2011/Hazing on College Campuses/26
HAZING ON COLLEGE CAMPUSES;
WHO IS LIABLE?
by
Elizabeth A. Marcuccio*
Joseph P. McCoUum**
I. INTRODUCTION
An individual has the right to be free from harmful or
offensive contact by another, including intentional contact
anticipated to cause physical harm and emotional distress. The
common law recognizes this right to be free from unpermitted
contact, as well as the corresponding duty to conduct oneself in
a manner that prevents unreasonable risks to others. When
dealing with hazing on college campuses, the law differs from
state to state. Currently forty-four states have anti-hazing
statutes. These statutes play an important role in setting forth
the proper public policy on this issue.
In the past hazing was seen as a legitimate rite of
passage, and young people who succumbed to the pressures of
classmates where believed to be getting what they deserved.
Now, in addition to civil liability, wrongdoers are facing
criminal prosecution for their actions.^
•Associate Professor of Business Law, Siena College, Loudonville New
York
**Assistant Professor of Quantitative Business Analysis, Siena College,
Loudonville, New York
27/Vol 26/North East Journal of Legal Studies
II. ANTI-HAZING STATUTES
Typically state statutes that outlaw hazing prohibit any
willful act that recklessly or intentionally endangers the
physical health of a student. Only Alabama, Ohio, Oklahoma,
and Rhode Island recognize the mental as well as the physical
aspects of hazing (see Figure 1).^ Although a particular state
may not have enacted a hazing statute, often actions that
constitute hazing may be prosecuted under other criminal
statutes, such as the state's assault or reckless endangerment
laws. In most states, hazing is considered a misdemeanor, with
fines ranging from $100 to $5,000.'* However, in Illinois,
Indiana, Missouri, Texas, Virginia, and Wisconsin, hazing that
results in death or "great bodily harm" is categorized as a
felony (see Figure 2).^ The New Hampshire law is also
particularly aggressive, stating that in addition to the individual
wrongdoers, institutions may also be charged with a
misdemeanor for "knowingly condoning hazing or negligently
failing to take adequate measures to prevent student hazing".^
Figure 1: Hazing Statutes
Number Name
Type
AZ, AR, CA, CO, CT,
DE, FL, GA, ID, IL, IN,
IA, KS, KY, LA, ME,
MD, MA, MI, MN, MS,
Physical Hazing
40
MO, NE, NV, NH, NJ,
Only
NY, NC, ND, OR, PA,
SC, TN, TX, UT, VT,
VA, WA, WV, WI
Mental and Physical
AL, OH, OK, RI
4
Hazing
AK, HI, MT, NM, SD,
WY
6
None
2011/Hazing on College Campuses/28
Figure 2: Criminal Charges by State for Hazing
Type
No. List
Felony
8
IL, IN, MO, TX, UT, VA, WV, WI
Misdemeanor
23
Fine
Other
None
7
6
6
AL, AZ, AR, CA, CO, DE, FL, GA,
ID, L^, KS, MD, NE, NV,NH, NY,
NC, ND, OH, PA, RI, SC, WA
CT, LA, MA, MS, OK, OR, VT
KY, ME, MI, MN, NJ, TN
AK, HI, MT, NM, SD, WY
Many state statutes contain stipulations outlining stiff
punishment for those aiding or assisting in hazing activities. It
is evident that lawmakers acknowledge the significance of the
peer pressure and coercion components of hazing. In the vast
majority of states, criminal statutes include a provision that
bars the wrongdoers from defending their conduct on the basis
of the alleged consent by the pledge or new member to the
hazing activities.^
HI. CIVIL LIABILITY
In addition to criminal sanctions, wrongdoers face civil
liability. Unlike the criminal courts, most civil courts allow
those involved in hazing activities to defend their actions based
on the plaintiffs purported consent, and courts are holding
hazed students responsible for decisions made with informed
consent. This issue, however, is more complex than it seems.
Often hazing involves circumstances where the victim never
truly consents to the hazing or where the consent is obtained by
the forced consumption of alcohol, threats, or extreme group
pressure. Ultimately, many of these students withhold their
consent to hazing, but only after they have suffered serious
harm.*
29/Vol 26/North East Journal of Legal Studies
When injury or death occurs as a result of hazing there
is no question that the individual parties involved in the
incident are subject to liability. Many lawsuits also focus on
the fact that the fraternity or university did not take sufficient
action to protect the injured party. Whether these institutions
can also be sued depends on the specific facts of the case.
IV. THE FRATERNITY
The national fraternity is often the hardest to reach in a
lawsuit. Many fraternities are set up to shield the national
organization from liability arising out of the misconduct of its
members and local chapters. They are frequently formed as
unincorporated associations. This is a unique legal form that is
not required to be registered with the state. In a further attempt
to avoid litigation, the national organizations often structure
their corporate documents to "affirmatively disavow any
obligation to supervise or control conduct of chapters or
members."^ These corporate documents establish the national
fraternity as merely a clearinghouse for information and ideas,
as well as a general resource for local chapters. The documents
further indicate that the national fraternity will have no
responsibility for certain types of misconduct by the chapter or
its members, including hazing.'"
Even when a fraternity is established using this type of
structure, the national fraternity can still be liable if it is found
to supervise and have a measure of control over its local
chapters. For example, many of the national organizations hire
"leadership consultants" who are former members of the
fraternity that have recently graduated. These individuals are
responsible for traveling to universities to make stire individual
chapters are following the laws and rules, and to provide
training in alcohol and related matters. They often have the
power to take away the chapter's charter if rules are not being
2011/Hazing on College Campuses/30
obeyed." This indieates that, despite what the eorporate
doeuments say, the national fraternity oversees and manages its
loeal ehapters. What if the eontaet between the national and
loeal entities is minimal? The national organization may have
eontaet with a loeal ehapter only two times per year, and eould
have 300 to 400 ehapters at various universities nationwide.
Does the national fraternity have suffieient eontrol over the
loeal ehapters to be held liable?
Under eommon law ageney prineiples it is the degree of
eontrol that the national fraternity has over the loeal ehapters
that determines whether the national fraternity ean be sued.
Defense attorneys will argue that the national fraternity has no
intent to eontrol the day-to-day aetivities of a loeal ehapter.
They merely give the loeal fraternity a lieense to use their
name and symbol, and offer some guidelines. Nevertheless if
the national fraternity is in the position to ehange the behavior
of its members, a plaintiff ean sue the national fraternity, and
win.'^ In many eases there is no sueh thing as membership
solely in the loeal ehapter. Also the ehapter pays dues to the
national fraternity. Therefore members earrying out initiation
aetivities at the loeal level are doing so under the authority of
the national fraternity and direetly for its benefit. Through the
authority eonveyed upon the ehapter by the fraternity's
organizational doeuments, the national organization has, in
faet, established the membership intake proeess. Therefore it
has the authority to either modify the proeess or prevent the
eondueting of initiations altogether.'^
Most fraternities have strong anti-hazing and antiunderage drinking polieies that stena from the national
organization. These polieies are detailed in manuals, and
representatives from the fraternity go to various eollege
eampuses to give talks about these issues. By establishing
these polieies the national fraternity is attempting to exereise
31/Vol 26/North East Journal of Legal Studies
control over the chapters. However, it can be argued that this
is not enough to render the national fraternity liable. The
policy statements can be seen as nothing more than the
fraternity's mission statement, especially if there is no penalty
attached for violating the policy. '
V. THE UNIVERSITY
Universities may also face liability for student injury or
death as a result of hazing. Historically, colleges and
universities were looked upon as "parental supervisors", and
courts did not question the authority of universities over their
students.'^ This line of reasoning, the in loco parentis doctrine,
saw its demise with the Third Circuit's ruling in Bradshaw v.
Rawlings.^^ In Bradshaw v. Rawlings two students attended a
picnic sponsored by the school at which alcohol was served.
Rawlings became intoxicated. While driving back to campus
Rawlings lost control of his car and struck a parked vehicle.
Bradshaw, a passenger in Rawlings' car, was rendered a
quadriplegic. Bradshaw later sued the college, among others,
claiming that it had breached its duty to protect him from
unreasonable risk of harm.'' The Third Circuit determined that
since the students were no longer minors, there was no special
relationship existing between the college and the students.
Therefore the college had no duty to control a student's
conduct to prevent him from harming another.'^
The Bradshaw decision clearly establishes a "no-duty"
model, allowing courts to conclude that a "custodial,
supervisory relationship between a university and its students
[is] inconsistent with modem educational objectives".' Rabel
V. Illinois Wesleyan University^^ is another example of this "no
duty" movement.
2011/Hazing on College Campuses/32
In Rabel a student. Chérie Rabel, suffered a skull
fracture and concussion after being forcibly grabbed, picked
up, and accidentally dropped on the ground by a member of Phi
Gamma Delta fraternity. Rabel filed a complaint against the
university claiming, in part, that the university's "policies,
regulations, and handbook created a special relationship with
its students and a corresponding duty to protect its students
against the alleged misconduct of a fellow student."^' In its
decision the Appellate Court stated:
we do not believe that the university, by its handbook,
regulations, or policies voluntarily assumed or placed itself in a
custodial relationship with its students, for purposes of
imposing a duty to protect its students from the injury
occasioned here. The university's responsibility to its students,
as an institution of higher education, is to properly educate
them. It would be unrealistic to impose upon a university the
additional role of custodian over its adult students and to
charge it with the responsibility for assuring their safety and
the safety of others. Imposing such a duty of protection would
place the university in the position of an insurer of the safety of
its students.•^^
After the Bradshaw and Rabel decisions, courts were
unlikely to hold universities legally responsible for the actions
and injuries of their students. However subsequent case law
established that, under certain circumstances, universities
assume a duty of care.
In Furek v. University of Delaware
the court
demonstrated that it was willing to depart from the strict "no
duty" standard and impose liability on universities under
certain factual circumstances. In Furek a fraternity pledge
suffered first- and second-degree bums after a fraternity
member poured oven cleaner over his head and back as part of
33/Vol 26/North East Journal of Legal Studies
Hell night high jinks. Attendance at the secret Hell night
ceremony was mandatory for pledges in order to be accepted
into the Sigma Phi Epsilon fratemity. The events took place in
the chapter house, which was leased from the University of
Delaware by the fratemity. The university had an established
policy prohibiting hazing. ^'^
The Delaware Supreme Court determined that the
university's effort to regulate hazing exposed it to liability for
hazing-related injuries. The university not only had a duty to
protect its students from the dangers of hazing, it had an
obligation to exercise appropriate restraint over the conduct of
fratemity members. Even though the university did not control
the day-to-day activities of the chapter, it had an obligation to
promote general campus safety and security.'^^ Recent case law
indicates that the Bradshaw line of reasoning is still a frequent
and justifiable defense, but the Furek decision is a landmark
example of how the "no duty" principle is not applicable in
every situation, particularly when hazing-related injuries are
involved.^^
The Furek decision has left colleges and universities in
a dilemma. If they exercise strict control over fratemities they
have an implied duty of care that can expose them to liability if
breached. Conversely, exercising no control is not the answer.
Many states now have laws that require universities to adopt
anti-hazing policies, and failure to do so can result in liability.
VL STATISTICAL ANALYSIS
In our statistical analysis we studied 43 colleges in New
York State that have Greek Life on campus and 41 colleges
that do not have Greek Life. Our data was retrieved from the
websites "mynextcollege.com" and "collegeprowler.com".
Our goal was to determine what factors may influence the
2011/Hazing on College Campuses/34
absence or presence of Greek Life. The first factors studied
were geographical location of the college, the cost of going to
that college, and average undergraduate size for the college.
As Figure 3 clearly indicates, only undergraduate size differs
significantly. College campuses with Greek Life have an
average undergraduate population approximately 2.25 times
larger than colleges without Greek Life.
Figure 3: Comparing Campus Life in
New York Colleges
Greek
Life
Without Greek Life
Number
in Suburban Areas
18
20
Number
in Rural Areas
12
8
Number
in Urban Areas
13
13
Ave Cost of Tuition 20,123
19,995
Ave Cost of Room
and Board
8,965
8,714
Ave Undergraduate
Size
6,374
2,852
Ave Percent of On
Campus Housing
55
56
The reason it appears that Greek Life prevails on larger
campuses is because 21% of colleges with Greek Life have
undergraduate populations in excess of 10,000 students, and
71% of colleges without Greek Life have less than 3,000
students. However Greek Life exists on both large and small
college campuses. For example Hartwick College, one of the
smallest colleges, (under 2,000 students) and New York
35/Vol 26/North East Journal of Legal Studies
University, one of the largest eolleges, (over 20,000 students)
both have Greek Life.
Next, we determined how many males and females
partieipated in Greek Life and found the average number of
Fraternities and Sororities on eollege eampuses (See Figure 4).
Figure 4: Facts About Greek Life in
New York Colleges
Ave. Percentage of Males in Fraternities
Ave. Pereentage of Females in Sororities
Ave. Number of Fraternities on Campus
Ave. Number of Sororities on Campus
8%
7%
10
8
Roughly 15% of students on eollege eampuses
partieipate in Greek Life. Sinee the average undergraduate size
is 6,374 students, approximately 956 students on a typieal New
York eampus belong to a Greek Organization. Therefore eaeh
Fraternity or Sorority on eampus has approximately 53
members.
Figure 5: Type of Governance for Greek Life
Colleges With
(Out of 43)
Type of Council
38
Dean of Greek Life
27
Panhellenie Couneil
Interfratemity Couneil 21
26
Greek Couneil
7
Other
It was important to our study to determine whether New
York eolleges with Greek Life-have a Dean or Director of
2011/Hazing on College Campuses/36
Greek Life, and whether any govemance councils exist on
these New York campuses. Figure 5 above summarizes the
type of govemance that colleges have in place.
The following definitions are helpful in understanding
Figure 5:
The Interfratemity Council (IFC) is a council formed by
members of all the fi-aternities on campus. The IFC, as defined
by Comell University, is a "form of common goveming
council, in which the member chapters collectively assemble
and discuss issues affecting the Fratemity and Greek System as
a whole". ^' The Comell website goes on to mention that "The
council's primary concem is the safety, security, and
advancement of each member fratemity house". ^^
I
I
The Panhellenic Council is a council formed by
members of all the sororities on campus. The Panhellenic
Council, as defined by Columbia University, is "an umbrella
organization to promote mutual collaboration among individual
chapters of the Greek system". ^^ The Columbia University
website further states: "in order to achieve its goals [the
association] implements programming that foster the universal
sorority ideals of leadership, integrity, and scholarship among
its members". ^'^
I
I
|
!
j
!
!
\
I
I
Figure 5 makes it clear that colleges are putting
safeguards in place to govem Greek Life. Over 88% of New
York colleges that have Greek Life also have a Dean to oversee
their Greek organizations. It appears that these colleges have
assumed a duty of care for their students. Nevertheless eleven
deaths have occurred due to some type of hazing on nine New
York campuses since 1970. ^' In other words, approximately
21% of the colleges in New York State that have Greek Life
have had a death due to hazing. The most recent were Kevin
¡
!
I
!
i
37/Vol 26/North East Journal of Legal Studies
Lawless at lona in 1999, Jonathan Marconi at SUNY Cortland
in 2001, Ben Klein at Alfred University in 2002, Jerry Hopkins
at Rochester Institute of Technology in 2003, Walter Dean
Jennings at SUNY Pittsburgh in 2003, and Arman Partamian
at SUNY Geneseo in 2009.
It should be noted that the deaths of Walter Jennings,
Arman Partamian, and Jonathan Marconi were all associated
with unrecognized Greek Organizations. These deaths, along
with injuries suffered by Bryan Parslow at SUNY Brockport in
2009, have prompted some colleges to list unrecognized Greek
Organizations on their college website and warn that they will
not support a student's choice in joining these organizations.
The University at Buffalo's website states: "The University at
Buffalo does not advise nor control the actions of these offcampus groups. Typically, the instances of hazing are high for
these groups as well. Affiliation with these groups is a
violation of the UB Student Code of Conduct and puts students
at risk for suspension and/or expulsion from the University.
University policy
in accordance with SUNY policy changes
mandates a permanent transcript notation for students who are
found to be responsible for hazing incidents that involve the
injury of another person."
It is clear that the SUNY college system is taking a
stand against unrecognized chapters. The website of SUNY
Oneonta goes into detail of what it is like to be a member of
one of these organizations and the effects it has on the
community. It states: "Being a member of an unrecognized
Greek organization is likely to be an unrewarding experience,
regardless of what they may tell the student. Many of these
organizations pledge until very close to the end of the semester
and then their dues go towards parties, shirts, and alcohol. This
is where the phrase 'You pay for your friends' comes from in
regards to joining a Greek organization because the dues
2011/Hazing on College Campuses/38
money is going towards nothing productive to society. These
organizations are just social groups. Unrecognized
organizations give a bad reputation to all Greek organizations
in the city of Oneonta, which makes it harder for recognized
organizations to keep their reputations positive. Unrecognized
organizations are often a nuisance to society: causing fights,
large amounts of noise ordinance violations, unpleasant living
environments, destruction to off-campus housing, etc.
Unrecognized fratemities are banned from living in many
apartments, which is stated in many leases, along with
fratemity and sorority hazing activities. Landlords are aware
of the problem but there is only so much they can do." "
What can colleges do in addition to making students
aware of the risks of joining these organizations? Alfred
University, after the death of a pledge in 2002, started an
investigation into the hazing practices of the Greek
Organizations on its campus. This investigation resulted in the
tmstees of the university eliminating all Greek Life on campus.
In a similar manner Ithaca College banned all Greek Life in the
198O's due to a hazing incident. However banning Greek Life
from campus will not entirely solve the problem of hazing,
since unrecognized fratemities will continue to exist.
VII. CONCLUSION
Fratemity hazing has resulted in at least one death
every year since 1970.^"* Yet the practice continues despite the
deaths, the enactment of anti-hazing statutes and the increasing
number of lawsuits. The states' adoption of anti-hazing
legislation reflects the shift in society's view of hazing. While
legislation has improved greatly during the last decade to
combat hazing, it is evident that more progress needs to be
made. The mental as well as physical aspects of hazing should
39/Vol 26/North East Journal of Legal Studies
be recognized, and heavier punishments must be imposed for
hazing offenses.
In civil lawsuits plaintiffs frequently use a negligence
theory to recover for hazing-related injuries. When suing the
national fraternity or university, the focal point of the litigation
is whether a duty of care exists. In seeking to establish a duty,
students will typically claim that fraternities and universities
assume a duty when they attempt to regulate or control chapter
conduct or activities. This puts the organizations in the
awkward position of deciding whether to limit their liability by
exercising very strict control, or by exercising no control
whatsoever.
END NOTES
' Fierberg, Douglas (2004) "Protect Your Rights",
www.hazinglaw.com/rights.htm. The following states do not
currently have hazing laws: Alaska, Hawaii, Montana, New
Mexico, South Dakota and Wyoming.
^ http://www.thegreekshop.com/hazing.html.
'' Manley, Burke, Lipton, & Cook (2000). Hazing: Know the
consequences of your actions. The FRMT Risk Management
Newsletter, 7, 1-3.
^ http://www.thegreekshop.com/hazing.html.
2011/Hazing on College Campuses/40
s
Fierberg, Douglas (2004).
www.hazinglaw.eom/rights.htm.
I
"Proteet
Your
Rights",
I
i
I
^ Gertner, Reni (2005). Fraternity Lawsuits Becoming More
Common—What to Evaluate in Suing a Fraternity. Lawyers
Weekly USA, 1-2.
'" Id. at 2.
" Id. at 4.
'^ Id. at 3.
'^ Id. at 4.
'"Id.
'^ MaeLaehlan, J. (2000). Dangerous Traditions: Hazing
Rituals on Campus and University Liability, Journal of College
and University Law, 26(3), 514.
'^ Bradshaw v. Rawlings, 612 F.2d 135 (3'''^ Cir. 1979).
'^ Id. at 136.
'^ Id. at 143.
'^ MaeLachlan, J. (2000). Dangerou Ttraditions: Hazing
Rituals on Campus and University Liability, Journal of College
and University Law, 26(3), 521.
41/Vol 26/North East Journal of Legal Studies
^° Rabel v. Illinois Wesleyan University, 161 111. App. 3d 348
(1987).
^' Id. at 356.
^^ Id. at 361.
" Furekv. University of Delaware, 594 A.2d 506 (Del. 1991).
^'* Id. at 508.
^^ Id. at 514.
^^ Gertner, Reni (2005). Fraternity Lawsuits Becoming More
Common—What to Evaluate in Suing a Fraternity. Lawyers
Weekly USA, 5.
^'http://comellifc.com/about-the-ifc
^^Id.
^^http://www.columbia.edu/cu/panhel/aboutus.htm
•^'http://hazing.hanknuwer.com/
^^http://www.student-affairs.buffalo.edu/greeklife/grigc.php
^ ^http : 11www. oneonta. edu/development/huntunion/i gc/recunrec
.html
^^
Fierberg, Douglas (2004)
www.hazinglaw.com/rights.htm.
"Protect
Your
Rights",
Copyright of North East Journal of Legal Studies is the property of North East Academy of Legal Studies in
Business, Inc and its content may not be copied or emailed to multiple sites or posted to a listserv without the
copyright holder's express written permission. However, users may print, download, or email articles for
individual use.
The Effect of Marijuana
Decriminalization on
Hospital Emergency Room
Drug Episodes: 1975-1978
Karyn E. Model
Reprinted from Journal of the
American Statistical Association
.
/
L
The Effect of Marijuana Decriminalization on Hospital
Emergency Room Drug Episodes: 1 9 7 5 - 1 9 7 8
KARYN E MODEL*
Between 1973 and 1978, 12 states with collectively over one-third of the total U.S. population enacted laws that decrimmahzed the
possession of marijuana. This article uses standard metropolitan statistical area (SMSA) level data on hospital emergency room drug
episodes collected by the Drug Abuse Warning Network to measure the effect of changes in drug penalties on substance abuse crises.
The regression models demonstrate that marijuana decriminalization was accompanied by a significant reduction in episodes involving
drugs other than marijuana and an increase in marijuana episodes. Although possible biases in the data preclude firm conclusions,
the results suggest that some substitution occurs towards the less severely penalized drug when punishments are differentiated.
KEY WORDS:
Drug Abuse Warning Network; Drug policy; Marijuana decriminahzation; Substitution.
Drug control policy in the United States is generally formulated under the assumption that such policies are effective
in influencing drug use. This is accomplished through traditional economic channels; the fact that the possession or
sale of an illegal substance carries the risk of arrest and conviction serves to increase the cost of these goods. As penalties
increase, the cost of the substance may rise as sellers require
greater compensation for dealing in illegal goods, while buyers must also incorporate possible penalties into their full
costs of use. Thus U.S. policy proceeds on the assumption
that the demand for drugs will vary inversely with the severity
of penalties, because these penalties serve to increase costs.
The decriminalization of marijuana by 12 states between
1973 and 1978 is one of the few instances where penalties
for an illegal substance were actually reduced. Decriminalization maintained marijuana’s illegality but designated firstoffense possession as a civil (not criminal) offense. Prison
sentences were abolished and replaced with small fines (typically $100) for first offense possession of (usually) less than
1 ounce of marijuana. The reduced penalties also signalled
a decreased priority for marijuana possession arrests and thus
served to divert police attention away from these offenses.
States that decriminalized marijuana experienced a dramatic
reduction in possession arrests (National Governor’s Conference 1977). Marijuana use thus became “cheaper” as a
result of both the decline in probability of apprehension as
well as the reduction in possible penalties imposed.
Empirical research concerning the effect of decriminalization on drug use is scarce. Analysis of data from Monitoring
the Future, an annual survey of the values and life-styles of
high school seniors, found that seniors in decriminalized
states reported using no more marijuana than did their
counterpart in control states (Johnston, O’Malley, and
Bachman 198 1). This study did not, however, control for
demographic characteristics of subjects and did not examine
the use of substances other than marijuana. Also, high school
* Karyn E. Model is Associate Economist, RAND Corporation, Santa
Monica CA 90407-2 138. The author thanks Joshua Angrist and Lawrence
Katz, as well as the participants in the Labor Seminar at Harvard and the
Workshop on The Economics of Illegal Drugs at the National Bureau of
Economic Research, for many helpful conversations and comments. The
author is also indebted to the many reviewers who sent their extremely
helpful comments on an earlier version of this article, to those anonymous
reviewers who helped shape the final version, and to Andrea Kopstein at
the National Institute on Drug Abuse for help in obtaining the data.
youth represent a sample that may not respond to new legislation in the same manner as the general population.
Standard economic analysis would predict that legal
changes impact the use of marijuana by changing its full use
price. Also, one must consider the possibility of related effects
on the use of substitute or complement goods. Changes in
marijuana policy may affect not only marijuana use, but
also the use of other intoxicating substances.
DiNardo and Lemieux (1992) also used Monitoring the
Future data to analyze the impact of increased minimum
drinking ages (which can similarly be interpreted as imposing
increased costs on seniors’ alcohol consumption on both alcohol and marijuana use. They found that higher drinking
ages are associated with reduced alcohol consumption, but
increased marijuana use. This result lends support to the
existence of substitution in consumption between marijuana
and alcohol.
This article analyzes the effects of marijuana decriminalization on drug mentions in hospital emergency room (ER)
episodes between 1975 and 1978. The outcome studied here
is an ER drug mention. A drug mention occurs when medical
staff at a reporting ER detect drug use in an ER patient
(though substance abuse need not be the cause of, or even
related to, the ER visit). Section 1 describes the medical and
demographic data assembled for use in this study. Section 2
outlines a simple statistical model used to identify the effect
of marijuana decriminalization on hospital emergency room
drug episodes. Section 3 presents the results of estimation
of this model. All regression specifications confirm that decriminalized cities experienced a statistically significant
increase in marijuana mentions as well as a significant reduction in the mention of other drugs relative to nondecriminalized standard metropolitan statistical areas (SMSA’s) .
Section 4 discusses these results and offers some concluding
remarks.
I. DATA FROM THE DRUG ABUSE
WARNING NETWORK
The Drug Abuse Warning Network (DAWN) has collected
data on drug-related ER episodes in 24 major SMSA’s since
1972 (though data at the level necessary for the analysis here
Reprinted by permission from Journal of the American Statistical
Association,
Copyright
737
September 1993, Vol. 88, No. 423, pp. 737-747.
1993 American Statistical Association.
738
Journal of the American Statistical Association. September 1993
were not available until 1975). DAWN is a large-scale nationwide drug abuse data collection program sponsored by
the National Institute on Drug Abuse (NIDA) and the Drug
Enforcement Administration (DEA) . Participating ER’s report all drug abuse ER episodes using a standardized questionnaire. DAWN records data on all ER episodes involving
illicit drugs as well as “the use of prescription drugs in a
manner inconsistent with accepted medical use” (National
Institute on Drug Abuse 1976). Episodes involving alcohol
are recorded only when alcohol was used in conjunction
with another illicit drug or with a prescription drug used for
nonmedical purposes. (For this reason, the analysis that follows does not examine alcohol-related episodes separately
since they are not recorded in the data.)
DAWN reports refer to ER drug episodes directly related
to substance abuse (such as overdoses) as well as incidents
in which evidence of drug use was obtained. For example,
a victim in a motor vehicle accident exhibiting evidence of
drug use would be interviewed and tested for possible inclusion as a DAWN drug abuse episode. The DAWN documentation states that for each drug abuse episode, “the drug’s
causal involvement can range from being directly and totally
responsible for the emergency room episode, acting in combination with other abused drugs to bring about the crisis,
or have no causal relationship even though abused and present during a given episode.” The data are also periodically
updated when a previously unrecorded episode is found to
have involved drug abuse (National Institute on Drug Abuse
1976).
One potential problem with the DAWN data is that patients may not cooperate in disclosing drug use if ER physicians do not detect the possibility of use independently.
This self-reporting impediment could result in nonreporting
or misreporting of information. One recent study polled current marijuana users (members of the National Organization
for the Reform of Marijuana Laws [NORML]) as to the
conditions under which they would report marijuana use to
health care professionals. Although the overall response rate
was low, 95% of the respondents reported that they would
disclose information regarding marijuana use to a doctor or
a nurse if they had suffered a major health problem believed
to be caused by marijuana (Mathre 1988). Because most
DAWN respondents have suffered major medical crises, this
study indicates that the majority would respond accurately
to physicians’ inquiries about their marijuana use (though
NORML members are certainly not a representative population sample). But the fact that individuals are more likely
to divulge drug use when they believe it to be related to their
medical condition may indicate that DAWN data more accurately measures drug abuse-caused episodes as opposed to
drug abuse-related episodes. Additionally, because DAWN
reports are also determined by doctors’ and nurses’ observation of crisis occurrences, these data should not reflect
quite such substantial reporting prejudice as are found in
purely self-reporting interview settings (though they are likely
not as accurate as chemical tests of blood and/or urine).
Issues of reporting bias will be discussed at length in the next
section.
The unit of analysis in this study is what is referred to in
DAWN reports as a drug mention. An ER episode can involve
the mention of up to six drugs, so that each drug mention is
not necessarily associated with a separate individual. Also,
the same individual may visit an ER more than once in any
reporting period (quarter). DAWN does not record personal
identifiers for specific ER episodes, so it is impossible to
identify the fraction of repeat ER patients (NIDA 1977).
Only quarterly SMSA-level data are published. Micro-data
are collected at the hospital level but not released.
One issue that arises when using such “drug abuse indicator” data is the way in which DAWN ER mentions translate into actual drug use in the population as a whole. Based
on aggregate trend data from NIDA’s National Household
Survey on Drug Abuse and relevant SMSA population data,
past month marijuana use prevalence is estimated as ap
proximately 12.7% of the population over the years relevant
to the current study. Applied to the mean SMSA in the sample (and ignoring the issue of multiple visits), this suggests
approximately 4 0 0 , 0 0 0 past month marijuana users per
DAWN SMSA in any given quarter, indicating that on average each user is associated with .000 1 mentions per quarter
(or, conversely, that generating one additional marijuana
mention requires 9,500 additional users in an SMSA per
quarter). Overall prevalence of any illicit drug use is ap
proximately 13.9%, or 420,000 users per SMSA each with
an average of .003 mentions per quarter (and requiring 325
additional users to generate one extra DAWN mention of
any drug) (NIDA 1989). Although the population drug use
prevalence figures are interesting in and of themselves, it is
clear that DAWN medical crises occur in only a minute
fraction of the drug abusing population. Additionally, not
all ER visits are actual emergencies, and all emergencies that
occur may not be reported to the local ER. Thus this article
more accurately identifies changes in ER drug mentions for
the ER-using population, which may not be equivalent to
the population at large.
DAWN attempted to include all eligible ER’s in all but
three of the sampled SMSA’s. A random sample of eligible
ER’s was used in New York, Chicago, and Los Angeles, because these SMSA’s have larger populations than the other
participant SMSA’s. Eligible ER’s are defined as “ER’s which
are open 24 hours a day; located in non-federal, short term
general hospitals; and which have at least 1000 patient visits
to the ER in a year. Specialty hospitals, hospital units of
institutions, and pediatric hospitals are excluded (NIDA
1977, p. 2).
Data inconsistencies arise because the ER’s in the DAWN
sample change over time; occasionally new reporting facilities
are added and others are dropped (NIDA, 1977). This article
analyses drug mentions recorded by “consistently reporting”
ER’s only. Consistent reporters are defined as those having
reported on at least 90% of the possible reporting days since
January 1974 (NIDA 1976). Data on numbers of drug mentions are supplemented with information on the total number
of consistently reporting ER’s in the SMSA each quarter, as
well as the percent of all ER’s in the SMSA participating in
the DAWN system; this participation percent is referred to
Model: Marijuana Decriminalization and Emergency Drug Episodes
739
Table 1. Marijuana Decriminalization in States with DAWN Cities
Maximum penalties for possession
Before decriminalization
California:
Enacted 1 /1/76
(San Diego, Los Angeles, San Francisco)
1st: NMT’ 1 yr.
2nd: NMT 20 yrs.
3rd: 5 yrs.-life
Colorado:
Enacted 7/1/75
(Denver)
>
Minnesota:
Enacted 4/1 /76
(Minneapolis/St. Paul)
New York:
Enacted 7/29/77
(New York, Buffalo)
Ohio:
Enacted 11/22/75
(Cleveland)
After decriminalization
1 oz: O-6 mos. and $500
oz: NMT 1 yr. and NMT $500
oz: 2-l 5 yrs. and $10,000
1 oz: O-6 mos. and $500
oz: NMT 1 yr. and NMT $1.000
oz: NMT 3 yrs. and NMT $3,000
1.5 oz: O-3 yrs. and $3,000
oz: NMT 1 yr.
oz: 3-7 yrs.
oz: 5-15 yrs.
lb: 15 yrs.-life
1st:
2nd:
3rd:
1 st: NMT 1 yr. and NMT $1,000
2nd: NMT 10 yrs.
and/or 0-15 days
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