State Policies and the Opioid Crisis: Understanding the Complex Dynamics

A new study co-authored by MIT economists provides insight into the opioid crisis, examining the role of state-level policies and geography in its spread. The study reveals that state policies involving "pill mills" contributed to addiction over time, with laws restricting pain clinics reducing risky opioid use by 5 percent between 2006 and 2019. The researchers also found that enacting these laws near the onset of the crisis could have reduced risky use by 30 percent over the same period. The study emphasizes the importance of understanding the dynamics of addiction and preventing its onset, as addicted users may later seek out nonprescription opioids, exacerbating the problem.

Key Takeaways:

• State-level policies involving "pill mills" contributed significantly to the opioid crisis, with laws restricting pain clinics reducing risky opioid use by 5 percent between 2006 and 2019.
• Enacting laws restricting pain clinics near the onset of the crisis, in the 1990s, could have reduced risky use by 30 percent over the same time period.
• The study found a greater role for place-based factors than for personal characteristics in accounting for the drivers of risky opioid use.
• People moving to a state with a 3.5 percentage point higher rate of risky use would experience an average increase of 1 percentage point in the first year, and 0.3 percentage points in each subsequent year.
• The study identified the "addiction channel" and the "availability channel" as key mechanisms driving opioid use, with existing users getting continued access to prescribed opioids having an impact on overall opioid uptake that was 2.5 times as large as that of new users falling into addiction.
• The study highlights the importance of preventing the onset of addiction, as addicted users may later seek out nonprescription opioids, exacerbating the problem.

Statistics:

• Between 2006 and 2019, laws restricting pain clinics reduced risky opioid use by 5 percent.
• Enacting laws restricting pain clinics near the onset of the crisis, in the 1990s, could have reduced risky use by 30 percent over the same time period.
• Over the 2006-2019 period, people falling into addiction through new prescriptions had an impact on overall opioid uptake that was 2.5 times as large as that of existing users getting continued access to prescribed opioids.
• In states that lagged in enacting restrictions on pain clinics, the trend of increased opioid use was particularly pronounced.
• As of 2017, there were more than twice as many U.S. deaths from opioids as from homicide.

Sources:

• "What Drives Risky Prescription Opioid Use: Evidence from Migration," by Amy Finkelstein, Matthew Gentzkow, and Dean Li, Quarterly Journal of Economics.
• Research support was provided by the National Institute on Aging, the Social Security Administration, and the Stanford Institute for Economic Policy Research.
• The study used data from the Social Security Disability Insurance program, covering about 3 million cases from 2006 to 2019.