IDEAS home Printed from
   My bibliography  Save this paper

How the Reformulation of OxyContin Ignited the Heroin Epidemic


  • William N. Evans
  • Ethan Lieber
  • Patrick Power


We attribute the recent quadrupling of heroin death rates to the August, 2010 reformulation of an oft-abused prescription opioid, OxyContin. The new abuse-deterrent formulation led many consumers to substitute to an inexpensive alternative, heroin. Using structural break techniques and variation in substitution risk, we find that opioid consumption stops rising in August, 2010, heroin deaths begin climbing the following month, and growth in heroin deaths was greater in areas with greater pre-reformulation access to heroin and opioids. The reformulation did not generate a reduction in combined heroin and opioid mortality—each prevented opioid death was replaced with a heroin death.

Suggested Citation

  • William N. Evans & Ethan Lieber & Patrick Power, 2018. "How the Reformulation of OxyContin Ignited the Heroin Epidemic," NBER Working Papers 24475, National Bureau of Economic Research, Inc.
  • Handle: RePEc:nbr:nberwo:24475
    Note: HC HE

    Download full text from publisher

    File URL:
    Download Restriction: no

    Other versions of this item:

    References listed on IDEAS

    1. 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.
    2. Seema Jayachandran & Adriana Lleras-Muney & Kimberly V. Smith, 2010. "Modern Medicine and the Twentieth Century Decline in Mortality: Evidence on the Impact of Sulfa Drugs," American Economic Journal: Applied Economics, American Economic Association, vol. 2(2), pages 118-146, April.
    3. Bruce E. Hansen, 2001. "The New Econometrics of Structural Change: Dating Breaks in U.S. Labour Productivity," Journal of Economic Perspectives, American Economic Association, vol. 15(4), pages 117-128, Fall.
    4. Peltzman, Sam, 1975. "The Effects of Automobile Safety Regulation," Journal of Political Economy, University of Chicago Press, vol. 83(4), pages 677-725, August.
    5. 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.
    Full references (including those not matched with items on IDEAS)


    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.

    Cited by:

    1. Christopher J. Ruhm, 2018. "Deaths of Despair or Drug Problems?," NBER Working Papers 24188, National Bureau of Economic Research, Inc.
    2. 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.
    3. Pohl, R. Vincent, 2018. "Time Trends Matter: The Case of Medical Cannabis Laws and Opioid Overdose Mortality," MPRA Paper 87237, University Library of Munich, Germany.
    4. Borgschulte, Mark & Corredor-Waldron, Adriana & Marshall, Guillermo, 2018. "A path out: Prescription drug abuse, treatment, and suicide," Journal of Economic Behavior & Organization, Elsevier, vol. 149(C), pages 169-184.
    5. Alexander Ahammer, 2019. "A novel supply-side measure to combat abuse of addictive prescription drugs," Economics working papers 2019-11, Department of Economics, Johannes Kepler University Linz, Austria.
    6. Strulik, Holger, 2019. "From Pain Patient to Junkie: An Economic Theory of Painkiller Consumption and its Impact on Wellbeing and Longevity," Annual Conference 2019 (Leipzig): 30 Years after the Fall of the Berlin Wall - Democracy and Market Economy 203510, Verein für Socialpolitik / German Economic Association.
    7. Gihleb, Rania & Giuntella, Osea & Zhang, Ning, 2019. "Prescription Drug Monitoring Programs and Neonatal Outcomes," IZA Discussion Papers 12796, Institute of Labor Economics (IZA).
    8. Daniel W. Sacks & Alex Hollingsworth & Thuy D. Nguyen & Kosali I. Simon, 2019. "Can Policy Affect Initiation of Addictive Substance Use? Evidence from Opioid Prescribing," NBER Working Papers 25974, National Bureau of Economic Research, Inc.
    9. Dionissi Aliprantis & Mark E. Schweitzer, 2018. "Opioids and the Labor Market," Working Papers (Old Series) 1807, Federal Reserve Bank of Cleveland, revised 15 May 2018.
    10. Thuy D. Nguyen & W. David Bradford & Kosali I. Simon, 2019. "How do Opioid Prescribing Restrictions Affect Pharmaceutical Promotion? Lessons from the Mandatory Access Prescription Drug Monitoring Programs," NBER Working Papers 26356, National Bureau of Economic Research, Inc.
    11. David Powell & Rosalie Liccardo Pacula, 2020. "The Evolving Consequences of OxyContin Reformulation on Drug Overdoses," NBER Working Papers 26988, National Bureau of Economic Research, Inc.
    12. Ruhm, Christopher J., 2019. "Drivers of the fatal drug epidemic," Journal of Health Economics, Elsevier, vol. 64(C), pages 25-42.
    13. Deiana, Claudio & Giua, Ludovica, 2018. "The US Opidemic: Prescription Opioids, Labour Market Conditions and Crime," MPRA Paper 85712, University Library of Munich, Germany.
    14. Strulik, Holger, 2019. "Opioid epidemics," Center for European, Governance and Economic Development Research Discussion Papers 371, University of Goettingen, Department of Economics.
    15. Casey B. Mulligan, 2020. "Prices and Federal Policies in Opioid Markets," Working Papers 2020-10, Becker Friedman Institute for Research In Economics.
    16. Casey B. Mulligan, 2020. "Prices and Federal Policies in Opioid Markets," NBER Working Papers 26812, National Bureau of Economic Research, Inc.
    17. Doleac, Jennifer & Mukherjee, Anita, 2018. "The Moral Hazard of Lifesaving Innovations: Naloxone Access, Opioid Abuse, and Crime," IZA Discussion Papers 11489, Institute of Labor Economics (IZA).

    More about this item

    JEL classification:

    • I1 - Health, Education, and Welfare - - Health
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets

    NEP fields

    This paper has been announced in the following NEP Reports:


    Access and download statistics


    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:nbr:nberwo:24475. See general information about how to correct material in RePEc.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: (). General contact details of provider: .

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service hosted by the Research Division of the Federal Reserve Bank of St. Louis . RePEc uses bibliographic data supplied by the respective publishers.