The Reformulation of OxyContin and Availability of Substance Use Treatment Facilities in the United States

I examine how the substance use treatment sector responded to the abuse-deterrent reformulation of OxyContin, which contributed to a shift from prescription opioid misuse to heroin and synthetic opioids. First, I document a national increase in substance use treatment facilities after the reformulation and a shift toward outpatient-only care. Medication-assisted treatment with buprenorphine and naltrexone grew strongly throughout the first and second waves of the opioid crisis, while opioid treatment programs providing methadone increased relatively modestly after the reformulation. To isolate the role of exposure to OxyContin’s reformulation, I use variation in states’ pre-reformulation OxyContin misuse rates in a continuous difference-in-differences design. I find that pre-reformulation misuse rates are associated with larger increases in substance use treatment facilities after the reformulation, particularly outpatient-only facilities, with limited evidence misuse rates the availability of medication-assisted treatment services or inpatient care across states. Medicaid expansion under the Affordable Care Act was associated with more substance use treatment facilities and this effect was stronger in states with higher misuse rates, while the expansion of substance use treatment facilities was lower in states with certificate-of-need laws, highlighting the importance of insurance and regulatory barriers in treatment access. Back-of-the envelope estimates suggest the additional SUT facilities averted 2,700-7,800 overdose deaths between 2011 and 2019, corresponding to a value of $36-102 billion.