The state of the science in opioid policy research

Schuler, Megan S.; Heins, Sara E.; Smart, Rosanna; Griffin, Beth Ann; Powell, David; Stuart, Elizabeth A.; Pardo, Bryce; Smucker, Sierra; Patrick, Stephen W.; Pacula, Rosalie Liccardo; Stein, Bradley D.

doi:10.1016/j.drugalcdep.2020.108137

Cited by 38 publications

(34 citation statements)

References 74 publications

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“…This method of abuse is arguably the most dangerous, as this high level of potency comes with a heightened risk for addiction and overdose death. 3 Prior to the reformulation, OxyContin was one of the highest selling prescription drugs in the United States (ranking 15th in sales) with more than $3 billion in annual sales in 2010 (Bartholow 2011). OxyContin sales grew rapidly due to an aggressive marketing campaign 4 that promoted the drug for a wide range of conditions, including non-cancer chronic pain, and as a first line therapy (GAO 2003).…”

Section: A Background On Oxycontinmentioning

confidence: 99%

Supply-Side Drug Policy in the Presence of Substitutes: Evidence from the Introduction of Abuse-Deterrent Opioids

Alpert

Powell

Pacula

2018

American Economic Journal: Economic Policy

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169

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Overdose deaths from prescription opioid pain relievers nearly quadrupled between 1999 and 2010. We study the consequences of one of the largest supply disruptions to date to abusable opioids—the introduction of an abuse-deterrent version of OxyContin in 2010. Supply-side interventions that limit access to opioids may have the unintended consequence of increasing use of substitute drugs, including heroin. Exploiting cross-state variation in OxyContin exposure, we find that states with the highest initial rates of OxyContin misuse experienced the largest increases in heroin deaths. Our results imply that the recent heroin epidemic is largely due to the reformulation of OxyContin. (JEL I12, I18)

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Section: A Background On Oxycontinmentioning

confidence: 99%

Supply-Side Drug Policy in the Presence of Substitutes: Evidence from the Introduction of Abuse-Deterrent Opioids

Alpert

Powell

Pacula

2018

American Economic Journal: Economic Policy

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169

139

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“…This synthesis of the NAL literature draws from a broader scoping review of opioid policy evaluation studies, details of which are described in Schuler et al . [10], updated to include articles published to December 2019. Briefly, the broader review searched for articles published in English within 13 medicine, social science, economic and legal databases using a defined set of search terms (details provided in the Supporting information).…”

Section: Methodsmentioning

confidence: 99%

Systematic review of the emerging literature on the effectiveness of naloxone access laws in the United States

2020

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Background and Aims Naloxone access laws (NALs) have been suggested to be an important strategy to reduce opioid‐related harm. We describe the evolution of NALs across states and over time and review existing evidence of their overall association with naloxone distribution and opioid overdose as well as the potential effects of specific NAL components. Methods Descriptive analysis of temporal variation in US regional adoption of NAL components, accompanied by a systematic search of 13 databases for studies (published between 2005 and 20 December 2019) assessing the effects of NALs on naloxone distribution or opioid‐related health outcomes. Eleven studies, all published since 2018, met inclusion criteria. Study time‐frames spanned 1999–2017. Opioid‐related overdose mortality, emergency department episodes and naloxone distribution were correlated with the presence of a NAL and, where data were available, NAL components. Results Existing evidence suggests mixed, but generally beneficial, effects for NALs. Nearly all studies show that NALs, particularly those that permit naloxone distribution without patient‐specific prescriptions, are associated with increased naloxone access [incidence rate ratios (IRR) range from 1.40, 95% confidence interval (CI) = 1.15–1.66 to 7.75, 95% CI = 1.22–49.35] and increased opioid‐related emergency department visits (IRR range from 1.14, 95% CI = 1.07–1.20 to 1.15, 95% CI = 1.02–1.29). Most studies show NALs are associated with reduced overdose mortality, although findings vary depending on the specific NAL components and time‐period analyzed (IRR range from 0.66, 95% CI = 0.42–0.90 to 1.27, 95% CI = 1.27–1.27). Few studies account for the variation in opioid environments (i.e. illicit versus prescription) or other policy dimensions that may be correlated with outcomes. Conclusions The existing literature on naloxone access laws in the United States supports beneficial effects for increased naloxone distribution, but provides inconclusive evidence for reduced fatal opioid overdose. Mixed findings may reflect variation in the laws’ design and implementation, confounding effects of concurrent policy adoption, or differential effectiveness in light of changing opioid environments.

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“…In that same timeframe, 46 800 people died of an opioid overdose, with two thirds of the deaths involving synthetic opioids (including fentanyl and fentanyl analogues) 3. In response to the rising burden of disease, a range of opioid related policies have been implemented, which have been geared towards reducing high risk opioid prescribing, improving access to treatment, and expanding overdose prevention efforts 4…”

mentioning

confidence: 99%

“…One perspective points to the co-occurring cannabis liberalisation as a potential means of reducing opioid related harms. Increased availability of cannabis has been suggested to result in the partial substitution of opioids for cannabis in managing pain 4. In a linked paper, Hsu and colleagues (doi:10.1136/bmj.m4957) contribute to this area of research by using an ecological design paired with county data from 2014 to 2018 5.…”

mentioning

confidence: 99%