Does Intra-household Contagion Cause an Increase in Prescription Opioid Use?

Abstract

Opioid use claims many thousands of lives each year. This article considers the diffusion of prescription opioid (PO) use within family households as one potential culprit of the proliferation of these medications. In an analysis of hundreds of millions of medical claims and almost 14 million opioid prescriptions in one state between 2010 and 2015, we show that the use of POs spreads within family households. We also show that the treatment effect of exposure to a family member’s PO use is driven by an increase in PO consumption for medical conditions that members of treated and untreated families experience at nearly identical rates. This pattern of results suggests household exposure causes an uptick in patient demand for prescription opioids. We use an instrumental variable estimation strategy to address the well-known challenges to estimating a causal effect of intra-household contagion, such as genotypic similarities among family members, assortative matching in partner selection, and clustering of health conditions within households. The results spotlight the salience of the most ubiquitous social structure, the family household, in accelerating opioid consumption to unprecedented levels. The findings also suggest that rather than direct social influence between physicians, the spread of prescription behavior in physician networks may be driven by shifts in patient demand that propagate through the patient sharing network.

Gender Differences in COVID-19 Related Attitudes and Behavior: Evidence from a Panel Survey in Eight OECD Countries

“…Gender differences in our outcomes of interest are lower for individuals who live in a household than for those who live alone, consistent with the hypothesis that views on the pandemic and on appropriate health measures, as well as behavior, diffuse within households. This echoes evidence of similar transmission patterns for other types of beliefs and behavior, such as voting or using drugs (Nickerson, 2008;De Vaan & Stuart, 2019). In addition, we find that people with COVID-19 symptoms and those who know others with such symptoms are more likely to comply with health measures, and that gender differences are smaller among them, suggesting that first-hand experience of the pandemic enables men to bridge part of the gap with women.…”

Reconsidering the Reference Category

“…This logic also extends to quasi-experimental and observational studies that are structured theoretically around an intervention. As an example, de Vaan and Stuart (2019) asked whether the introduction of opioids into a household increases the likelihood of a subsequent opioid prescription for another household member. Having opioids introduced into the household is not an experimental intervention, but is theoretically akin to being the “treatment” group, and so not having opioids introduced into the household is the appropriate reference category.…”

Moving from Adoption to Use: Physicians’ Mixed Commitments in Deciding to Use Robotic Technologies

“…Today, attention to diffusion persists because the key task for a large swath of doctors is prescribing pharmaceuticals. So, when studying adoption of new technologies in medicine, scholars have generally focused on tasks involving giving patients pills (e.g., de Vaan & Stuart, 2019; King et al., 2013). These technologies require little professional or organizational investment.…”