Economics of Marijuana and Opioids
Paper Session
Sunday, Jan. 3, 2021 12:15 PM - 2:15 PM (EST)
- Chair: David Bradford, University of Georgia
The Labor Supply Consequences of the Opioid Crisis
Abstract
In this paper, I focus on the effects of broad changes in opioid access on labor outcomes for 1981-2018. I examine changes in labor outcomes over time based on state-level variation in initial conditions which exposed some states to the opioid crisis more than others. Complementary work shows that the introduction of OxyContin in 1996 explains a large share of the national rise in overdose death rates (Alpert et al., 2019). My focus on OxyContin is due to its pivotal role in the opioid crisis. Within just a few years after its introduction, OxyContin was the most abused opioid, outpacing all other types of oxycodone combined. Evidence from Purdue Pharma’s launch plan for OxyContin suggests that they targeted less promotional activity to “triplicate states,” states with especially stringent prescription drug monitoring programs in 1996. Triplicate states were less exposed to the introduction of OxyContin as measured by morphine equivalent doses, prescriptions, and detailing. These differences persist to today.I implement a difference-in-differences design, comparing labor outcomes in non-triplicate states to outcomes in triplicate states both before and after the introduction of OxyContin, while relying primarily on event studies to transparently trace the conditional trajectory of these outcomes over time. The traditional event study approach, implemented regularly in difference-in-differences designs, is problematic, however. Under reasonable conditions which likely hold regularly in empirical applications, event study estimates may be biased even when the "parallel trends" assumption holds. I provide theoretical and empirical evidence of this bias.
Hassle Costs versus Information: How Do Prescription Drug Monitoring Programs Reduce Opioid Prescribing?
Abstract
Past work demonstrates that mandated (or “must access”) prescription drug monitoring programs (PDMPs) decrease opioid prescribing, but provides limited evidence on mechanisms. PDMPs provide physicians with information but also introduce a hurdle to writing an opioid prescription (a hassle cost). We analyze Kentucky’s landmark PDMP to understand how mandates reduce prescriptions, disentangling the role of information versus hassle costs. Focusing on the emergency department (ED), we show that opioid prescriptions declined sharply for both patients who are opioid-naïve and those who are non-naïve, implying an important role for hassle costs. The decline was largest for patients who exhibit “doctor shopping” behaviors and effectively zero for opioid naïve patients presenting with opioid-appropriate conditions, suggesting that doctors also use the information in the PDMP. On net, although the PDMP mandate clearly affected prescribing through the information provided, the mandate’s hassle cost explains the majority of the decline in prescribing.The Hazards of Unwinding the Prescription Opioid Epidemic: Implications for Child Abuse and Neglect
Abstract
We examine how two interventions designed to curtail prescription opioid misuse, the reformulation of OxyContin and the implementation of must‐access prescription drug monitoring programs (PDMPs), affected child abuse and neglect. Our results suggest that counties with greater initial rates of prescription opioid usage experienced relatively larger increases in substantiated child abuse and neglect subsequent to OxyContin’s reformulation. We also find larger increases in child abuse and neglect after must‐access PDMP implementation in counties with higher pre‐intervention exposure to opioids. Our results uncover unintended consequences of reducing the supply of an addictive good without adequate support (or alternatives) for dependent users.Discussant(s)
Jevay Grooms
,
Howard University
David Beheshti
,
University of Texas-San Antonio
Anne Burton
,
Cornell University
Christine Durrance
,
University of Wisconsin
JEL Classifications
- I1 - Health