Association for Public Policy Analysis & Management

Introduction: The opioid crisis remains of epidemic proportions in the United States. In 2017, 47,600 deaths were attributed to opioids, 17,029 of which were attributed to prescription opioids alone. The United States Department of Health and Human Services (HHS) holds the authority to exclude physician participation in federally funded health care programs based on a variety of criteria, including the wrongful manufacturing, distribution, prescribing, and dispensing of controlled substances (including opioids). Examining the relationship between physician behavior and mortality incidence could help better inform policy to combat the opioid crisis.

Methods: We assess the relationship between the incidence of HHS physician sanctions and opioid related mortality from 2000 to 2016. We extracted opioid mortality data from The Centers for Disease Control and Prevention’s National Vital Statistics System multiple cause-of-death mortality files. The county-level overdose death data were merged with a longitudinal database of all active physicians in the U.S. using sequential name and address matching. All HHS sanctioned physicians were identified. We estimated difference-in-means tests and regression analyses across sanctioned and non-sanctioned physicians.

Results: Preliminary results indicate that HHS exclusions are associated with a significant reduction in opioid related deaths between 2000 and 2016. Counties with greater numbers of physicians who received HHS exclusions saw larger reductions in deaths than counties with fewer exclusions and more unsanctioned active physicians.

Discussion: These findings provide insight on the relationship between physician exclusions and opioid mortality. The majority of first-time opioid users receive the prescription from their physician. Excluding physicians exhibiting adverse behavior is one pathway to mitigate opioid misprescribing. Prescription opioid overdose deaths have remained stable from 2016 to 2017, perhaps in part to HHS exclusion efforts. Our results support that targeted efforts at the federal level to combat adverse physician behavior show promise for opioid epidemic relief.