When Innovation Goes Wrong: Technological Regress and the Opioid Epidemic

Abstract

The fourfold increase in opioid deaths between 2000 and 2017 rivals even the COVID-19 pandemic as a health crisis for America. Why did it happen? Measures of demand for pain relief – physical pain and despair – are high and in many cases rising, but their increase was nowhere near as large as the increase in deaths. The primary shift is in supply, primarily of new forms of allegedly safer narcotics. These new pain relievers flowed in greater volume to areas with more physical pain and mental health impairment, but since their apparent safety was an illusion, opioid deaths followed. By the end of the 2000s, restrictions on legal opioids led to further supply-side innovations, which created the burgeoning illegal market that accounts for the bulk of opioid deaths today. Because opioid use is easier to start than end, America's opioid epidemicis likely to persist for some time.

Opium Price Shocks and Prescription Opioids in the USA*

“…If changes in the quantity of opioids dispensed in the USA are determined by economic incentives to suppliers based on the price of the raw material, this mechanism can be expected to be stronger in areas with higher ex‐ante exposure to opioids, as proxied by (the log of) the per capita number of mining sites in 1983. These counties would represent the most fertile local markets for analgesics, where PO promotion campaigns presumably have the greatest chance of success (Cutler and Glaeser, 2021; Alpert et al ., 2022). Accordingly, we estimate the following model: $$$$ \Delta \mathrm{ln} MGEp{c}_{ct}=\alpha +\beta \left(\ln Mines1983p{c}_c\ast \Delta \mathrm{ln} Opium{P}_t\right)+{\delta}_t+{\gamma}_c+t{\theta}_c+{\epsilon}_{ct}, $$$$ where $$$ \Delta \mathrm{ln} MGEp{c}_{ct} $$$ is the log change in the per capita amount of morphine gram equivalent (MGE) dispensed in county $$$ c $$$ between quarter $$$ t-1 $$$ and quarter $$$ t $$$, $$$ \Delta \mathrm{ln} Opium{P}_t $$$ is the log change in the average price of dry opium in Afghanistan between quarters $$$ t-1 $$$ and $$$ t $$$, and …”

“…This evidence is consistent with recent contributions by Cutler et al . (2019) and Cutler and Glaeser (2021), who show that patient demand is relatively less important than supply‐side factors in explaining the US opioid crisis. Furthermore, this result is in line with the literature that investigates the initial causes of the opioid crisis, showing the crucial importance of supply‐side factors (Van Zee, 2009; Alpert et al ., 2022; Arteaga and Barone, 2022).…”

“…Our findings are in line with Cutler et al . (2019) and Cutler and Glaeser (2021). The former show that patient demand is relatively less important than supply‐side factors in explaining variation in healthcare spending.…”

“…This evolved with a steady rise in the dispensation of natural and semi‐synthetic opioids, such as oxycodone‐based drugs, which reflected changes in the promotional practices of drug manufacturing and retailing companies and in the prescribing routines of physicians (Van Zee, 2009; Alpert et al ., 2022). Conversely, the price elasticity on the changes in PO distributed is less evident in the post‐2010 years, when the reformulation of OxyContin ignited the heroin epidemic and fully synthetic opioids increased in popularity (Alpert et al ., 2018; Evans et al ., 2019; Cutler and Glaeser, 2021). Moreover, in the period of greatest expansion of natural and semi‐synthetic opioids, reductions in the price of opium are significantly associated with higher per capita drug overdose death rates and drug‐related crimes.…”

The effect of opioid use on traffic fatalities

“…17 Individuals using powdered heroin are often unaware of whether fentanyl is mixed in it(Ciccarone, 2019; Drug Enforcement Administration, 2018;Gladden et al, 2017). As opioid prescriptions fell by one third from 2011(Cutler & Glaeser, 2021) and OxyContin was reformulated in 2010, heroin and fentanyl use became more prominent that may have increased the unintentional intake of fentanyl. Because the individual does not realize the amount of fentanyl he/she has taken, the unexpected impairment while driving could increase which may have translated into higher traffic fatalities.18 There is not a single factor contributing to the decreasing trends in overall traffic fatalities (shown in Supporting Information S1: FigureA1), and researchers have identified many different potential factors, including public health policies and state regulations(Bandi et al, 2015).…”