47 E 65th St
New York, NY 10065
Ethan Lieber is as Assistant Professor at the University of Notre Dame.
Seminar topic: “How the Reformulation of Oxycontin Ignited the Heroin Epidemic” (with Bill Evans and Patrick Power)
Abstract: We examine the recent rise in heroin poisoning deaths and attribute the increase to the reformulation of OxyContin, an extended-release painkiller that was at the center of the rise in opioid abuse. Prior to the reformulation, recreational users could easily crush the drug to create a powder that could be snorted or liquefied and injected. This allowed users to circumvent the extended-release mechanism and gain access to a high dose of the drug all at once. Without notice, an abuse-deterrent version of OxyContin replaced the old formulation in early August, 2010 making it difficult to abuse the drug in this way. In the first part of the paper, we use national time series data at the monthly and quarterly level and long-standing techniques from the macro literature to date regime changes. These results show that OxyContin use and deaths stop rising and/or decline in August 2010 while heroin use and deaths begin to climb the following month. We then use the pre-reform specifics of heroin markets and OxyContin use to break states up into areas with high and low substitution possibilities. The shift to heroin would be easier and more pronounced in areas with greater access to heroin or areas with a greater use of opioids in the pre-reform period. Using monthly data on mortality rates at the state level for heroin and opioid deaths, we find that high substitution states had a much larger increase in heroin death rates. However, nationally, the reformulation generated no change in total heroin and opioids mortality, though we do find that areas with less access to heroin see slight reductions in combined heroin and opioids mortality. This suggests that the FDA’s push for more abuse-deterrent formulations of other opioids might have limited impact when there are readily-available alternatives and emphasizes the importance of considering consumers’ equilibrium responses to interventions that affect the full price of opioids.