Drug markets and the opioid epidemic

毒品市场和阿片类药物流行

• 批准号: 10517901
• 负责人: James Travis Donahoe
• 金额: $ 2.36万
• 依托单位: HARVARD UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-30 至 2023-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10517901
• 关键词: Drug; markets; opioid; epidemic

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.

项目摘要：美国药物使用流行病是#年最严重的健康危机之一 历史，自1999年以来已夺走了100多万美国人的生命。尽管一部重要的文学作品 关于疫情，我们仍然有很多不知道的地方。这个项目将解决两个未解决的问题。第一个是 研究处方药市场执法干预的效果。在受管制物质下 处理受管制物质的ACT(CSA)、医生、药房和药品分销商 防止转用(即非法使用受管制物质)的义务。就阿片类药物而言，一些 医生、药店和药品分销商因以下原因被关闭或面临刑事指控 违反他们的CSA义务。这些干预措施对阿片类药物供应和健康的影响尚不清楚。 拟议的项目将收集与处方有关的所有联邦执法干预的新数据 从2000年代中期开始服用阿片类药物。这些数据将由个人从业者和公司级别的数据进行补充 关于阿片类药物供应，并用于构建一种衡量所有美国人暴露于执法干预的指标。 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以下方面的影响 县阿片类药物供应。为了研究健康，该项目将使用来自国家统计局的受限使用的生命统计数据 卫生统计中心(NCHS)衡量县过量死亡率。AIM 2将使用这些数据，以及 使用执法数据和与目标1相同的方法，评估执法的影响 关于处方阿片类药物、非法阿片类药物和所有药物死亡的干预措施。 这个项目将研究的第二个问题是什么经济和社会因素可以解释 非法阿片类药物(即海洛因和非法制造的芬太尼)造成的死亡人数持续上升。非法阿片类药物死亡 在政策开始减少处方阿片类药物供应后的十年里，基本上连续上升。目标3 将考察两种关于原因的经济和社会理论。第一种理论是毒品向下倾斜 供给。这一理论认为，更多地使用阿片类药物会在贩毒中产生规模经济，而且这会 降低非法阿片类药物价格和增加使用。第二种理论是关于厚市场的。这个理论是， 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卖家的社会互动，而且 这些相互作用进一步增加了非法阿片类药物的使用。该项目将从NCHS的重要统计数据中提取 数据，以及其他一些数据集，以测试每种理论在多大程度上可以解释非法阿片类药物的上升 死亡。在阿片类药物扩大期间，将在县一级估计时间序列回归 从处方类阿片到海洛因(2006年至2014年)和从海洛因到芬太尼(2010+)的流行。要测试 厚市场理论，回归将与附近地区和 县有大量Facebook好友的地区，县本身的非法阿片类药物死亡率也很高。为了测试 在供应下降的情况下，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。