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Substitution Effects and Opioid Abuse: An Empirical Analysis of Prescription Drug Monitoring Programs
Over the last two decades, prescription opioid abuse has become a widespread social problem in the United States. Prescription drug monitoring programs have been established in nearly every state as a response to this problem, and previous research indicates that these programs are decreasing the amounts of certain opioids prescribed by doctors. This paper uses fatal overdose data from the Centers for Disease Control and Prevention to examine whether the reduction in the diversion of prescription opioids has led to substitution effects towards an alternative opioid: heroin. Ordinary Least Squares and Trimmed Least Absolute Deviations results indicate that monitoring programs are related to a non-statistically significant reduction in heroin deaths. That is, substitution effects either do not occur through the mechanism of monitoring programs, or they are outweighed by other factors—for instance, the “gatekeeper effect” discussed herein. Meanwhile, in a robustness check, monitoring programs in existence for three or more years are found to be weakly related to a 16% reduction in prescription opioid deaths.
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