What Happened in NYC After Raising the Smoking Age to 21?

In 2014, New York City became the first major city in the USA to raise the tobacco purchase age to 21.  Prior to that, it was 18, much like the rest of the country.   The law was passed by Mayor Bloomberg at the end of 2013, and it went into effect in May 2014.

Since then, two states (California and Hawaii) have also raised it to 21 (both in 2016) and several counties and towns/cities as well from 2013-2017, though a few localities had also done so earlier as well.  When Needham, MA did so in 2005-2008, there was much praise from the pro-21 crowd when surveys showed that teen smoking rates had dropped much faster in Needham than in its surrounding communities (which were 18) from 2006-2010.  So it is very curious indeed that no one seems to be talking about what happened in NYC since they raised their smoking age.

We think we know why.  At first glance, it does appear to have had some effect.  According to the CDC's Youth Risk Behavior Survey (YRBS), teen smoking rates did in fact drop from 2013 to 2015 in NYC: 

2005   11.2%
2007   8.5%
2009   8.4%
2011   8.5%
2013   8.2%
2015   5.8%

Those are the percentages of combined 9-12 grade students who reported any current cigarette smoking in the past 30 days.  Looks impressive at first:  a relative 29% drop from 2013 to 2015.  But take a look at the same data for the nation as a whole, for comparison:

2005   23.0%
2007   20.0%
2009   19.5%
2011   18.1%
2013   15.7%
2015   10.8%

As you can see, the nation as a whole also saw a similar (if even faster) drop in teen smoking at the same time, with a relative 31% decrease from 2013 to 2015, despite no change in the smoking age in most places.  And the teen smoking rate in NYC was already much lower before the law change, having dropped more dramatically than the rest of the USA prior to 2007 and then remaining at a low level since. 

How about San Francisco, another major city that raised its age limit to 21?

2005   10.9%
2007   8.0%
2009   10.4%
2011   10.7%
2013   7.5%
2015   5.4%

They also saw a similar size drop from 2013-2015, to the tune of 28% (vs. 29% in NYC and 31% in the USA overall).  Just one problem though.  San Francisco did not raise their smoking age until 2016, so these data show that the drop in the smoking rate happened while it was still 18, before the age limit was raised.  Thus, it would actually be part of the no-change control group, not the experimental group.  And if you include the decrease since 2011, San Francisco in fact saw more progress than NYC.

Thus, we can conclude that the decrease in teen smoking in NYC following the hike in the purchase age was most likely NOT causally linked to it, and would most likely have occurred regardless given the above counterfactual data.  Kinda like we at Twenty-One Debunked initially predicted back in 2013 after first learning of the law change being proposed.  So if that wasn't the cause, what was?  Well, we know that nationwide, as well as in NYC, the secular trend for the past four decades (except a brief increase from 1992-1997) has been downward for both teen and adult smoking.  This was due to a general combination of education/awareness, taxation, regulation, and advertising restrictions, and the resulting cultural changes.  And in very recent years, electronic cigarettes have gained popularity as an alternative to combustible cigarettes, and in fact overtaking the latter and becoming at least twice as popular among high-schoolers by 2015.  Note that this was also true in NYC despite the 21 age limit applying to e-cigarettes as well.

Bottom line:  it looks like the supposed benefits of raising the smoking age to 21 were, shall we say, all smoke and mirrors.  The supposed success of Needham, MA was likely a statistical fluke and/or a result of endogeneity, much like the "early adopter" effects of the first few states to raise the drinking age to 21 creating that particular mirage in the 1980s.  Or perhaps increased enforcement in general relative to neighboring towns did the trick regardless of the age limit, like it did in Woodridge, IL and several other communities the 1990s.  And even if such benefits of the 21 age limit were real, we at Twenty-One Debunked would still not support an age limit any higher than 18, on principle alone.  Old enough to fight and vote = old enough to drink and smoke.  'Nuff said.

What Should the Blood Limits for THC Be?

Now that cannabis is legal in eight states for recreational use, and numerous other states for medical use, the issue of how to handle driving under the influence of cannabis (DUIC) is currently being hotly and heavily debated.  Many states, both where cannabis is legal and where it is illegal, currently set an arbitrary non-zero number for their blood-THC limit, while others set the limit at zero (i.e. zero-tolerance), while still others do not set any specific per se limit despite driving while impaired being illegal.  And as of 2017, there remains zero evidence that any of these laws actually save any lives on the highways or otherwise.

Recently, the state of Oregon, where cannabis is legal, has effectively stopped enforcing their legal per se limit for THC, citing a lack of scientific evidence to justify such a policy.  To wit, the Oregon Liquor Control Commission’s report on the matter also supports the idea that cannabis is far less impairing than alcohol:

“The rate of drivers tested by Drug Recognition Experts who are positive for THC intoxication rose between 2013 and 2014, but did not increase following legalization [in 2015]. Fatal accidents data is highly variable year-to-year, making trend analysis difficult. But in Oregon in 2015 there were only three more traffic fatalities involving a driver testing positive for THC compared to 2004. Moreover, the rate of THC-related fatal accidents is also considerably lower than such accidents involving alcohol intoxication. Finally, while overall traffic fatalities and alcohol-related fatalities spiked in 2015, THC-related fatalities did not."

Even the AAA now concedes that, while being high on weed can cause driving impairment, it is significantly less impairing than alcohol and is in fact comparable to driving with a “noisy child in the back of the car,” and only half as dangerous as talking on a hands-free cellphone (which is legal in all states).  That said, we should also note that different drivers may be affected differently, and novice users and/or novice drivers may be a lot more impaired than more experienced users and/or drivers.  And combining cannabis with alcohol is known to be significantly more dangerous in terms of driving impairment than either one alone as well.  But there is currently no scientific evidence strong enough to justify a zero-tolerance or per se limit for THC, as its pharmacokinetics are far too complex to correlate blood THC levels with actual driving impairment.  For example, frequent users (including medical users) can test positive several days after the last time they used it, even if they are not impaired in the least, and thus get unjustly snared in the same dragnet as those who are actually impaired from toking up an hour or two ago.

Twenty-One Debunked does not recommend that anyone drive under the influence of cannabis.  But our laws must reflect reality nonetheless.  Thus, we make the following recommendations:

• Follow Colorado's lead and set a prima facie limit for THC instead of a per se limit.  That distinction is crucial, as that would not mean automatic guilt, but a rebuttable presumption of guilt for going over the limit, which can still be challenged in court to prove non-impairment.
• Set the limit at no lower than Colorado's 5 ng/mL, as that level, though imperfect, provides the clearest separation between impaired and non-impaired driving according to the best research.  Zero tolerance = zero intelligence.
• Do not test for inactive metabolites, except perhaps to confirm recency of use.
• Increase the use of field sobriety tests and drug-recognition experts, and use saliva tests to check for recent cannabis use before drawing any blood.
• Work on developing better methods of determining actual impairment, but do NOT use that as an excuse or delaying tactic for keeping cannabis illegal.
• Consider allowing a "medical necessity" defense for medical users.
• Make the penalties for DUIC alone significantly lower than for alcohol and other drugs, but in combination with other substances, or if anyone is injured or killed, throw the book at 'em!
• For illicit drugs other than cannabis, a per se limit would in fact be appropriate.
• Get much tougher on bad and reckless drivers in general, as well as distracted driving.
• And in keeping with the overall mission of Twenty-One Debunked, set the age limit for cannabis at 18 and do not treat drivers aged 18-20 any differently than drivers over 21 with respect to cannabis.

In other words, facts > feelings, even in the "post-truth" era.

We should also note that the rather modest increase in traffic deaths in 2015 and 2016 nationwide, and in 2014 in some states as well, does NOT seem to be caused by recent cannabis legalization in several states.  Increases occurred in both legalized and non-legalized states, as did some decreases, and there was no clear pattern in that regard.  A much more plausible explanation is the massive drop in gas prices from late 2014 to 2016, which is known to increase traffic fatalities (all else being equal), along with the improving economy as well as "reversion to the mean" following an all-time record low per VMT in 2013-2014.  Ergo, QED.

Trump Is The Ultimate Wildcard

In terms of alcohol and drug policy, Donald Trump remains somewhat of a mystery.  On the one hand, he went on the record in the early 1990s calling for the legalization of all drugs, period.  Since then, however, he has flip-flopped several times on the issue of cannabis legalization, most recently seeming to oppose legalization for recreational use while supporting legalization for medical use, and even on recreational use contradicting himself by saying that we should "leave it up to the states" (which really means supporting federal legalization without actually saying the "L-word").  And if that does not result in result in enough head-scratching on the part of the reader, he has nonetheless nominated the racist, uber-conservative drug-warrior Jeff Sessions for Attorney General, who "joked" that he thought that the KKK was fine until he found out that they smoked pot.  Yes, he actually said that. And Mike Pence would likely be no friend of legalization either, at least from what we gather so far. 

As for Trump's position on the drinking age, he does not seem to have a clear position either way.   On the one hand, he himself is a teetotaller because he lost his older brother at an early age to alcoholism.  On the other hand, despite his right-wing authoritarian and proto-fascist tendencies he seems to be one of the least likely to adhere to conventions or traditions compared to any of the other candidates he ran against in any political party.  Thus, on both the drinking age and the War on (people who use a few particular) Drugs, he remains a wildcard.  Like a cross between a joker and a jack(ass), basically.  We at Twenty-One Debunked do NOT support him by any stretch of the imagination, and Ajax the Great voted for Bernie Sanders in the primary and Hillary Clinton in the general election.  But if he does somehow manage to budge in our direction on those particular issues, we will effectively stand with him on those issues while still opposing him nonetheless on practically all of the other issues.  And we are indeed prepared for him to flip-flop numerous times while in office as well, as we see that he is clearly quite fond of doing.