Essays on the Opioid Crisis

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Ndrianasy, Estrella
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Middle Tennessee State University
This dissertation consists of three separate chapters, each providing an empirical analysis on various aspects of the opioid crisis in the United States. Each chapter is a separate article. The opioid epidemic has claimed tens of thousands of lives across the U.S. since the early 2000s. It is currently the leading cause of drug overdose deaths prompting lawmakers to adopt several opioid-related policies. Chapter I looks at the impact of Naloxone Access Laws on opioid overdose deaths, treatment rehabilitation admissions, and the legal supply of controlled substances. These laws allow a layperson to use Naloxone (Narcan) in the event of an opioid overdose without fear of criminal, civil, or professional immunity prosecution. This study looks at whether the availability of Naloxone and immunity encourages riskier behaviors among addicts. Specifically, the laws may act as a safety net leading to moral hazard. The analysis uses a conditional panel fixed-effects and propensity score matching methods to ascertain the potential for moral hazard. The data used is a combination of panel data aggregated at the state level from the Treatment Episode Data Set, the Multiple Cause of Death, the Automation of Reports and Consolidated Orders System, and the Annual Social and Economic Supplement surveys. The paper finds no evidence for moral hazard stemming from the availability of Naloxone Access Laws on all outcomes of interest. However, concurrent opioid policies such as Prescription Drug Monitoring Programs and Good Samaritans laws are shown to be effective in increasing treatment rehabilitation admissions and reducing overdose deaths. Chapter II looks at another opioid related policy, the Prescription Drug Monitoring Programs and its mandatory query requirements. Among others, these initiatives required primarily physicians and pharmacists to query into a patient's health records prior to prescribing and/or dispensing opioids. These laws effectively increased the distribution and availability of prescription opioids. This papers posits such restriction might have the unintended effects of turning opioid abusers to illicit but readily available alternatives such as heroin. The analysis uses a conditional fixed effects logit framework and a simple fixed effect regression model to look at the impact of the queries into opioid overdose deaths from the Multiple Cause of Death data set. States requiring both prescribers and dispenser to query health records see an increase in heroin and methadone deaths but see a decrease in other synthetic narcotics. States with prescribers only requirements see a decrease in heroin deaths and no impact on other types of opioids. Therefore, the study finds mixed evidence on substitution to heroin from prescription opioids due to mandatory query requirements. Chapter III analyzes the rural-urban difference in the impact of the opioid crisis. Rural areas in the U.S., and particularly in the Appalachian region, are found to be disproportionately affected by the epidemic. The analysis uses the Multiple Cause of Death overdose deaths to compare opioid overdose deaths in a conditional fixed effects model to empirically quantify this phenomenon. It also controls for the OxyContin Reformulation of 2010 which was heavily marketed in rural areas including Appalachia. States located in Appalachia are found to have a significantly higher rate of heroin and methadone mortality whereas the reformulation led to an increase in other opioids and other synthetic narcotics fatalities.
Economics, Public health