[go: up one dir, main page]
More Web Proxy on the site http://driver.im/
IDEAS home Printed from https://ideas.repec.org/p/nbr/nberwo/21072.html
   My bibliography  Save this paper

How Increasing Medical Access to Opioids Contributes to the Opioid Epidemic: Evidence from Medicare Part D

Author

Listed:
  • David Powell
  • Rosalie Liccardo Pacula
  • Erin Taylor
Abstract
Drug overdoses involving opioid analgesics have increased dramatically since 1999, representing one of the United States’ top public health crises. Opioids have legitimate medical functions, but improving access may increase abuse rates even among those not prescribed the drugs given that opioids are frequently diverted to nonmedical use. We have little evidence about the causal relationship between increased medical access to opioids and spillovers resulting in abuse. We use the introduction of the Medicare Prescription Drug Benefit Program (Part D) as a large and differential shock to the geographic supply of opioids. We compare growth in opioid supply and abuse rates in states with large 65+ population shares to states with smaller elderly population shares with a focus on abuse among the Medicare-ineligible population. Part D increased opioid utilization for the 65+ population, and we show that this increase in utilization led to significant growth in the overall supply of opioids in high elderly share states relative to low elderly share states. This relative expansion in opioid supply resulted in an escalation in opioid-related substance abuse treatment admissions and opioid-related mortality among the Medicare-ineligible population, implying meaningful spillovers to individuals who did not experience any change in prescription drug benefits. The evidence suggests that increased opioid supply is associated with economically-important levels of diversion for nonmedical purposes. Our estimates imply that a 10% increase in medical opioid distribution leads to a 7.4% increase in opioid-related deaths and a 14.1% increase in substance abuse treatment admission rates for the Medicare-ineligible population.

Suggested Citation

  • David Powell & Rosalie Liccardo Pacula & Erin Taylor, 2015. "How Increasing Medical Access to Opioids Contributes to the Opioid Epidemic: Evidence from Medicare Part D," NBER Working Papers 21072, National Bureau of Economic Research, Inc.
    • Handle: RePEc:nbr:nberwo:21072
    Note: EH
    as

    Download full text from publisher

    File URL: http://www.nber.org/papers/w21072.pdf
    Download Restriction: no
    ---><---

    Other versions of this item:

    References listed on IDEAS

    as
    1. Manolis Galenianos & Rosalie Liccardo Pacula & Nicola Persico, 2012. "A Search-Theoretic Model of the Retail Market for Illicit Drugs," The Review of Economic Studies, Review of Economic Studies Ltd, vol. 79(3), pages 1239-1269.
    2. Jason Abaluck & Jonathan Gruber, 2011. "Choice Inconsistencies among the Elderly: Evidence from Plan Choice in the Medicare Part D Program," American Economic Review, American Economic Association, vol. 101(4), pages 1180-1210, June.
    3. Alpert, Abby & Lakdawalla, Darius & Sood, Neeraj, 2023. "Prescription drug advertising and drug utilization: The role of Medicare Part D," Journal of Public Economics, Elsevier, vol. 221(C).
    4. Abe Dunn & Adam Hale Shapiro, 2019. "Does Medicare Part D Save Lives?," American Journal of Health Economics, MIT Press, vol. 5(1), pages 126-164, Winter.
    5. Anne Case & Angus Deaton, 2017. "Mortality and Morbidity in the 21st Century," Brookings Papers on Economic Activity, Economic Studies Program, The Brookings Institution, vol. 48(1 (Spring), pages 397-476.
    6. Kolstad, Jonathan T. & Kowalski, Amanda E., 2012. "The impact of health care reform on hospital and preventive care: Evidence from Massachusetts," Journal of Public Economics, Elsevier, vol. 96(11), pages 909-929.
    7. Jason Abaluck & Jonathan Gruber, 2011. "Heterogeneity in Choice Inconsistencies among the Elderly: Evidence from Prescription Drug Plan Choice," American Economic Review, American Economic Association, vol. 101(3), pages 377-381, May.
    8. Helen G. Levy & Edward C. Norton & Jeffrey A. Smith, 2018. "Tobacco Regulation and Cost-Benefit Analysis: How Should We Value Foregone Consumer Surplus?," American Journal of Health Economics, University of Chicago Press, vol. 4(1), pages 1-25, Winter.
    9. Mark Duggan & Fiona Scott Morton, 2010. "The Effect of Medicare Part D on Pharmaceutical Prices and Utilization," American Economic Review, American Economic Association, vol. 100(1), pages 590-607, March.
    10. Jonathan D. Ketcham & Claudio Lucarelli & Eugenio J. Miravete & M. Christopher Roebuck, 2012. "Sinking, Swimming, or Learning to Swim in Medicare Part D," American Economic Review, American Economic Association, vol. 102(6), pages 2639-2673, October.
    11. David A. Jaeger & Theodore J. Joyce & Robert Kaestner, 2020. "A Cautionary Tale of Evaluating Identifying Assumptions: Did Reality TV Really Cause a Decline in Teenage Childbearing?," Journal of Business & Economic Statistics, Taylor & Francis Journals, vol. 38(2), pages 317-326, April.
    12. Cutler, David M & Gruber, Jonathan, 1996. "The Effect of Medicaid Expansions on Public Insurance, Private Insurance, and Redistribution," American Economic Review, American Economic Association, vol. 86(2), pages 378-383, May.
    13. Jonathan Gruber, 2011. "Massachusetts points the way to successful health care reform," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 30(1), pages 184-192, December.
    14. Becker, Gary S & Grossman, Michael & Murphy, Kevin M, 1991. "Rational Addiction and the Effect of Price on Consumption," American Economic Review, American Economic Association, vol. 81(2), pages 237-241, May.
    15. Grossman, Michael & Chaloupka, Frank J., 1998. "The demand for cocaine by young adults: a rational addiction approach," Journal of Health Economics, Elsevier, vol. 17(4), pages 427-474, August.
    16. Johanna Catherine Maclean & Brendan Saloner, 2018. "Substance Use Treatment Provider Behavior and Healthcare Reform: Evidence from Massachusetts," Health Economics, John Wiley & Sons, Ltd., vol. 27(1), pages 76-101, January.
    17. Jenny Williams & Rosalie Liccardo Pacula & Rosanna Smart, 2019. "De Facto or De Jure? Ethnic Differences in Quit Responses to Legal Protections of Medical Marijuana Dispensaries," NBER Working Papers 25555, National Bureau of Economic Research, Inc.
    18. Cameron, A. Colin & Gelbach, Jonah B. & Miller, Douglas L., 2011. "Robust Inference With Multiway Clustering," Journal of Business & Economic Statistics, American Statistical Association, vol. 29(2), pages 238-249.
    19. Jonathan D. Ketcham & Kosali Simon, 2008. "Medicare Part D's Effects on Elderly Drug Costs and Utilization," NBER Working Papers 14326, National Bureau of Economic Research, Inc.
    20. Santhosh, L. & Meriwether, M. & Saucedo, C. & Reyes, R. & Cheng, C. & Clark, B. & Tipperman, D. & Schroeder, S.A., 2014. "From the sidelines to the frontline: How the substance abuse and mental health services administration embraced smoking cessation," American Journal of Public Health, American Public Health Association, vol. 104(5), pages 796-802.
    21. Paulozzi, L.J., 2006. "Opioid analgesic involvement in drug abuse deaths in American metropolitan areas," American Journal of Public Health, American Public Health Association, vol. 96(10), pages 1755-1757.
    22. Christopher Carpenter & Carlos Dobkin, 2009. "The Effect of Alcohol Consumption on Mortality: Regression Discontinuity Evidence from the Minimum Drinking Age," American Economic Journal: Applied Economics, American Economic Association, vol. 1(1), pages 164-182, January.
    23. Alpert, Abby, 2016. "The anticipatory effects of Medicare Part D on drug utilization," Journal of Health Economics, Elsevier, vol. 49(C), pages 28-45.
    24. Hollingsworth, Alex & Ruhm, Christopher J. & Simon, Kosali, 2017. "Macroeconomic conditions and opioid abuse," Journal of Health Economics, Elsevier, vol. 56(C), pages 222-233.
    25. Chaloupka, Frank, 1991. "Rational Addictive Behavior and Cigarette Smoking," Journal of Political Economy, University of Chicago Press, vol. 99(4), pages 722-742, August.
    26. Yelowitz, Aaron S., 2000. "Public policy and health insurance choices of the elderly: evidence from the medicare buy-in program," Journal of Public Economics, Elsevier, vol. 78(3), pages 301-324, November.
    27. Powell, David & Pacula, Rosalie Liccardo & Jacobson, Mireille, 2018. "Do medical marijuana laws reduce addictions and deaths related to pain killers?," Journal of Health Economics, Elsevier, vol. 58(C), pages 29-42.
    28. Thomas C. Buchmueller & Colleen Carey, 2018. "The Effect of Prescription Drug Monitoring Programs on Opioid Utilization in Medicare," American Economic Journal: Economic Policy, American Economic Association, vol. 10(1), pages 77-112, February.
    29. Jeffrey M Wooldridge, 2010. "Econometric Analysis of Cross Section and Panel Data," MIT Press Books, The MIT Press, edition 2, volume 1, number 0262232588, April.
    30. Swensen, Isaac D., 2015. "Substance-abuse treatment and mortality," Journal of Public Economics, Elsevier, vol. 122(C), pages 13-30.
    31. Cutler, David M. & Jessup, Amber & Kenkel, Donald & Starr, Martha A., 2015. "Valuing Regulations Affecting Addictive or Habitual Goods," Journal of Benefit-Cost Analysis, Cambridge University Press, vol. 6(2), pages 247-280, July.
    32. Johanna Catherine Maclean & Brendan Saloner, 2019. "The Effect of Public Insurance Expansions on Substance Use Disorder Treatment: Evidence from the Affordable Care Act," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 38(2), pages 366-393, March.
    33. Abby Alpert & David Powell & Rosalie Liccardo Pacula, 2018. "Supply-Side Drug Policy in the Presence of Substitutes: Evidence from the Introduction of Abuse-Deterrent Opioids," American Economic Journal: Economic Policy, American Economic Association, vol. 10(4), pages 1-35, November.
    34. Carlos Dobkin & Nancy Nicosia, 2009. "The War on Drugs: Methamphetamine, Public Health, and Crime," American Economic Review, American Economic Association, vol. 99(1), pages 324-349, March.
    35. Mireille Jacobson, 2004. "Baby Booms and Drug Busts: Trends in Youth Drug use in the United States, 1975–2000," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 119(4), pages 1481-1512.
    36. J. M. C. Santos Silva & Silvana Tenreyro, 2006. "The Log of Gravity," The Review of Economics and Statistics, MIT Press, vol. 88(4), pages 641-658, November.
    37. Bronchetti, Erin Todd, 2014. "Public insurance expansions and the health of immigrant and native children," Journal of Public Economics, Elsevier, vol. 120(C), pages 205-219.
    38. Mark G. Duggan & Fiona Scott Morton, 2011. "The Medium-Term Impact of Medicare Part D on Pharmaceutical Prices," American Economic Review, American Economic Association, vol. 101(3), pages 387-392, May.
    39. Anne Case & Angua Deaton, 2015. "Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century," Working Papers 15078.full.pdf, Princeton University, Woodrow Wilson School of Public and International Affairs, Research Program in Development Studies..
    40. Jonathan Gruber & Kosali Simon, 2007. "Crowd-Out Ten Years Later: Have Recent Public Insurance Expansions Crowded Out Private Health Insurance?," NBER Working Papers 12858, National Bureau of Economic Research, Inc.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. 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.
    2. Matthew T. Knowles, 2022. "How access to addictive drugs affects the supply of substance abuse treatment: Evidence from Medicare Part D," Health Economics, John Wiley & Sons, Ltd., vol. 31(8), pages 1649-1675, August.
    3. Ruhm, Christopher J., 2019. "Drivers of the fatal drug epidemic," Journal of Health Economics, Elsevier, vol. 64(C), pages 25-42.
    4. Buckles, Kasey & Evans, William N. & Lieber, Ethan M.J., 2023. "The drug crisis and the living arrangements of children," Journal of Health Economics, Elsevier, vol. 87(C).
    5. Gal Wettstein, 2019. "Health insurance and opioid deaths: Evidence from the Affordable Care Act young adult provision," Health Economics, John Wiley & Sons, Ltd., vol. 28(5), pages 666-677, May.
    6. Aparna Soni, 2024. "Estimating price elasticities of demand for pain relief drugs: evidence from Medicare Part D," International Journal of Health Economics and Management, Springer, vol. 24(4), pages 481-515, December.
    7. David Beheshti, 2019. "Adverse health effects of abuse‐deterrent opioids: Evidence from the reformulation of OxyContin," Health Economics, John Wiley & Sons, Ltd., vol. 28(12), pages 1449-1461, December.
    8. Lucy Xiaolu Wang, 2021. "The complementarity of drug monitoring programs and health IT for reducing opioid‐related mortality and morbidity," Health Economics, John Wiley & Sons, Ltd., vol. 30(9), pages 2026-2046, September.
    9. Christopher J. Ruhm, 2019. "Shackling the Identification Police?," Southern Economic Journal, John Wiley & Sons, vol. 85(4), pages 1016-1026, April.
    10. Johanna Catherine Maclean & Brendan Saloner, 2018. "Substance Use Treatment Provider Behavior and Healthcare Reform: Evidence from Massachusetts," Health Economics, John Wiley & Sons, Ltd., vol. 27(1), pages 76-101, January.
    11. Simone Balestra & Helge Liebert & Nicole Maestas & Tisamarie B. Sherry, 2021. "Behavioral Responses to Supply-Side Drug Policy During the Opioid Epidemic," NBER Working Papers 29596, National Bureau of Economic Research, Inc.
    12. Alberto Ortega, 2023. "Medicaid Expansion and mental health treatment: Evidence from the Affordable Care Act," Health Economics, John Wiley & Sons, Ltd., vol. 32(4), pages 755-806, April.
    13. Aliprantis, Dionissi & Fee, Kyle & Schweitzer, Mark E., 2023. "Opioids and the labor market," Labour Economics, Elsevier, vol. 85(C).
    14. Alice M. Ellyson & Jevay Grooms & Alberto Ortega, 2022. "Flipping the script: The effects of opioid prescription monitoring on specialty‐specific provider behavior," Health Economics, John Wiley & Sons, Ltd., vol. 31(2), pages 297-341, February.
    15. 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.
    16. Sumedha Gupta & Morhaf Al Achkar & Bradley Ray, 2022. "Are prescription drug monitoring laws effective for all? Evidence from administrative data," Contemporary Economic Policy, Western Economic Association International, vol. 40(1), pages 28-47, January.
    17. Borgschulte, Mark & Corredor-Waldron, Adriana & Marshall, Guillermo, 2018. "A path out: Prescription drug abuse, treatment, and suicide," Journal of Economic Behavior & Organization, Elsevier, vol. 149(C), pages 169-184.
    18. Shuo Zhang & Tat Y. Chan & Xueming Luo & Xiaoyi Wang, 2022. "Time-Inconsistent Preferences and Strategic Self-Control in Digital Content Consumption," Marketing Science, INFORMS, vol. 41(3), pages 616-636, May.
    19. Cotti, Chad D. & Gordanier, John M. & Ozturk, Orgul D., 2020. "The relationship of opioid prescriptions and the educational performance of children," Social Science & Medicine, Elsevier, vol. 265(C).
    20. Christopher J. Ruhm, 2018. "Deaths of Despair or Drug Problems?," NBER Working Papers 24188, National Bureau of Economic Research, Inc.

    More about this item

    JEL classification:

    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • K42 - Law and Economics - - Legal Procedure, the Legal System, and Illegal Behavior - - - Illegal Behavior and the Enforcement of Law

    NEP fields

    This paper has been announced in the following NEP Reports:

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:nbr:nberwo:21072. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: the person in charge (email available below). General contact details of provider: https://edirc.repec.org/data/nberrus.html .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.