Association for Public Policy Analysis & Management

To combat the current opioid epidemic, government officials are increasingly utilizing supply-side interventions, such as drug reformulations, which aim to combat prescription opioid misuse by reducing the supply of abuseable drugs. I study the unintended consequences of the OxyContin reformulation on child welfare utilization. Using an empirical strategy proposed by Alpert et al. (2018), I exploit cross-state variation in pre-reformulation rates of OxyContin misuse to compare child welfare utilization before and after the reformulation among states with differing levels of initial OxyContin misuse. There is growing literature that suggests that after the reformulation, a subset of people with opioid use disorder (OUD) transitioned from using prescription opioids to using heroin (Cicero et al., 2012; Cicero & Ellis, 2015). Therefore, states with more OxyContin misusers prior to the reformulation subsequently had a larger population at-risk for heroin use after the reformulation. To the extent that these individuals were caregivers, there would then be a higher demand for child welfare services. I find that foster care case rates increased after the reformulation. However, I show no statistically significant change in child maltreatment rates. This finding suggests that the increase in foster care cases is likely driven by the increased severity of foster care cases, reflected in the longer duration of time in the system, rather than more children entering the foster care system.

These results can inform policy discussions both about child welfare and drug policy. They imply that there are likely significant unintended consequences of one of the key policies used to combat the rise in opioid use disorder in the United States.