Working Paper: NBER ID: w26500
Authors: Abby E. Alpert; William N. Evans; Ethan M.J. Lieber; David Powell
Abstract: Overdose deaths involving opioids have increased dramatically since the mid-1990s, leading to the worst drug overdose epidemic in U.S. history, but there is limited empirical evidence on the initial causes. In this paper, we examine the role of the 1996 introduction and marketing of OxyContin as a potential leading cause of the opioid crisis. We leverage cross-state variation in exposure to OxyContin’s introduction due to a state policy that substantially limited OxyContin’s early entry and marketing in select states. Recently-unsealed court documents involving Purdue Pharma show that state-based triplicate prescription programs posed a major obstacle to sales of OxyContin and suggest that less marketing was targeted to states with these programs. We find that OxyContin distribution was about 50% lower in “triplicate states” in the years after the launch. While triplicate states had higher rates of overdose deaths prior to 1996, this relationship flipped shortly after the launch and triplicate states saw substantially slower growth in overdose deaths, continuing even twenty years after OxyContin's introduction. Our results show that the introduction and marketing of OxyContin explain a substantial share of overdose deaths over the last two decades.
Keywords: Opioid Crisis; OxyContin; Overdose Deaths; Pharmaceutical Marketing
JEL Codes: I12; I18
Edges that are evidenced by causal inference methods are in orange, and the rest are in light blue.
| Cause | Effect |
|---|---|
| OxyContin's introduction (L65) | drug overdose deaths (I12) |
| OxyContin's marketing (L65) | drug overdose deaths (I12) |
| triplicate states (P30) | lower exposure to OxyContin (I14) |
| nontriplicate states (Y40) | higher drug overdose deaths (I12) |
| nontriplicate states (Y40) | higher opioid overdose deaths (I12) |
| triplicate states (P30) | lower drug overdose deaths (I12) |
| triplicate states (P30) | lower opioid overdose deaths (I12) |
| lower exposure to OxyContin (I14) | slower growth in overdose deaths (I12) |