Working Paper: NBER ID: w29596
Authors: Simone Balestra; Helge Liebert; Nicole Maestas; Tisamarie B. Sherry
Abstract: We investigate behavioral responses to a staggered disruption in the supply of prescription opioids across U.S. states: the introduction of electronic Prescription Drug Monitoring Programs (PDMPs). Using administrative datasets, we find PDMPs curtail the proliferation of prescription opioids. Physicians respond to monitoring on the extensive margin, limiting the number of patients to whom they prescribe opioids without adjusting dosage or duration. This decreases supply to long-term opioid users, who evade the restrictions by acquiring prescriptions from out-of-state prescribers and by substituting to heroin. This causes a surge in heroin overdoses, which offsets reductions in hospitalizations and deaths from prescription opioids.
Keywords: Prescription Opioids; Drug Monitoring Programs; Health Outcomes
JEL Codes: I12; I18
Edges that are evidenced by causal inference methods are in orange, and the rest are in light blue.
| Cause | Effect |
|---|---|
| PDMPs (Y10) | reduction in opioid prescriptions (L42) |
| PDMPs (Y10) | reduction in individuals receiving opioid prescriptions (L42) |
| PDMPs (Y10) | physicians limiting prescriptions (I11) |
| physicians limiting prescriptions (I11) | reduction in access for chronic users (D16) |
| reduction in access for chronic users (D16) | shift towards illicit opioids (P37) |
| shift towards illicit opioids (P37) | increase in heroin use (I12) |
| shift towards illicit opioids (P37) | increase in heroin overdoses (I12) |
| shift towards illicit opioids (P37) | increase in mortality from heroin and synthetic opioids (I12) |
| reduction in opioid prescriptions (L42) | decrease in opioid-related hospitalizations (I12) |
| increase in heroin use (I12) | offset reduction in opioid-related hospitalizations (I14) |
| decrease in opioid-related hospitalizations (I12) | overall hospitalizations remain stable (I10) |