What Drives Risky Prescription Opioid Use? Evidence from Migration

Finkelstein, Amy; Gentzkow, Matthew; Li, Dean; Williams, Heidi

doi:10.3386/w30471

Cited by 9 publications

(7 citation statements)

References 73 publications

(126 reference statements)

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“…Case and Deaton (2017) attribute the surge in overdose deaths to worsening economic conditions and refer to the so-called deaths of despair hypothesis. In contrast, Currie et al (2018); Finkelstein et al (2018); Hollingsworth et al (2017); Ruhm (2018), and Schnell and Currie (2018) find little evidence for a causal impact of economic conditions and stress the importance of the availability of opioids. 4 There are a number of studies evaluating interventions tackling the opioid epidemic, both on the supply-side, such as prescription drug monitoring laws (Buchmueller & Carey, 2018;Gihleba et al, forthcoming;Grecu et al, 2019) or abuse-deterrent drug formulations (Alpert et al, 2018;Evans et al, 2019), and on the demand-side, such as syringe exchange programs (Packham, 2019).…”

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confidence: 90%

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The intergenerational persistence of opioid dependence: Evidence from administrative data

Ahammer

Halla

2022

Health Economics

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Opioid dependence, misuse, and overdoses are serious public health problems faced by many countries. Particularly in the United States (US) and Canada, the use of opioids has surged since the late 1990s. This trend is observed for both illicit opioids, such as heroin, and prescription opioids. Today, both countries are in the midst of a devastating opioid epidemic, which is likely to become even worse during the COVID-19 pandemic. 1 Some observers are worried that this epidemic could soon swap over to other countries. 2 In Europe, overdose deaths have recently begun to increase again too. Especially the emergence of potent synthetic opioids, such as fentanyl, is alarming (EMCDDA, 2017). To address this crisis and understand its persistence, it is crucial to identify important predictors of opioid dependence.Opioid dependence not only has a negative impact on users themselves but harms entire families. Children are particularly vulnerable. The incidence of neonatal abstinence syndrome, a condition that occurs if babies are exposed to opioids in utero, has increased almost fourfold between 2004(Tolia et al., 2015. Affected babies experience severe withdrawal symptoms up to 6 months after birth (McQueen & Murphy-Oikonen, 2016) and are more likely to have adverse outcomes in later life (Maguire et al., 2016). Children exposed to parental opioid dependence postnatally face obstacles as well. They are more likely to grow up in an unstable environment with economic and emotional challenges, such as secrecy, loss, conflict, violence, and fear (Nunes et al., 2000). Such childhood experiences are associated with severe limitations in economic and social functioning later in life, which may increase the likelihood of children's own substance abuse. Thus, the family is potentially an important factor in explaining opioid addiction.

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confidence: 90%

“…( 2018 ); Finkelstein et al. ( 2018 ); Hollingsworth et al. ( 2017 ); Ruhm ( 2018 ), and Schnell and Currie ( 2018 ) find little evidence for a causal impact of economic conditions and stress the importance of the availability of opioids.…”

Section: Introductionmentioning

confidence: 99%

The intergenerational persistence of opioid dependence: Evidence from administrative data

Ahammer

Halla

2022

Health Economics

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“…Our third set of models exploits a quasi-exogenous shock of physician migration, to test our hypotheses (Finkelstein, Gentzkow, and Williams, 2018; Molitor, 2018). This approach is similar to a growing body of work on migration to disentangle the effects of environmental-level factors and individual-level factors on health outcomes (Finkelstein, Gentzkow, and Williams, 2016; Molitor, 2018).…”

Section: Analytical Strategymentioning

confidence: 99%

“…For example, Molitor (2018) used physicians’ migration as quasi-exogenous environmental-level shocks on their practices, exploiting cardiologists’ migration to show that changes in the environment are associated with abrupt shifts in the physicians’ practices. Finkelstein and colleagues (2018) exploited the migration of Medicare patients to isolate the effects of patient demand from place-specific effects (such as the high prescribing rates) in driving opioid abuse.…”

Section: Analytical Strategymentioning

confidence: 99%

Where Is All the Deviance? Liminal Prescribing and the Social Networks Underlying the Prescription Drug Crisis

Zhang

Mohliver

King

2022

Administrative Science Quarterly

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The misuse of prescription drugs is a pressing public health crisis in the United States that is fueled by high-risk prescribing. We show that high-risk prescribing comprises two distinct practices: (1) routinely overprescribing to patients whose prescription -fill patterns are consistent with misuse or abuse, which conforms to the definition of deviance in sociology, and (2) routinely overprescribing to patients whose prescription-fill patterns are within possible bounds of medical use, which does not. We call the second practice “liminal prescribing,” a term that indicates it is legally and morally ambiguous. Using 213.9 million prescriptions to construct a four-year panel of the patient-sharing networks of 500,472 physicians, we find that deviant and liminal prescribers have starkly different social network structures and social influence processes; larger and more cohesive networks among prescribers are associated with more deviance but less liminality. Physicians’ ties to liminal prescribers increase liminal prescribing but do not increase deviance. Our results suggest that liminal prescribing is distinct from deviant prescribing and is not a milder form of deviant prescribing. Liminal prescribing is far more prevalent than deviance and accounts for most of the oversupplied benzodiazepines in our dataset (55.8 versus 8.7 percent, respectively). Our study highlights that the social structures supporting liminal practices differ from those that support either rule-abiding practices or deviance.

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“…In contrast, very little is known about the prevalence of opioid use at the time of application and how opioid use varies by applicant characteristics (Gebauer et al, 2019) or community prescribing practices. Recent research finds that about half of the variation in opioid abuse rates across U.S. counties is due to place-specific factors such as local prescribing practices (Finkelstein et al, 2021). Such information is potentially of tremendous value, however, to the disability research and policy community.…”

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confidence: 99%

Opioid Use Among Social Security Disability Insurance Applicants, 2013–2018

Maestas

Sherry

Strand

2023

Journal of Disability Policy Studies

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Opioid use is common among Social Security Disability Insurance (SSDI) beneficiaries who account for a disproportionate share of opioid-related hospitalizations and mortality. However, little is known about the prevalence of opioid use prior to SSDI enrollment. Understanding when opioid use is established and how it correlates with individual characteristics and community prescribing practices would inform policy approaches to reducing opioid-related harms among SSDI beneficiaries. We estimated the prevalence of opioid use among SSDI applicants by applying a natural language processing algorithm to SSDI application data. We find the prevalence of opioid use among SSDI applicants declined from 33% in 2013 to 24% in 2018. In contrast, the share of applicants with musculoskeletal impairments, which are commonly associated with pain, was unchanged. The share of applications reporting opioid use declined across both sexes, all age groups and education levels, and all regions. There was substantial variation, however, in the magnitude of decline by geography, with the smallest declines in parts of the Midwest and Southeastern United States. SSDI application rates and applications reporting opioid use were more likely to come from communities with higher opioid prescribing rates. Our estimates suggest most SSDI beneficiaries began opioid use prior to entering the SSDI program.

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What Drives Risky Prescription Opioid Use? Evidence from Migration

Abstract: NBER working papers are circulated for discussion and comment purposes. They have not been peer-reviewed or been subject to the review by the NBER Board of Directors that accompanies official NBER publications.

Cited by 9 publications

References 73 publications

The intergenerational persistence of opioid dependence: Evidence from administrative data

The intergenerational persistence of opioid dependence: Evidence from administrative data

Where Is All the Deviance? Liminal Prescribing and the Social Networks Underlying the Prescription Drug Crisis

Opioid Use Among Social Security Disability Insurance Applicants, 2013–2018

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