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. 2018 Nov;10(4):1-35.
doi: 10.1257/pol.20170082.

Supply-Side Drug Policy in the Presence of Substitutes: Evidence from the Introduction of Abuse-Deterrent Opioids

Abby Alpert  1 , David Powell  2 , Rosalie Liccardo Pacula  3
Affiliations

Supply-Side Drug Policy in the Presence of Substitutes: Evidence from the Introduction of Abuse-Deterrent Opioids

Abby Alpert et al. Am Econ J Econ Policy. 2018 Nov.

Abstract

Overdose deaths from prescription opioid pain relievers nearly quadrupled between 1999 and 2010. We study the consequences of one of the largest supply disruptions to date to abusable opioids - the introduction of an abuse-deterrent version of OxyContin in 2010. Supply-side interventions which limit access to opioids may have the unintended consequence of increasing use of substitute drugs, including heroin. Exploiting cross-state variation in OxyContin exposure, we find that states with the highest initial rates of OxyContin misuse experienced the largest increases in heroin deaths. Our results imply that the recent heroin epidemic is largely due to the reformulation of OxyContin.

Keywords: I12; I18; abuse-deterrence; heroin; opioids; supply-side drug policy.

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Figures

Figure 1:
Figure 1:. Trends in Drug Overdose Deaths: Prescription Opioids and Heroin
Notes: Deaths per 100,000 population from the National Vital Statistics System (NVSS). Opioid overdose deaths are coded using ICD-10 codes for underlying cause of death X40–X44, X60–X64, X85, and Y10–Y14 with a multiple cause code of T40.2 for natural and semisynthetic opioids (e.g., oxycodone and hydrocodone), T40.3 for methadone, and T40.4 for synthetic opioids excluding methadone (e.g., fentanyl and tramadol). Heroin deaths are coded using T40.1 and a drug poisoning underlying cause of death.
Figure 2:
Figure 2:. National Trends in Prescription Opioid Use
Notes: Rate of OxyContin misuse is the percentage of the population ages 12+ “using OxyContin for nonmedical use” in the National Survey on Drug Use and Health (NSDUH). We use the NSDUH Public Use Files individual level data without state-identifiers (available for each year, rather than 2-year waves) to construct the weighted mean rate of OxyContin misuse. Oxycodone doses are from the DEA’s Automation of Reports and Consolidated Orders System (ARCOS) and have been converted into morphine-equivalent doses per capita. Oxycodone is the primary ingredient in OxyContin and is also contained in other opioid pain relievers.
Figure 3:
Figure 3:. Relationship between Pre-Reformulation Rate of OxyContin Misuse and Change Between 2008–2012
Notes: Quartiles represent states with the highest and lowest pre-reformulation rates of OxyContin misuse (Quartile 4 includes the 25% of states with the highest pre-reformulation rates of OxyContin misuse). The change in the rate of OxyContin misuse is weighted by state population.
Figure 4:
Figure 4:. Effect of OxyContin Reformulation on Overdose Deaths– Baseline Event Study Specification
Notes: Each graph includes point estimates from event study (normalized to 0 in 2009) and 95% confidence intervals which are adjusted for within-state clustering.
Figure 5:
Figure 5:. Event Study Results for Heroin Deaths using Alternative Measures of the “Bite” of OxyContin Reformulation
Notes: Each graph includes point estimates from event study (normalized to 0 in 2009) and 95% confidence intervals which are adjusted for within-state clustering. Figure A uses NSDUH data to construct the “bite” measure; Figures B and C use ARCOS data.
Figure 6:
Figure 6:. Event Study Results for Heroin Prices
Notes: Point estimates from event study (normalized to 0 in 2009) with 95% confidence intervals. Heroin prices calculated using STRIDE data.
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References

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