.  So what is it?

"If it saves even ONE life, it's worth it"

Those nine words have clearly been a very, very slippery slope towards totalitarianism, which really came to a head during the pandemic.  And both sides of the lockdown and mandates debate have since given that idea up for the time being recently.  Thus, we may actually have a chance temporarily to finally end other illiberal policies like the 21 drinking age and similar abominations.  Pendulum Theory can therefore be used to our advantage. 

What are we waiting for?

Yet Another Study Finds No Link Between Cannabis Legalization And Traffic Casualties

Once again, yet another study finds that recreational cannabis legalization and retail commercialization did NOT lead to an increase in fatal or injury traffic crashes.  This study looked at Washington State, one of the first two states to legalize cannabis for recreational use, and actually found that legalization itself led to fewer fatal and injury crashes, while commercialization (retail sales) led to no statistically significant impacts on fatal or injury crashes (albeit correlated with a modest increase in non-injury crashes, likely from tourists).  These results jibe well with survey data that did not find a significant change in driving behavior while under the influence, despite a self-reported increase in cannabis use in general. 

These results dovetail rather nicely with several other studies in both the USA as well as Canada.

In other words, the fear that legalization or retail sales would cause carnage on the highways has turned out to be unfounded.  Look like yet another card in the prohibitionists' vast rolodex full of myths, lies, and half-truths needs to be retired for good.

UPDATE:  Also, a new study found that mental health treatment admissions actually go DOWN following recreational cannabis legalization.

Hey New York, Wanna Know A Secret?

Though cannabis legalization has been a positive development overall, in many places, the black market still exists to one degree or another, albeit much less so than when cannabis was illegal.  Nowhere else is this more true than in New York, whose uniquely arcane, difficult, and disastrously sluggish rollout of cannabis licenses statewide has led to a massive proliferation of unlicensed weed shops, especially in NYC where such shops outnumber licensed ones by a whopping 250 to one.  So how does one solve such a bedeviling problem?

Enter Rear Admiral Luther E. Gregory.  In the 1930s, Prohibition was repealed, and Washington State along with other states were now faced with the task of shutting down the well-established bootleggers and speakeasies that persisted even after Repeal.   Admiral Gregory was asked to head the state's Liquor Control Board, and given carte blanche to come up with a solution, one which worked surprisingly well in fact:

1. End Prohibition, first of all.
2. Give amnesty and issue licenses to anyone willing to play by the state's rules, whether former bootleggers or otherwise.
3. Set the alcohol taxes as low as possible at first, the lowest in the country in fact.
4. Punish sellers who don't play by the rules, with an iron fist--i.e. blacklisting scofflaws from ever selling liquor in the state again.
5. After holding down alcohol taxes for three years, abruptly raise taxes to the point where they're now the highest in the nation.

Problem solved.  The legal market proved to be competitive with what was left of the black market, and drinkers overwhelmingly preferred the former over the latter, driving the latter out of business.  And the black market never came back even after raising taxes dramatically.  Looking back, it should have been so obvious indeed.

Substitute "cannabis" for "alcohol", and there is literally no reason whatsoever why this strategy would not work in this day and age.  And instead of holding down taxes for three years, merely one or two years should be sufficient to get the same results, even if the hike is automatically scheduled.  Doing so would minimize the greatest risk of the strategy, namely, that the fledgling legal cannabis industry would then become so powerful that they would resist and successfully quash any attempt to raise taxes in the future.  They would not become that powerful in just a year or two, and probably not for several years, but the black market could be easily quashed in that timeframe all the same.  But most importantly, cut the ridiculous red tape and, and make cannabis licenses easier and cheaper to get, particularly for the current gray market shops.

Now over to you, New York.  Remember, the cart does NOT go before the horse.