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The Evolving Consequences of OxyContin Reformulation on Drug Overdoses

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  • David Powell
  • Rosalie Liccardo Pacula

Abstract

Recent evidence suggests that the short-term transition of the opioid crisis from prescription opioids to heroin can be attributed to the reformulation of OxyContin, which substantially reduced access to abusable prescription opioids. In this paper, we find that over a longer time horizon, reformulation stimulated illicit drug markets to grow and evolve. We compare overdose trajectories in areas more exposed to reformulation, defined as states with higher rates of nonmedical OxyContin use before reformulation, to less exposed areas. More exposed areas experienced disproportionate increases in fatal overdoses involving synthetic opioids (fentanyl) and nonopioid substances like cocaine, suggesting that these new epidemics are related to the same factors driving the rise in heroin deaths. Instead of just short-term substitution from prescription opioid to heroin overdoses, the transition to illicit markets spurred by reformulation led to growth in the overall overdose rate to unprecedented levels.

Suggested Citation

  • David Powell & Rosalie Liccardo Pacula, 2021. "The Evolving Consequences of OxyContin Reformulation on Drug Overdoses," American Journal of Health Economics, University of Chicago Press, vol. 7(1), pages 41-67.
    • Handle: RePEc:ucp:amjhec:doi:10.1086/711723
    DOI: 10.1086/711723
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    Blog mentions

    As found by EconAcademics.org, the blog aggregator for Economics research:
    1. Chris Sampson’s journal round-up for 15th March 2021
      by Chris Sampson in The Academic Health Economists' Blog on 2021-03-15 12:00:14

    Citations

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    Cited by:

    1. David Cho & Daniel I. García & Joshua Montes & Alison E. Weingarden, 2021. "Labor Market Effects of the Oxycodone-Heroin Epidemic," Finance and Economics Discussion Series 2021-025, Board of Governors of the Federal Reserve System (U.S.).
    2. Bradford, Ashley C. & Fu, Wei & You, Shijun, 2024. "The devastating dance between opioid and housing crises: Evidence from OxyContin reformulation," Journal of Health Economics, Elsevier, vol. 98(C).
    3. Sujeong Park, 2025. "The Growth of Illicit Drug Use and Its Effects on Murder Rates," Health Economics, John Wiley & Sons, Ltd., vol. 34(3), pages 456-471, March.
    4. Shannon M. Monnat, 2022. "Demographic and Geographic Variation in Fatal Drug Overdoses in the United States, 1999–2020," The ANNALS of the American Academy of Political and Social Science, , vol. 703(1), pages 50-78, September.
    5. Graham, Francis W. & de New, Sonja C. & Nielsen, Suzanne & Petrie, Dennis, 2023. "Revisiting the OxyContin Reformulation: The Role of Licit Substitutes," IZA Discussion Papers 16653, Institute of Labor Economics (IZA).
    6. Tim Bersak & Richard Gearhart & Nyakundi Michieka, 2024. "CBD as a cure‐all? The impacts of state‐level legalization of prescription cannabidiol (CBD) on opioid prescriptions," Southern Economic Journal, John Wiley & Sons, vol. 90(3), pages 701-740, January.
    7. Smart, Rosanna & Powell, David & Pacula, Rosalie Liccardo & Peet, Evan & Abouk, Rahi & Davis, Corey S., 2024. "Investigating the complexity of naloxone distribution: Which policies matter for pharmacies and potential recipients," Journal of Health Economics, Elsevier, vol. 97(C).
    8. Abouk, Rahi & Powell, David, 2021. "Can electronic prescribing mandates reduce opioid-related overdoses?," Economics & Human Biology, Elsevier, vol. 42(C).
    9. Evan D. Peet & David Powell & Rosalie Liccardo Pacula, 2024. "Using Policy and Innovation to Improve Life-Saving Access to Naloxone," NBER Working Papers 33105, National Bureau of Economic Research, Inc.
    10. d'Este, Rocco, 2022. "Scientific Advancements in Illegal Drugs Production and Institutional Responses: New Psychoactive Substances, Self-Harm, and Violence inside Prisons," IZA Discussion Papers 15248, Institute of Labor Economics (IZA).
    11. David Cho & Alvaro Mezza & Joshua Montes, 2022. "Choices and Implications when Measuring the Local Supply of Prescription Opioids," Finance and Economics Discussion Series 2022-078, Board of Governors of the Federal Reserve System (U.S.).
    12. Denis Agniel & Jonathan H. Cantor & Johanna Catherine Maclean & Kosali I. Simon & Erin Taylor, 2023. "Insurance Coverage and Provision of Opioid Treatment: Evidence from Medicare," NBER Working Papers 31884, National Bureau of Economic Research, Inc.
    13. Dhaval Dave & Bilge Erten & David Hummel & Pinar Keskin & Shuo Zhang, 2025. "Fighting abuse with prescription tracking: mandatory drug monitoring and intimate partner violence," Journal of Population Economics, Springer;European Society for Population Economics, vol. 38(3), pages 1-27, September.
    14. J. Travis Donahoe & Adam Soliman, 2025. "What fueled the illicit opioid epidemic? New evidence from a takeover of white powder heroin markets," CEP Discussion Papers dp2073, Centre for Economic Performance, LSE.
    15. David Powell, 2025. "Understanding the demographics of the opioid overdose death crisis," Journal of Population Economics, Springer;European Society for Population Economics, vol. 38(3), pages 1-31, September.
    16. Agustina Laurito, 2024. "Spillovers of the Heroin Epidemic on Grandparent Caregiving," Population Research and Policy Review, Springer;Southern Demographic Association (SDA), vol. 43(2), pages 1-25, April.
    17. Jonathan Gruber & Johanna Catherine Maclean & Bill Wright & Eric Wilkinson & Kevin G. Volpp, 2020. "The effect of increased cost‐sharing on low‐value service use," Health Economics, John Wiley & Sons, Ltd., vol. 29(10), pages 1180-1201, October.
    18. Martin Andersen & Johanna Catherine Maclean & Michael F. Pesko & Kosali I. Simon, 2020. "Paid sick-leave and physical mobility: Evidence from the United States during a pandemic," NBER Working Papers 27138, National Bureau of Economic Research, Inc.
    19. Zai, Xianhua, 2024. "Beyond the brink: Unraveling the opioid crisis and its profound impacts," Economics & Human Biology, Elsevier, vol. 53(C).
    20. Park, Sujeong & Powell, David, 2021. "Is the rise in illicit opioids affecting labor supply and disability claiming rates?," Journal of Health Economics, Elsevier, vol. 76(C).
    21. Johanna Catherine Maclean & Justine Mallatt & Christopher J. Ruhm & Kosali Simon, 2022. "The Opioid Crisis, Health, Healthcare, and Crime: A Review of Quasi-Experimental Economic Studies," The ANNALS of the American Academy of Political and Social Science, , vol. 703(1), pages 15-49, September.
    22. DiNardi, Michael, 2025. "The Reformulation of OxyContin and Availability of Substance Use Treatment Facilities in the United States," MPRA Paper 124502, University Library of Munich, Germany.
    23. Daniele, Gianmarco & Le Moglie, Marco & Masera, Federico, 2023. "Pains, guns and moves: The effect of the U.S. opioid epidemic on Mexican migration," Journal of Development Economics, Elsevier, vol. 160(C).
    24. Martin Andersen & Johanna Catherine Maclean & Michael F. Pesko & Kosali Simon, 2023. "Does paid sick leave encourage staying at home? Evidence from the United States during a pandemic," Health Economics, John Wiley & Sons, Ltd., vol. 32(6), pages 1256-1283, June.
    25. Resul Cesur & Joseph J. Sabia & W. David Bradford, 2024. "The effect of combat deployments on veteran opioid abuse," Health Economics, John Wiley & Sons, Ltd., vol. 33(6), pages 1284-1318, June.

    More about this item

    JEL classification:

    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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