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Supply-Side Drug Policy in the Presence of Substitutes Evidence from the Introduction of Abuse-Deterrent Opioids

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  • Abby Alpert
  • David Powell
  • Rosalie Liccardo Pacula

Abstract

Overdose deaths from prescription opioid pain relievers nearly quadrupled between 1999 and 2010, making this the worst drug overdose epidemic in U.S. history. In response, numerous supply-side interventions have aimed to limit access to opioids. However, these supply disruptions may have the unintended consequence of increasing the use of substitute drugs, including heroin. We study the consequences of one of the largest supply disruptions to date to abusable opioids — the introduction of an abuse-deterrent version of OxyContin in 2010. Our analysis exploits across state variation in exposure to the OxyContin reformulation. Using data from the National Survey on Drug Use and Health (NSDUH), we show that states with higher pre-2010 rates of OxyContin misuse experienced larger reductions in OxyContin misuse, permitting us to isolate consumer substitution responses. We estimate large differential increases in heroin deaths immediately after reformulation in states with the highest initial rates of OxyContin misuse. We find less evidence of differential reductions in overall opioid-related deaths, potentially due to substitution towards other opioids, including more harmful synthetic opioids such as fentanyl. Our results imply that a substantial share of the dramatic increase in heroin deaths since 2010 can be attributed to the reformulation of OxyContin.

Suggested Citation

  • Abby Alpert & David Powell & Rosalie Liccardo Pacula, 2017. "Supply-Side Drug Policy in the Presence of Substitutes Evidence from the Introduction of Abuse-Deterrent Opioids," Working Papers WR-1181, RAND Corporation.
  • Handle: RePEc:ran:wpaper:wr-1181
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    Cited by:

    1. Mark McInerney, 2017. "The Affordable Care Act, Public Insurance Expansion and Opioid Overdose Mortality," Working papers 2017-23, University of Connecticut, Department of Economics.
    2. Suppliet, Moritz, 2017. "Umbrella Branding in Pharmaceutical Markets," Discussion Paper 2017-034, Tilburg University, Tilburg Law and Economic Center.
    3. Deiana, Claudio & Giua, Ludovica, 2018. "The US Opidemic: Prescription Opioids, Labour Market Conditions and Crime," MPRA Paper 85712, University Library of Munich, Germany.
    4. 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.
    5. 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).
    6. 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.
    7. 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.
    8. 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.
    9. Böckerman, Petri & Kortelainen, Mika & Laine, Liisa T. & Nurminen, Mikko & Saxell, Tanja, 2019. "Digital Waste? Unintended Consequences of Health Information Technology," Working Papers 117, VATT Institute for Economic Research.
    10. 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.
    11. Christopher J. Ruhm, 2018. "Deaths of Despair or Drug Problems?," NBER Working Papers 24188, National Bureau of Economic Research, Inc.
    12. repec:eee:jhecon:v:60:y:2018:i:c:p:177-197 is not listed on IDEAS
    13. 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).
    14. Daniel I. Rees & Joseph J. Sabia & Laura M. Argys & Joshua Latshaw & Dhaval Dave, 2017. "With a Little Help from My Friends: The Effects of Naloxone Access and Good Samaritan Laws on Opioid-Related Deaths," NBER Working Papers 23171, National Bureau of Economic Research, Inc.
    15. repec:eee:jhecon:v:64:y:2019:i:c:p:25-42 is not listed on IDEAS

    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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