Environmental Prevention

Keg Registration Paradox

I’m attending the Research Society on Alcoholism conference in Washington, DC right now. It’s always an interesting meeting with some of the top researchers in the field sharing their emerging findings.

I was struck by one little strange finding on a poster by James Fell and his PIRE colleagues (Fell, Fisher, Voas, Blackman, & Tippetts) titled The relationship of 16 underage drinking laws to reductions in underage drinking and driving fatal crashes in the United States. They found some impressive declines (16%) in fatal crashes resulting from a core set of laws restricting sale and possession to those under 21. But one finding puzzled the researchers: keg registration laws correlated with an increase in fatal crashes (12%) among those under 21.

What’s going on? According to Jim Fell, they also found that beer consumption went down for young people in the states with keg registrations. So beer consumption was down, but alcohol-related traffic fatalities went up. Frankly, I was not surprise. There have been a number of studies that have found keg parties result in lower intoxication levels than other forms of alcohol-service parties at colleges; we, along with our PIRE colleagues even published one of them (Clapp, Lange, Min, Shillington, Johnson & Voas, 2003). We found that “Bring Your Own Beverage”, often the opposite of a keg party, resulted in higher levels of consumption.

Perhaps it’s time to acknowledge that kegs of beer are, in fact, a protective form of alcohol service for young people. Of course one can get very drunk at a “kegger.” Of course, a big barrel of beer is worse than one small can of beer. But if young people are intent on drinking, it is better to make them fight through a crowd to get to nasty-cheap beer with low alcohol content than to push them towards taking shots of liquor. Fatal alcohol poisoning is far more likely from distilled forms of alcohol because it is very easy to consume the alcohol faster than it absorbs through the stomach into the blood stream. Beer can be consumed very quickly too, but it takes far more effort to do it over consumption is thus far less likely to occur with beer. If intoxication is lower, than risk of fatal crashes will decline too.

I am in this business to save lives. Keg registration has never been shown to save lives, and now is actually showing the opposite effect. People who promoted it were working with the best intentions and logic, but not empirical evidence. We have to start believing our own data, even when it comes out in a direction we aren’t expecting. I’m now convinced that we should stop demonizing kegs, permit them as we once did, and perhaps begin the shift back to this less potent form of alcohol. It may just save some lives.

Oregon's Meth Precursor Experiment

It seemed so logical, restrict precursor chemicals necessary to make methamphetamines and supply of this dangerous drug of abuse would diminish. Oregon apparently went down that road more stringently than most states, but instead of seeing their problems shrink, news reports are telling us that the opposite is true. “There’s so much, it’s ridiculous” is how one cop described the current state of affairs. Apparently, while Oregon has successfully shut down most small-time meth labs, the void is being filled by drug cartels who are flooding the market. Violence may be increasing as well with the shift in suppliers.

From a prevention point of view, this would seem to be a failure. But the question we have to ask is, was this foreseeable? Was there research to guide the original policy shift, and if so, where did it go wrong? Or, indeed could research have predicted the failure.

According to the news accounts, Oregon made its policy changes in 2005, making products containing ephedrine and pseudoephedrine a schedule III medication. Thus, in Oregon such common cold and allergy medicines became a prescription only purchase. Restrictions on the quantity any one person could possess were enacted as well. Thus, a major aspect of the law was on the regulation of retail purchase of precursors, which are the source for small-scale meth labs. Given that the sentiment in Oregon was that small-time meth “cooks” were creating the problem, it makes sense that retail purchase was a concern. But what does the research say?

Research is scant
There are few studies reporting the results precursor restrictions on meth use and availability. One contemporaneous study (Cunningham and Liu, 2005) casts some doubts on such restrictions. Their report demonstrated marked reductions immediately following restrictions on bulk precursors was enacted either on the Federal or California State level. However, the authors found that “The regulation targeting precursors typically used by small-scale producers…had little or no effect on arrests” (p.485). Indeed even the effects of bulk sale restrictions that were observed were short-lived, with arrests rebounding within 2 to 3 years following the regulations. Of course, conclusions based upon this study are made problematic because the authors were studying arrests; changes in the laws of insterest may have affected arrest rates independently of actual use rates. So while this study appears to have predicted the Oregon failure, it must be acknowledged that it was not a definitive study. Another study conducted by the same researchers had previously demonstrated reductions in hospital admissions from the bulk precursor regulations (Cunningham and Liu, 2003). But some debate within the literature (e.g., Reuter and Caulkins, 2003) exists whether the supply-side intervention should have had such a dramatic result, given the somewhat modest effects on price and availability.

Environmental Prevention
A major tenet in environmental prevention is that with restrictions of access, abuse will be diminished. Oregon’s experience would appear to contradict that theory. However, it in fact could be argued that yet again the theory is left untested, for policy changes that were intended to limit availability have failed, perhaps predictably. But without the requisite reduction in availability, the environment did not actually alter in a preventive way, and thus use rates would not be expected to decline. A terrible example of what can happen when policy moves ahead of research.