Working Paper: NBER ID: w27520
Authors: Sumedha Gupta; Thuy D. Nguyen; Patricia R. Freeman; Kosali I. Simon
Abstract: A large concern in U.S. opioid policy is whether supply side controls are effective at reducing the quantity of opioids prescribed, without harmful substitution. An unstudied way that policy targeted a major opioid through the federal Controlled Substance Act (CSA) was the August 2014 scheduling of tramadol products, the second most popular opioid medication at the time. Twelve states implemented the identical policy prior to federal action, providing a unique opportunity to compare effectiveness of the same opioid policy at state versus federal levels. This is important because many recent opioid policy interventions have only taken the form of state actions, while federal policy has largely been advisory. Seven weeks after tramadol's scheduling, the leading opioid form on the market, hydrocodone combination products, was move to the more restricted level II (no refills allowed) from level III in the CSA, allowing us to test a new question in the opioid literature: competitive spillover effects from regulations targeting one drug. Using weekly prescription data spanning 2007-2017, this study finds that tightening prescribing restrictions on one opioid leads to decreases in its use, but also causes some increases in prescriptions of close competitors, leading to no statistically detectable short-run reduction in total opioid prescriptions.
Keywords: opioid policy; scheduling changes; prescribing behavior; controlled substances; substitution effects
JEL Codes: I11; I18; I28
Edges that are evidenced by causal inference methods are in orange, and the rest are in light blue.
| Cause | Effect |
|---|---|
| Federal upscheduling of hydrocodone combination products (HCPs) (I19) | Decline in the rate of prescriptions and patients prescribed HCPs (I11) |
| Initial scheduling of tramadol as a Schedule IV controlled substance (L90) | Decline in tramadol prescriptions (R48) |
| Federal upscheduling of hydrocodone combination products (HCPs) (I19) | Increase in prescribing of less regulated opioids like tramadol (H27) |
| Federal upscheduling of hydrocodone combination products (HCPs) (I19) | Increase in prescribing of similarly regulated opioids like oxycodone (L65) |
| Federal and state scheduling changes (H77) | Changes in prescribing practices (I11) |