Working Paper: NBER ID: w24475
Authors: William N. Evans; Ethan Lieber; Patrick Power
Abstract: 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.
Keywords: OxyContin; heroin; opioid epidemic; structural breaks; abuse-deterrent formulations
JEL Codes: I11; I18
Edges that are evidenced by causal inference methods are in orange, and the rest are in light blue.
| Cause | Effect |
|---|---|
| Reformulation of OxyContin (O30) | Cessation of growth in opioid consumption (Q31) |
| Reformulation of OxyContin (O30) | Increased heroin use (I12) |
| Increased heroin use (I12) | Increased heroin death rates (I12) |
| Reformulation of OxyContin (O30) | Increased heroin death rates (I12) |
| Higher pre-reformulation access to heroin (P22) | Greater increases in heroin deaths (I12) |
| Reduction in opioid-related mortality (I14) | Increases in heroin-related deaths (I12) |