Powell David, Pacula Rosalie Liccardo
RAND.
Sol Price School of Public Policy and Schaeffer Center for Health Policy and Economics, University of Southern California, and NBER.
Am J Health Econ. 2021 Winter;7(1):41-67. doi: 10.1086/711723. Epub 2020 Dec 22.
Recent evidence suggests that the short-term transition of the opioid crisis from prescription opioids to heroin can be attributed to the reformulation of OxyContin, which substantially reduced access to abusable prescription opioids. In this paper, we find that over a longer time horizon, reformulation stimulated illicit drug markets to grow and evolve. We compare overdose trajectories in areas more exposed to reformulation, defined as states with higher rates of nonmedical OxyContin use before reformulation, to less exposed areas. More exposed areas experienced disproportionate increases in fatal overdoses involving synthetic opioids (fentanyl) and nonopioid substances like cocaine, suggesting that these new epidemics are related to the same factors driving the rise in heroin deaths. Instead of just short-term substitution from prescription opioid to heroin overdoses, the transition to illicit markets spurred by reformulation led to growth in the overall overdose rate to unprecedented levels.
近期证据表明，阿片类药物危机从处方阿片类药物到海洛因的短期转变可归因于奥施康定的重新配方，这大幅减少了可滥用处方阿片类药物的获取。在本文中，我们发现，从更长的时间跨度来看，重新配方刺激了非法毒品市场的增长和演变。我们将重新配方影响更大的地区（定义为重新配方前非医疗用途奥施康定使用率较高的州）与影响较小的地区的过量用药轨迹进行了比较。受影响更大的地区在涉及合成阿片类药物（芬太尼）和可卡因等非阿片类物质的致命过量用药方面出现了不成比例的增加，这表明这些新的流行病与导致海洛因死亡人数上升的相同因素有关。重新配方引发的向非法市场的转变，并非仅仅是从处方阿片类药物过量用药到海洛因过量用药的短期替代，而是导致总体过量用药率增长到了前所未有的水平。
