Association for Public Policy Analysis & Management

Drug overdoses are now the leading killer of Americans under age 55. Recent research has shown that opioids prescribed by doctors has been an important contributing factor in the crisis. However, widespread prescriptions for opioids may have additional negative public health consequences, the effects of which have not yet been measured in taking account of the costs of the crisis. Car crash fatalities may be one such consequence. Opioids cause users to experience sedation and drowsiness, and the FDA requires that prescriptions for opioids be accompanied by a warning against driving or operating heavy machinery. Thus, increased prescriptions may impact fatalities if users tend to drive while under the influence. Using data from the Fatality Analysis Reporting System (FARS) and county fixed-effects models, we estimate the relationship between the number of prescriptions in a county-year and the number of fatal car crashes. We investigate whether counties with larger increases in prescription rates also experience increased fatal crashes where a driver was intoxicated. We find evidence that increased prescriptions in a county are associated with increased fatal crashes (2 percent increase), and increases in the number of crashes involving an opioid (20 percent increase). We find no relationship between prescriptions and crashes involving alcohol, a potential substitute for opioids. We conclude that the current fatality costs of the crisis may be underestimated since they only include fatalities due to overdose, ignoring potential spillovers to other causes of death.