Working Paper: NBER ID: w29139
Authors: Joshua C. Tibbitts; Benjamin W. Cowan
Abstract: We investigate the relationship between opioid diverting policy and suicides among the veteran population. The opioid epidemic of the past two decades has had devastating health consequences among U.S. veterans and military personnel. In 2013, the Veterans Health Administration (VA) implemented the Opioid Safety Initiative (OSI) with the goal of discouraging prescription opioid dependence among VA patients. Between 2012 and 2017, prescription opioids dispensed by the VA fell 41% (VA, 2018). Because this involved the aggressive curtailing of opioid prescriptions for many VA patients, OSI may have had a detrimental effect on veterans’ mental health leading to suicide in extreme cases. In addition, because rural veterans have much higher rates of VA enrollment, more prescription opioid use and abuse, and lower rates of substance abuse and mental health treatment utilization, we expect any effect of OSI on veteran suicides to be concentrated in rural areas. We find that OSI raised the veteran suicide rate relative to the non-veteran (“civilian”) rate with rural veterans suffering the lion’s share of the increase. We estimate that OSI raised the rural veteran suicide rate by a little over one-third between 2013 and 2018.
Keywords: opioid safety initiative; veteran suicides; opioid prescriptions; mental health; rural veterans
JEL Codes: I12; I18
Edges that are evidenced by causal inference methods are in orange, and the rest are in light blue.
| Cause | Effect |
|---|---|
| Opioid Safety Initiative (OSI) (L17) | veteran suicide rate (H56) |
| Opioid Safety Initiative (OSI) (L17) | rural veteran suicide rate (H56) |
| veteran suicide rate (H56) | rural veteran suicide rate (H56) |
| Opioid Safety Initiative (OSI) (L17) | urban veteran suicide rate (R23) |