An Empirical Analysis of Policy Responses to the Opioid Epidemic

Abstract

This dissertation studies the relationship between state laws, federal regulations, and the ongoing opioid epidemic. Chapter one studies the effect of naloxone access laws on opioid overdoses. Using a richly detailed dataset, this chapter separately identifies the effects of different naloxone access provisions on different subpopulations of opioid users. The results demonstrate that loosening naloxone prescription requirements saves thousands of lives annually, particularly among illegal drug users in urban areas. Chapter two investigates the effect of the U.S. Food and Drug Administration’s 2014 boxed warnings on opioid prescriptions. The FDA required manufacturers of opioids to place a boxed warning on the drug labels of all extended release opioid products in April 2014. Using the language of the warning, this chapter explores how the warning affected opioid prescriptions among groups that the warning targeted. I find that the warning decreased prescriptions to repeat users of opioids by thirty-five percent, but did not affect prescriptions to relatively riskier opioid users or individuals that the warning specifically targeted. Finally, chapter three studies the relationship between fatal occupational injuries and opioid overdoses. I find consistent evidence that opioid abuse significantly increased fatal worker injuries, while finding no evidence that dangerous working conditions increase fatal opioid overdoses. Approximately 300 worker fatalities that occurred between 2006 and 2016 are attributable to opioid abuse.