Association for Public Policy Analysis & Management

In recent years, use of addictive prescription drugs such as benzodiazepines, opioids, and stimulants rose dramatically in the United States. Because health insurance lowers the cost of purchasing addictive prescription drugs, losing coverage may cause individuals to decrease use or substitute to riskier drugs sold on the black market. Decreased use of appropriate medications can reduce health and quality of life, and individuals who stop using these prescription drugs can experience dangerous withdrawal symptoms, including death. In addition, individuals who substitute to black market drugs may suffer serious medical consequences such as overdose or death due to variations in drug quality. Using a regression discontinuity design, I estimate the effect of aging out of health insurance from the Affordable Care Act’s dependent coverage mandate at age 26 on legal purchases of prescribed benzodiazepines, opioids, and stimulants. Aging out of insurance at 26 is associated with a 0.9-1.7 percentage point decrease in the likelihood of purchasing a prescribed opioid. Individuals who lose insurance from aging out at 26 are 27-50 percentage points less likely to purchase a prescribed opioid. These changes are driven by reductions in opioid prescriptions purchased by women. I also find decreases in purchasing stimulants and benzodiazepines, although these effects are smaller and imprecise.