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Why Are Opioid Prescribing Rates Higher in Rural Versus Urban Areas?

Author

Listed:
  • Modestino, Alicia Sasser

    (Northeastern University)

  • Young, Garry

    (National Institute of Economic and Social Research (NIESR))

  • Hasan, Md Mahmudul

    (University of Florida)

  • Shi, Jiesheng

    (Northeastern University)

  • Alam, Md Noor E

    (Northeastern University)

Abstract

Patients in rural areas have higher rates of opioid use and overdose than those in urban areas that are linked to the greater prevalence and amounts of opioids prescribed. We merge individual claims data with county-level supply and demand factors to examine this relationship between geographical density and opioid prescribing. We find patients in rural areas are 10 percentage points more likely to receive an opioid prescription with about half of this differential attributable to the underlying health of the local population. A Blinder-Oaxaca decomposition reveals that roughly 80 percent of the remaining gap is explained by a combination of supply and demand factors. Allowing for the interaction of demand (e.g., working in a physically demanding occupation) and supply (e.g., healthcare delivery system) variables eliminates the gap. Our findings suggest several way states can reduce the gap in opioid prescribing between rural and urban areas, with possible downstream impacts on overdose and mortality.

Suggested Citation

  • Modestino, Alicia Sasser & Young, Garry & Hasan, Md Mahmudul & Shi, Jiesheng & Alam, Md Noor E, 2025. "Why Are Opioid Prescribing Rates Higher in Rural Versus Urban Areas?," IZA Discussion Papers 17738, Institute of Labor Economics (IZA).
    • Handle: RePEc:iza:izadps:dp17738
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    More about this item

    Keywords

    opioid; prescribing; density; health disparity; geography;
    All these keywords.

    JEL classification:

    • I14 - Health, Education, and Welfare - - Health - - - Health and Inequality
    • I15 - Health, Education, and Welfare - - Health - - - Health and Economic Development
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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