Markov chain modeling of initiation and demand: The case of the US cocaine epidemic

Everingham and Rydall's Markov chain model of cocaine demand is modified and updated in the light of recent data. Key insights continue to hold, e.g., that the proportion of cocaine demand stemming from heavy vs. light users changed dramatically over the 1980s. New insights emerge, e.g., pertaining to the average duration of a career of heavy use (about 12 years) and the negative relationship between heavy use and epidemic ‘infectivity’ or the number of new initiates per current user per year. This illustrates how simple modeling can yield insights directly relevant to managing complex drug control policy questions.