Drug markets and the opioid epidemic

美国物质使用流行病是美国最严重的健康危机之一。 自1999年以来，已有超过100万美国人丧生。尽管有大量的文献 关于这一流行病，我们仍有许多不了解的情况。本项目将解决两个悬而未决的问题。一是 研究处方药市场执法干预的效果。受管制物质 根据CSA法案，处理受控物质的医生、药房和药品分销商必须 防止转移的义务（即，非法使用受管制物质）。就阿片类药物而言， 医生，药店和药品分销商被关闭或面临刑事指控， 违反了CSA的规定。这些干预措施对阿片类药物供应和健康的影响尚不清楚。 拟议中的项目将收集所有与处方有关的联邦执法干预的新数据 阿片类药物的研究这些数据将补充个人从业者和公司一级的数据 阿片类药物供应，并用于构建一个措施，暴露于执法干预，为所有美国 县随着时间的推移目标1将使用时间序列分析来估计执法干预对 县阿片类药物供应为了研究健康问题，该项目将使用来自国家统计局的限制使用的生命统计数据。 卫生统计中心（NCHS）测量县过量死亡率。目标2将使用这些数据，沿着 利用执法数据和与目标1相同的方法，估计执法的影响 对处方阿片类药物、非法阿片类药物和所有药物造成的死亡采取干预措施。 本项目将研究的第二个问题是经济和社会因素可以解释什么 非法阿片类药物造成的死亡人数不断上升（即，海洛因和非法制造的芬太尼）。非法类阿片死亡 在政策开始减少处方阿片类药物供应后的十年里，目标3 将探讨两种经济和社会理论。第一种理论是毒品向下倾斜 供应这一理论认为，阿片类药物的大量使用产生了贩毒的规模经济， 非法阿片类药物价格下降，使用增加。第二个理论是关于厚市场的。这个理论认为， 更多的非法阿片类药物使用增加了人们与非法阿片类药物使用者和销售者的社会互动， 这些相互作用进一步增加了类阿片的非法使用。该项目将利用国家卫生统计中心的生命统计数据 数据，沿着一些其他数据集，以测试每种理论可以解释非法阿片类药物上升的程度 死亡在扩大阿片类药物使用期间，将在县级估计时间序列回归 从处方类阿片到海洛因（2006年至2014年）以及从海洛因到芬太尼（2010年以上）的流行情况。测试 厚市场理论，回归将涉及附近地区非法阿片类药物使用的外源性增加， 地区县有大量的Facebook朋友，他们自己的非法阿片类药物死亡率也很高。测试 由于供应量下降，回归将把海洛因使用的外源性增加与海洛因价格联系起来。

Project Summary: The United States substance use epidemic is one of the most significant health crises in history, having claimed the lives of more than 1 million Americans since 1999. Despite a significant literature on the epidemic, there is still much we do not know. This project will address two open questions. The first is to study the effects of enforcement interventions in prescription drug markets. Under the Controlled Substances Act (CSA), physicians, pharmacies, and pharmaceutical distributors who handle controlled substances have obligations to prevent diversion (i.e., illicit uses of controlled substances). In the case of opioids, a number of physicians, pharmacies, and pharmaceutical distributors were shut down or faced criminal charges due to violating their CSA obligations. The effects of these interventions on opioid supply and health are unknown. The proposed project will assemble new data on all federal enforcement interventions related to prescription opioids since the mid-2000s. These data will be supplemented with individual practitioner and firm-level data on opioid supply and used to construct a measure of exposure to enforcement interventions for all U.S. counties over time. Aim 1 will use time-series analysis to estimate the impact of enforcement interventions on county opioid supply. To study health, the project will use restricted-use vital statistics data from the National Center for Health Statistics (NCHS) to measure county overdose death rates. Aim 2 will use this data, along with the enforcement data and same methodology as aim 1, to estimate the impact of enforcement interventions on deaths from prescription opioids, illicit opioids, and all drugs. The second question this project will examine is what economic and social factors can explain continuously rising deaths from illicit opioids (i.e., heroin and illicitly manufactured fentanyl). Illicit opioid deaths have risen essentially continuously for ten years after policy began reducing prescription opioid supply. Aim 3 will examine two economic and social theories about why. The first theory is downward sloping illicit drug supply. This theory is that greater opioid use generated economies of scale in drug trafficking, and that this has reduced illicit opioid prices and increased use. The second theory is about thick markets. This theory is that greater illicit opioid use has increased people’s social interactions with illicit opioid users and sellers, and that these interactions have further increased illegal opioid use. The project will draw from the NCHS vital statistics data, along with a number of other datasets, to test how much each theory can explain rising illegal opioid deaths. Time-series regressions will be estimated at the county-level during the expansion of the opioid epidemic from prescription opioids to heroin (2006 to 2014) and from heroin to fentanyl (2010+). To test the thick markets theory, regressions will relate exogeneous increases in illicit opioid use in nearby areas and in areas counties have high numbers of Facebook friends with on county’s own illegal opioid death rates. To test downward sloping supply, regressions will relate exogeneous increases in heroin use to heroin prices.