Origins of the Opioid Crisis and its Enduring Impacts

85 Pages Posted: 3 Dec 2019

See all articles by Abby Alpert

Abby Alpert

University of Pennsylvania - The Wharton School

William N. Evans

University of Notre Dame; National Bureau of Economic Research (NBER)

Ethan Lieber

University of Notre Dame

David Powell

RAND Corporation

Date Written: November 2019

Abstract

Overdose deaths involving opioids have increased dramatically since the mid-1990s, leading to the worst drug overdose epidemic in U.S. history, but there is limited empirical evidence on the initial causes. In this paper, we examine the role of the 1996 introduction and marketing of OxyContin as a potential leading cause of the opioid crisis. We leverage cross-state variation in exposure to OxyContin’s introduction due to a state policy that substantially limited OxyContin’s early entry and marketing in select states. Recently-unsealed court documents involving Purdue Pharma show that state-based triplicate prescription programs posed a major obstacle to sales of OxyContin and suggest that less marketing was targeted to states with these programs. We find that OxyContin distribution was about 50% lower in “triplicate states” in the years after the launch. While triplicate states had higher rates of overdose deaths prior to 1996, this relationship flipped shortly after the launch and triplicate states saw substantially slower growth in overdose deaths, continuing even twenty years after OxyContin's introduction. Our results show that the introduction and marketing of OxyContin explain a substantial share of overdose deaths over the last two decades.

Suggested Citation

Alpert, Abby and Evans, William N. and Lieber, Ethan and Powell, David, Origins of the Opioid Crisis and its Enduring Impacts (November 2019). NBER Working Paper No. w26500, Available at SSRN: https://ssrn.com/abstract=3496477

Abby Alpert (Contact Author)

University of Pennsylvania - The Wharton School ( email )

3641 Locust Walk
Philadelphia, PA 19104-6365
United States

William N. Evans

University of Notre Dame ( email )

913 Flanner Hall
Notre Dame, IN 46530
United States
574-631-7039 (Phone)

National Bureau of Economic Research (NBER)

1050 Massachusetts Avenue
Cambridge, MA 02138
United States

Ethan Lieber

University of Notre Dame ( email )

361 Mendoza College of Business
Notre Dame, IN 46556-5646
United States

David Powell

RAND Corporation ( email )

1776 Main Street
P.O. Box 2138
Santa Monica, CA 90407-2138
United States

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