Association for Public Policy Analysis & Management

Background: The opioid crisis in the United States continues without any sign of slowing. Preliminary figures from 2016 suggest that a growing share of opioid-related deaths are attributed to illicitly-sourced opioids, like heroin and uncontrolled synthetic opioid analogs. Some have criticized recent supply-side efforts to reduce access to prescription opioids for displacing some opioid-dependent users to more harmful street opioids. Additional research suggests that opioid-involved deaths have been undercounted in recent years, impeding our understanding of the magnitude of the problem let alone policies aimed at addressing it. Methods: We adopt an approach detailed in the literature to adjust for under-reporting of opioid-related overdose deaths. Corrected rates were imputed using CDC death certificate data and county-specific controls for 2008-2015. The reported counts and adjusted estimates were then regressed on policy indicators aimed at reducing supply of prescription opioids. In particular, we measure the strength of prescription drug monitoring programs (PMPs) in state-quarters between 2008 and 2015 to determine the association with overdose deaths attributed to prescription opioids and illicitly-sourced opioids. Results: Imputed death counts suggests that illicit and prescription drug-related overdoses were undercounted by as much as 23 and 33 percent, respectively, depending on the year. Earlier work has shown that PMP strength is negatively associated with prescription opioid overdose deaths. Results here support those findings for observed prescription overdose deaths; yet this association is not significant after adjusting for under-reporting. In all models considered, PMP strength was significant and positively associated with observed or adjusted illicit opioid deaths. Estimates suggest that a one point increase in PMP strength is associated with a 1 to 2.5% (p < 0.001) increase in illicit opioid overdose deaths. Discussion: Prescription drug monitoring programs have been promoted by authorities as one mechanism to curb the country’s growing opioid problem. However, early results here suggest that these programs may be working against those goals, at least in the short term. The increased lethality of synthetic opioids in illicit markets pose considerable risk to chronic prescription opioid misusers facing supply constraints. Though these estimates suggest a displacement effect due to PMPs, more research is needed to determine the net effect of policy design and implementation.