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Behavioral Responses to Supply-Side Drug Policy During the Opioid Epidemic

Author

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  • Balestra, Simone

    (University of St. Gallen)

  • Liebert, Helge

    (Swiss National Bank)

  • Maestas, Nicole

    (Harvard Medical School)

  • Sherry, Tisamarie B.

    (RAND)

Abstract

We investigate behavioral responses to a staggered disruption in the supply of prescription opioids across U.S. states: the introduction of electronic Prescription Drug Monitoring Programs (PDMPs). Using administrative datasets, we find PDMPs curtail the proliferation of prescription opioids. Physicians respond to monitoring on the extensive margin, limiting the number of patients to whom they prescribe opioids without adjusting dosage or duration. This decreases supply to long-term opioid users, who evade the restrictions by acquiring prescriptions from out-of-state prescribers and by substituting to heroin. This causes a surge in heroin overdoses, which offsets reductions in hospitalizations and deaths from prescription opioids.

Suggested Citation

  • Balestra, Simone & Liebert, Helge & Maestas, Nicole & Sherry, Tisamarie B., 2022. "Behavioral Responses to Supply-Side Drug Policy During the Opioid Epidemic," IZA Discussion Papers 15221, Institute of Labor Economics (IZA).
    • Handle: RePEc:iza:izadps:dp15221
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    1. Janet Currie & Hannes Schwandt, 2021. "The Opioid Epidemic Was Not Caused by Economic Distress but by Factors That Could Be More Rapidly Addressed," The ANNALS of the American Academy of Political and Social Science, , vol. 695(1), pages 276-291, May.
    2. Clément de Chaisemartin & Xavier D'Haultfœuille, 2020. "Two-Way Fixed Effects Estimators with Heterogeneous Treatment Effects," American Economic Review, American Economic Association, vol. 110(9), pages 2964-2996, September.
    3. Molly Schnell & Janet Currie, 2018. "Addressing the Opioid Epidemic: Is There a Role for Physician Education?," American Journal of Health Economics, University of Chicago Press, vol. 4(3), pages 383-410, Summer.
    4. Angélica Meinhofer, 2018. "Prescription Drug Monitoring Programs: The Role of Asymmetric Information on Drug Availability and Abuse," American Journal of Health Economics, University of Chicago Press, vol. 4(4), pages 504-526, Fall.
    5. Strulik, Holger, 2021. "From pain patient to junkie: An economic theory of painkiller consumption and its impact on wellbeing and longevity," Journal of Health Economics, Elsevier, vol. 76(C).
    6. Simon Heß, 2017. "Randomization inference with Stata: A guide and software," Stata Journal, StataCorp LP, vol. 17(3), pages 630-651, September.
    7. Grossmann, Volker & Strulik, Holger, 2021. "Illicit drugs and the decline of the middle class," Journal of Economic Behavior & Organization, Elsevier, vol. 183(C), pages 718-743.
    8. Fally, Thibault, 2015. "Structural gravity and fixed effects," Journal of International Economics, Elsevier, vol. 97(1), pages 76-85.
    9. Sant’Anna, Pedro H.C. & Zhao, Jun, 2020. "Doubly robust difference-in-differences estimators," Journal of Econometrics, Elsevier, vol. 219(1), pages 101-122.
    10. William N. Evans & Ethan M. J. Lieber & Patrick Power, 2019. "How the Reformulation of OxyContin Ignited the Heroin Epidemic," The Review of Economics and Statistics, MIT Press, vol. 101(1), pages 1-15, March.
    11. Dobkin, Carlos & Nicosia, Nancy & Weinberg, Matthew, 2014. "Are supply-side drug control efforts effective? Evaluating OTC regulations targeting methamphetamine precursors," Journal of Public Economics, Elsevier, vol. 120(C), pages 48-61.
    12. Caulkins, J.P. & Schoeff, D., 2001. "Drug prices and emergency department mentions for cocaine and heroin," American Journal of Public Health, American Public Health Association, vol. 91(9), pages 1446-1448.
    13. Young, Alwyn, 2019. "Channeling Fisher: randomization tests and the statistical insignificance of seemingly significant experimental results," LSE Research Online Documents on Economics 101401, London School of Economics and Political Science, LSE Library.
    14. Callaway, Brantly & Sant’Anna, Pedro H.C., 2021. "Difference-in-Differences with multiple time periods," Journal of Econometrics, Elsevier, vol. 225(2), pages 200-230.
    15. Wooldridge, Jeffrey M., 1999. "Distribution-free estimation of some nonlinear panel data models," Journal of Econometrics, Elsevier, vol. 90(1), pages 77-97, May.
    16. Thomas C. Buchmueller & Colleen Carey, 2018. "The Effect of Prescription Drug Monitoring Programs on Opioid Utilization in Medicare," American Economic Journal: Economic Policy, American Economic Association, vol. 10(1), pages 77-112, February.
    17. Jill Horwitz & Corey S. Davis & Lynn S. McClelland & Rebecca S. Fordon & Ellen Meara, 2018. "The Problem of Data Quality in Analyses of Opioid Regulation: The Case of Prescription Drug Monitoring Programs," NBER Working Papers 24947, National Bureau of Economic Research, Inc.
    18. Ciani Emanuele & Fisher Paul, 2019. "Dif-in-Dif Estimators of Multiplicative Treatment Effects," Journal of Econometric Methods, De Gruyter, vol. 8(1), pages 1-10, January.
    19. Angélica Meinhofer, 2018. "Prescription Drug Monitoring Programs: The Role of Asymmetric Information on Drug Availability and Abuse," American Journal of Health Economics, MIT Press, vol. 4(4), pages 504-526, Fall.
    20. Beth Ann Griffin & Megan S. Schuler & Elizabeth A. Stuart & Stephen Patrick & Elizabeth McNeer & Rosanna Smart & David Powell & Bradley Stein & Terry Schell & Rosalie Liccardo Pacula, 2020. "Variation in Performance of Commonly Used Statistical Methods for Estimating Effectiveness of State-Level Opioid Policies on Opioid-Related Mortality," NBER Working Papers 27029, National Bureau of Economic Research, Inc.
    21. Thomas C. Buchmueller & Colleen M. Carey & Giacomo Meille, 2020. "How well do doctors know their patients? Evidence from a mandatory access prescription drug monitoring program," Health Economics, John Wiley & Sons, Ltd., vol. 29(9), pages 957-974, September.
    22. DiNardo, John & Lemieux, Thomas, 2001. "Alcohol, marijuana, and American youth: the unintended consequences of government regulation," Journal of Health Economics, Elsevier, vol. 20(6), pages 991-1010, November.
    23. Abby Alpert & David Powell & Rosalie Liccardo Pacula, 2018. "Supply-Side Drug Policy in the Presence of Substitutes: Evidence from the Introduction of Abuse-Deterrent Opioids," American Economic Journal: Economic Policy, American Economic Association, vol. 10(4), pages 1-35, November.
    24. Kim, Bokyung, 2021. "Must-access prescription drug monitoring programs and the opioid overdose epidemic: The unintended consequences," Journal of Health Economics, Elsevier, vol. 75(C).
    25. Carlos Dobkin & Nancy Nicosia, 2009. "The War on Drugs: Methamphetamine, Public Health, and Crime," American Economic Review, American Economic Association, vol. 99(1), pages 324-349, March.
    26. Goodman-Bacon, Andrew, 2021. "Difference-in-differences with variation in treatment timing," Journal of Econometrics, Elsevier, vol. 225(2), pages 254-277.
    27. J. M. C. Santos Silva & Silvana Tenreyro, 2006. "The Log of Gravity," The Review of Economics and Statistics, MIT Press, vol. 88(4), pages 641-658, November.
    28. Sacks, Daniel W. & Hollingsworth, Alex & Nguyen, Thuy & Simon, Kosali, 2021. "Can policy affect initiation of addictive substance use? Evidence from opioid prescribing," Journal of Health Economics, Elsevier, vol. 76(C).
    29. Abby Alpert & William N Evans & Ethan M J Lieber & David Powell, 2023. "Origins of the Opioid Crisis and its Enduring Impacts," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 137(2), pages 1139-1179.
    30. Anca M. Grecu & Dhaval M. Dave & Henry Saffer, 2019. "Mandatory Access Prescription Drug Monitoring Programs and Prescription Drug Abuse," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 38(1), pages 181-209, January.
    31. Alwyn Young, 2019. "Channeling Fisher: Randomization Tests and the Statistical Insignificance of Seemingly Significant Experimental Results," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 134(2), pages 557-598.
    32. Christopher J. Ruhm, 2016. "Taking the Measure of a Fatal Drug Epidemic," NBER Working Papers 22504, National Bureau of Economic Research, Inc.
    33. Anne Case & Angua Deaton, 2015. "Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century," Working Papers 15078.full.pdf, Princeton University, Woodrow Wilson School of Public and International Affairs, Research Program in Development Studies..
    34. Gihleb, Rania & Giuntella, Osea & Zhang, Ning, 2018. "The Effects of Mandatory Prescription Drug Monitoring Programs on Foster Care Admissions," IZA Discussion Papers 11470, Institute of Labor Economics (IZA).
    35. Gary S. Becker & Kevin M. Murphy & Michael Grossman, 2006. "The Market for Illegal Goods: The Case of Drugs," Journal of Political Economy, University of Chicago Press, vol. 114(1), pages 38-60, February.
    36. Davis, C.S. & Pierce, M. & Dasgupta, N., 2014. "Evolution and convergence of state laws governing controlled substance prescription monitoring programs, 1998-2011," American Journal of Public Health, American Public Health Association, vol. 104(8), pages 1389-1395.
    37. Abby E. Alpert & Sarah E. Dykstra & Mireille Jacobson, 2020. "How Do Prescription Drug Monitoring Programs Reduce Opioid Prescribing? The Role of Hassle Costs versus Information," NBER Working Papers 27584, National Bureau of Economic Research, Inc.
    38. Alan B. Krueger, 2017. "Where Have All the Workers Gone? An Inquiry into the Decline of the U.S. Labor Force Participation Rate," Brookings Papers on Economic Activity, Economic Studies Program, The Brookings Institution, vol. 48(2 (Fall)), pages 1-87.
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    Cited by:

    1. Ruenzi, Stefan & Maeckle, Kai, 2023. "Friends with Drugs: The Role of Social Networks in the Opioid Epidemic," VfS Annual Conference 2023 (Regensburg): Growth and the "sociale Frage" 277574, Verein für Socialpolitik / German Economic Association.
    2. Lucas Marín Llanes & Hernando Zuleta, 2022. "Myths of drug consumption decriminalization: effects of Portuguese decriminalization on violent and drug use mortality," Documentos CEDE 20328, Universidad de los Andes, Facultad de Economía, CEDE.

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    More about this item

    Keywords

    prescription drugs; opioid crisis; heroin; prescription drug monitoring programs;
    All these keywords.

    JEL classification:

    • H75 - Public Economics - - State and Local Government; Intergovernmental Relations - - - State and Local Government: Health, Education, and Welfare
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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