Association for Public Policy Analysis & Management

Deaths from drug overdose have been rising at a meteoric rate in recent years to become the leading cause of injury death in the United States as of 2010. To put this in perspective, drug poisoning caused more deaths than motor vehicle traffic crashes, which has long held the number one spot in causes of injury death. The majority of drug overdose deaths are caused by prescription drug use, and in particular, opioid-based painkillers such as oxycodone and methadone. In this paper, we analyze the impact of state legislative strategies that have been introduced in recent years in response to the burgeoning epidemic. As of 2010, more than 40 states have enacted some kind of prescription drug control law, but so far there has been scant research on whether these laws are effective in curbing prescription drug abuse and overdose. The eight types of laws we consider are (1) laws requiring a physical examination before prescribing, 2) laws requiring tamper-resistant prescription forms, 3) laws regulating pain clinics, 4) laws setting prescription drug limits, 5) laws prohibiting “doctor shopping”/fraud, 5) laws requiring patient identification before dispensing, 7) immunity laws providing immunity from prosecution for individuals seeking assistance during an overdose, and 8) prescription drug monitoring programs (PDMP), which are statewide electronic databases that keep track of substances dispensed in each state. Results suggest that stricter regulation of pain clinics and PDMP may be effective in decreasing opioid drug deaths. Interestingly, we find that deaths from illicit drugs (ex., heroin and cocaine) are impacted as well, suggesting there may be substitution effects between prescription and illicit drugs. Further, immunity laws significantly increase and improve survival outcomes of ER visits for both prescription and illicit drug overdose, implying there may be “positive” spillover effects on illicit drug users.