Supply-Side Drug Policy in the Presence of Substitutes: Evidence from the Introduction of Abuse-Deterrent Opioids

Alpert, Abby; Powell, David; Pacula, Rosalie Liccardo

doi:10.2139/ssrn.2897179

Cited by 91 publications

(150 citation statements)

References 45 publications

(58 reference statements)

Supporting

Mentioning

138

Contrasting

Order By: Relevance

“…Consistent with Australian and international interpretations , we believe the decrease in Victorian pharmaceutical opioid‐related overdose ED attendances following April 2014 may be partly related to a reduction in the extramedical use of oxycodone following its reformulation.…”

Section: Discussionsupporting

confidence: 72%

“…Additional harms may be attributed to use of heroin, a prohibited drug with inconsistent quality and potency control. It has been argued that the heroin‐led second wave of the US opioid crisis was a direct result of the reformulation of oxycodone and resulted in the tripling of hepatitis C infection rates . We caution that this heroin trend should be closely monitored and proactive measures put in place urgently to prevent similar harms in Australia.…”

Section: Discussionmentioning

confidence: 94%

“…However, as outlined above, we also found a significant increase in the rate of heroin‐related harms in both ambulance and ED data around 2014. As others have argued, although supply waned, the demand for opioids continued and was probably met through other means . That is to say, the reduction in pharmaceutical‐related harms in Victoria may have been offset by partial substitution with heroin.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Recent trends in heroin and pharmaceutical opioid‐related harms in Victoria, Australia up to 2018

et al. 2019

View full text Add to dashboard Cite

Aims To characterize the trajectory in the years leading up to 2018 in pharmaceutical opioid and heroin morbidity in Victoria, Australia, and to assess the effect on that trajectory of reformulation of oxycodone to a form that could not be easily snorted or injected. Design Interrupted time-series analyses of population-level data before versus after reformulation of oxycodone, stratified by sex. Setting Victoria, Australia. Participants The population of Victoria aged 12+ years. Measurements Ambulance patient care and emergency department (ED) records were examined using both fixed-code and free-text fields, with each record manually cleaned and checked by trained coders. These were used to derive the output variables providing an index of harm: rates of opioid-related ambulance attendances and ED attendances for pharmaceutical opioids and heroin. The input variable was pre-versus post-oxycodone reformulation. Findings There were 30 045 opioid-related ambulance attendances from January 2012 to October 2018 (54% heroin-related), and 10 113 ED attendances from July 2008 to June 2018 (39% heroin-related). There was an increase in the rate (events per 100 000 people per year) of all opioid ED attendances from 2008 to 2018 [increase = 0.063; 95% confidence interval (CI) = 0.049, 0.078]. Pharmaceutical opioid ED attendances decreased from 2014 onwards (slope change = -0.083; 95% CI = -0.108, -0.059). Heroin-related ED attendances increased from 2014 to 2018; 11 324 heroin-related ambulance attendances and 1980 ED attendances were observed from April 2014 to June 2018, compared with the respective estimates of 8176, and 1661 had the pre-April 2014 trend continued (ambulance slope change = 0.296, 95% CI = 0.104, 0.489; ED slope change = 0.026, 95% CI = 0.005, 0.046). The inflection point of 2014 coincided with the re-formulation of oxycodone. Conclusion In Victoria, Australia, there appears to have been a trend starting around mid-2014 of increasing heroin-related harm, and a flattening of the increase or a decrease of harms relating to pharmaceutical opioids. These changes may, in part, reflect reformulation of oxycodone to reduce the extent to which it can be injected or snorted.

show abstract

Section: Discussionsupporting

confidence: 72%

Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Recent trends in heroin and pharmaceutical opioid‐related harms in Victoria, Australia up to 2018

et al. 2019

View full text Add to dashboard Cite

show abstract

“…In addition to the introduction of PDMPs, 5 researchers have examined the impact of the introduction of abuse-deterrent opioids (Cicero and Ellis, 2012;Alpert et al, 2016;Evans et al, 2017), the strengthening of pain clinic laws (Kennedy-Hendricks et al, 2016;Meinhofer, 2016), and improvements in access to opioid antagonists such as naloxone (Mueller et al, 2015;Rees et al, 2017) on opioid abuse and related health outcomes. To the best of our knowledge, this is the first study to examine whether additional physician training is likely to have a significant role to play in addressing the opioid epidemic.…”

Section: Introductionmentioning

confidence: 99%

Addressing the Opioid Epidemic: Is There a Role for Physician Education?

Schnell¹,

Currie

2017

View full text Add to dashboard Cite

Using national data on opioid prescriptions written by physicians from 2006 to 2014, we uncover a striking relationship between opioid prescribing and medical school rank. Even within the same specialty and practice location, physicians who completed their initial training at top medical schools write significantly fewer opioid prescriptions annually than physicians from lower ranked schools. Additional evidence suggests that some of this gradient represents a causal effect of education rather than patient selection across physicians or physician selection across medical schools. Altering physician education may therefore be a useful policy tool in fighting the current epidemic.

show abstract

“…Despite suggestive evidence that the epidemic is at least partly iatrogenic or supply-driven, other evidence finds a strong association between the abuse of prescription drugs and other substance abuse disorders (McCabe et al, 2008). Recent research suggests that prescription drug abuse may be partly responsible for the rise in heroin overdose deaths (Lankenau et al 2012, Peavy et al 2012, Jones 2013, Alpert et al 2017, Evans et al 2017. One of the most common state-level policy response to the epidemic has been the introduction of prescription drug monitoring programs.…”

Section: The Prescription Drug Epidemic and Policy Responsesmentioning

confidence: 99%

A path out: Prescription drug abuse, treatment, and suicide

Borgschulte

Corredor-Waldron

Marshall

2018

Journal of Economic Behavior & Organization

View full text Add to dashboard Cite

Standard-Nutzungsbedingungen:Die Dokumente auf EconStor dürfen zu eigenen wissenschaftlichen Zwecken und zum Privatgebrauch gespeichert und kopiert werden.Sie dürfen die Dokumente nicht für öffentliche oder kommerzielle Zwecke vervielfältigen, öffentlich ausstellen, öffentlich zugänglich machen, vertreiben oder anderweitig nutzen.Sofern die Verfasser die Dokumente unter Open-Content-Lizenzen (insbesondere CC-Lizenzen) zur Verfügung gestellt haben sollten, gelten abweichend von diesen Nutzungsbedingungen die in der dort genannten Lizenz gewährten Nutzungsrechte. Terms of use: Documents in MARCH 2018Any opinions expressed in this paper are those of the author(s) and not those of IZA. Research published in this series may include views on policy, but IZA takes no institutional policy positions. The IZA research network is committed to the IZA Guiding Principles of Research Integrity. The IZA Institute of Labor Economics is an independent economic research institute that conducts research in labor economics and offers evidence-based policy advice on labor market issues. Supported by the Deutsche Post Foundation, IZA runs the world's largest network of economists, whose research aims to provide answers to the global labor market challenges of our time. Our key objective is to build bridges between academic research, policymakers and society. IZA Discussion Papers often represent preliminary work and are circulated to encourage discussion. Citation of such a paper should account for its provisional character. A revised version may be available directly from the author.Schaumburg-Lippe-Straße 5-9 53113 Bonn, Germany

show abstract

Supply-Side Drug Policy in the Presence of Substitutes: Evidence from the Introduction of Abuse-Deterrent Opioids

Cited by 91 publications

References 45 publications

Recent trends in heroin and pharmaceutical opioid‐related harms in Victoria, Australia up to 2018

Recent trends in heroin and pharmaceutical opioid‐related harms in Victoria, Australia up to 2018

Addressing the Opioid Epidemic: Is There a Role for Physician Education?

A path out: Prescription drug abuse, treatment, and suicide

Contact Info

Product

Resources

About