Inspiration for Post

Reading America's Syringe Exchanges Might Be Killing Drug Users/The Economist, December 1, 2022. To quote:

“Needle exchanges opened across America and Europe. For years no one detected the feared rise in substance abuse. That was before the opioid crisis plagued America and economists started looking into the trade-offs. A new study by Analisa Packham published in the Journal of Public Economics uncovers an uncomfortable truth: this particular harm-reduction tool does lots of harm. Ms Packham compares how drug users fared in counties that opened syringe exchanges between 2008 and 2016 with those in counties that did not. Before the clinics opened, upticks in HIV diagnoses or overdoses in one set of counties were mirrored in the other. Once a syringe exchange came to town, outcomes diverged. Rates of HIV fell by 15% in counties with the new programme. But deaths soared. On average syringe-exchange programmes led to a 22% spike in opioid-related mortality…

Leo Beletsky, a former drug dealer, now at Northeastern University, deems Ms Packham’s findings ‘nonsensical’…Don Des Jarlais, at New York University, argues that addicts do not respond to incentives like others do, making the moral-hazard effect inconceivable. Susan Sherman of Johns Hopkins University says she doubts that new evidence that harm reduction does more bad than good would convince her to disregard previous research demonstrating otherwise…

If syringe exchanges were better at referring addicts for treatment they could have more desirable outcomes, Ms Packham notes. Harm-reduction researchers admonish her for ignoring precedent. Disregarding the canon can indeed be dicey. But ignoring fresh evidence is worse.”

Excerpts from Letters to the Editor from a subsequent issue of The Economist, all critical of Mr. Packham’s research:

“Your article, based on a single new study in a rapidly changing drug-use environment, did not reflect the wealth of research…the world needs to move away from failed, punitive, stigmatising approaches towards a human-rights, community-led approach, rooted in decades of experience and evidence.”

“The distribution of sterile syringes and other life-saving services is not the reason why[so many] people have died of opioid-related overdoses…The real moral hazards were the drug firms’ gross production and promotion of legally prescribed opioids without having to bear the cost of the ensuing epidemic…”

“The exchanges do not encourage people to do drugs. If someone is abusing drugs they will continue to do so, clean or dirty needles. Alas the power of addiction is such that it trumps all rational behaviour.”

A Few Thoughts on Policy and the Scientific Process

Ask not “does this policy work”, but “under what conditions does this policy work, does not work, makes things worse, or creates new problems”.

Policy A does not cause Outcome B. Rather, under some conditions Policy A is likely to be followed by Outcome B. Under other conditions, outcomes may very well be different.

Successful policies don’t work forever. Policies have to be tweaked or even abandoned when conditions change.

“The simplified, linear description of the scientific method implies that science concludes … but in reality, scientific conclusions are always revisable if warranted by the evidence. Scientific investigations are often ongoing, raising new questions even as old ones are answered.” — Excerpt from How Science Works (my italics).

“Accepted theories are the best explanations available so far for how the world works. They have been thoroughly tested, are supported by multiple lines of evidence, and have proved useful in generating explanations and opening up new areas for research. However, science is always a work in progress, and even theories change.” — Excerpt from How Science Works

Policymakers should adopt a scientific state of mind: humble, dispassionate, and willing to discard old certainties as new evidence comes in.

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References:

How Science Works - Understanding Science. 2022. University of California Museum of Paleontology. 3 January 2022 http://www.understandingscience.org

Packham, Analisa, Are Syringe Exchange Programs Helpful or Harmful? New Evidence in the Wake of the Opioid Epidemic (July 2019). NBER Working Paper No. w26111, Available at SSRN: https://ssrn.com/abstract=3428163