Adverse Health Effects of Abuse-Deterrent Opioids : Evidence From the Reformulation of Oxycontin

The US is currently in the midst of the worst drug overdose epidemic in its history, with nearly 64,000 drug overdose deaths in 2016. In response, pharmaceutical companies have begun introducing abuse-deterrent painkillers, pills with properties that make the drug more difficult to misuse. The first such painkiller, a reformulated version of OxyContin, was released in 2010. Previous research has found no net effect on opioid mortality, with users substituting away from OxyContin toward heroin. This paper explores health effects of the reformulation beyond mortality. Exploiting variation across states in OxyContin misuse prior to the reformulation, I find large relative increases in the spread of hepatitis B and C in states most likely to be affected by the reformulation. In aggregate, the estimates suggest that absent the reformulation we would have observed between 66-75% fewer cases of hepatitis C and 46-60% fewer cases of hepatitis B. I document further evidence that points to the likely cause of these effects: the reformulation led individuals to substitute from OxyContin to heroin, which is substantially more likely to be injected, increasing exposure to blood-borne diseases