Working Paper: NBER ID: w26988
Authors: David Powell; Rosalie Liccardo Pacula
Abstract: Recent evidence suggests that the short-term transition of the opioid crisis from prescription opioids to heroin can be attributed to the reformulation of OxyContin, which substantially reduced access to abusable prescription opioids. In this paper, we find that over a longer time horizon, reformulation stimulated illicit drug markets to grow and evolve. We compare overdose trajectories in areas more exposed to reformulation, defined as states with higher rates of non-medical OxyContin use before reformulation, to less exposed areas. More exposed areas experienced disproportionate increases in fatal overdoses involving synthetic opioids (fentanyl) and non-opioid substances like cocaine, suggesting that these new epidemics are related to the same factors driving the rise in heroin deaths. Instead of just short-term substitution from prescription opioid to heroin overdoses, the transition to illicit markets spurred by reformulation led to growth in the overall overdose rate to unprecedented levels.
Keywords: opioid crisis; overdose rates; fentanyl; cocaine; illicit drug markets
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 reformulation (O30) | Increase in heroin overdoses (I12) |
| Oxycontin reformulation (O30) | Increase in synthetic opioid overdoses (I12) |
| Decrease in access to abusable prescription opioids (Q31) | Transition to illicit markets (P37) |
| Transition to illicit markets (P37) | Increase in overall overdose rates (I12) |
| Oxycontin reformulation (O30) | Increase in cocaine overdoses (I12) |
| Increase in heroin overdoses (I12) | Increase in synthetic opioid overdoses (I12) |