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The Evolving Consequences of OxyContin Reformulation on Drug Overdoses

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  • 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 nonmedical OxyContin use before reformulation, to less exposed areas. More exposed areas experienced disproportionate increases in fatal overdoses involving synthetic opioids (fentanyl) and nonopioid 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.

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  • David Powell & Rosalie Liccardo Pacula, 2021. "The Evolving Consequences of OxyContin Reformulation on Drug Overdoses," American Journal of Health Economics, University of Chicago Press, vol. 7(1), pages 41-67.
    • Handle: RePEc:ucp:amjhec:doi:10.1086/711723
    DOI: 10.1086/711723
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    Blog mentions

    As found by EconAcademics.org, the blog aggregator for Economics research:
    1. Chris Sampson’s journal round-up for 15th March 2021
      by Chris Sampson in The Academic Health Economists' Blog on 2021-03-15 12:00:14

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    Cited by:

    1. David Cho & Daniel I. García & Joshua Montes & Alison E. Weingarden, 2021. "Labor Market Effects of the Oxycodone-Heroin Epidemic," Finance and Economics Discussion Series 2021-025, Board of Governors of the Federal Reserve System (U.S.).
    2. Shannon M. Monnat, 2022. "Demographic and Geographic Variation in Fatal Drug Overdoses in the United States, 1999–2020," The ANNALS of the American Academy of Political and Social Science, , vol. 703(1), pages 50-78, September.
    3. Agustina Laurito, 2024. "Spillovers of the Heroin Epidemic on Grandparent Caregiving," Population Research and Policy Review, Springer;Southern Demographic Association (SDA), vol. 43(2), pages 1-25, April.
    4. Graham, Francis W. & de New, Sonja C. & Nielsen, Suzanne & Petrie, Dennis, 2023. "Revisiting the OxyContin Reformulation: The Role of Licit Substitutes," IZA Discussion Papers 16653, Institute of Labor Economics (IZA).
    5. Park, Sujeong & Powell, David, 2021. "Is the rise in illicit opioids affecting labor supply and disability claiming rates?," Journal of Health Economics, Elsevier, vol. 76(C).
    6. Jonathan Gruber & Johanna Catherine Maclean & Bill Wright & Eric Wilkinson & Kevin G. Volpp, 2020. "The effect of increased cost‐sharing on low‐value service use," Health Economics, John Wiley & Sons, Ltd., vol. 29(10), pages 1180-1201, October.
    7. Daniele, Gianmarco & Le Moglie, Marco & Masera, Federico, 2023. "Pains, guns and moves: The effect of the U.S. opioid epidemic on Mexican migration," Journal of Development Economics, Elsevier, vol. 160(C).
    8. Martin Andersen & Johanna Catherine Maclean & Michael F. Pesko & Kosali I. Simon, 2020. "Paid sick-leave and physical mobility: Evidence from the United States during a pandemic," NBER Working Papers 27138, National Bureau of Economic Research, Inc.
    9. Smart, Rosanna & Powell, David & Pacula, Rosalie Liccardo & Peet, Evan & Abouk, Rahi & Davis, Corey S., 2024. "Investigating the complexity of naloxone distribution: Which policies matter for pharmacies and potential recipients," Journal of Health Economics, Elsevier, vol. 97(C).
    10. Abouk, Rahi & Powell, David, 2021. "Can electronic prescribing mandates reduce opioid-related overdoses?," Economics & Human Biology, Elsevier, vol. 42(C).
    11. Zai, Xianhua, 2024. "Beyond the brink: Unraveling the opioid crisis and its profound impacts," Economics & Human Biology, Elsevier, vol. 53(C).
    12. d'Este, Rocco, 2022. "Scientific Advancements in Illegal Drugs Production and Institutional Responses: New Psychoactive Substances, Self-Harm, and Violence inside Prisons," IZA Discussion Papers 15248, Institute of Labor Economics (IZA).
    13. David Cho & Alvaro Mezza & Joshua Montes, 2022. "Choices and Implications when Measuring the Local Supply of Prescription Opioids," Finance and Economics Discussion Series 2022-078, Board of Governors of the Federal Reserve System (U.S.).
    14. Johanna Catherine Maclean & Justine Mallatt & Christopher J. Ruhm & Kosali Simon, 2022. "The Opioid Crisis, Health, Healthcare, and Crime: A Review of Quasi-Experimental Economic Studies," The ANNALS of the American Academy of Political and Social Science, , vol. 703(1), pages 15-49, September.
    15. Martin Andersen & Johanna Catherine Maclean & Michael F. Pesko & Kosali Simon, 2023. "Does paid sick leave encourage staying at home? Evidence from the United States during a pandemic," Health Economics, John Wiley & Sons, Ltd., vol. 32(6), pages 1256-1283, June.
    16. Denis Agniel & Jonathan H. Cantor & Johanna Catherine Maclean & Kosali I. Simon & Erin Taylor, 2023. "Insurance Coverage and Provision of Opioid Treatment: Evidence from Medicare," NBER Working Papers 31884, National Bureau of Economic Research, Inc.
    17. Resul Cesur & Joseph J. Sabia & W. David Bradford, 2024. "The effect of combat deployments on veteran opioid abuse," Health Economics, John Wiley & Sons, Ltd., vol. 33(6), pages 1284-1318, June.

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    JEL classification:

    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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