scholarly journals Supply-Side Drug Policy in the Presence of Substitutes: Evidence from the Introduction of Abuse-Deterrent Opioids

2018 ◽  
Vol 10 (4) ◽  
pp. 1-35 ◽  
Author(s):  
Abby Alpert ◽  
David Powell ◽  
Rosalie Liccardo Pacula
Keyword(s):  
Drug Policy ◽  
Unintended Consequence ◽  
Prescription Opioid ◽  
Supply Side ◽  
Supply Disruptions ◽  
State Variation ◽  
Overdose Deaths ◽  
Limit Access

Overdose deaths from prescription opioid pain relievers nearly quadrupled between 1999 and 2010. We study the consequences of one of the largest supply disruptions to date to abusable opioids—the introduction of an abuse-deterrent version of OxyContin in 2010. Supply-side interventions that limit access to opioids may have the unintended consequence of increasing use of substitute drugs, including heroin. Exploiting cross-state variation in OxyContin exposure, we find that states with the highest initial rates of OxyContin misuse experienced the largest increases in heroin deaths. Our results imply that the recent heroin epidemic is largely due to the reformulation of OxyContin. (JEL I12, I18)

An Effective Intervention: Limiting Opioid Prescribing as a Means of Reducing Opioid Analgesic Misuse, and Overdose Deaths

2020 ◽  
Vol 48 (2) ◽  
pp. 249-258 ◽  
Author(s):  
Brandi C. Fink ◽  
Olivier Uyttebrouck ◽  
Richard S. Larson
Keyword(s):  
Opioid Analgesic ◽  
Opioid Analgesics ◽  
Fold Increase ◽  
Prescribing Patterns ◽  
Prescription Opioid ◽  
Heroin Use ◽  
Overdose Death ◽  
Opioid Prescribing ◽  
Prescription Opioid Misuse ◽  
Overdose Deaths

Overdose deaths involving prescription opioids killed more than 17,000 Americans in 2017, marking a five-fold increase since 1999. High prescribing rates of opioid analgesics have been a substantial contributor to prescription opioid misuse, dependence, overdose and heroin use. There was recognition approximately ten years ago that opioid prescribing patterns were contributing to this startling increase in negative opioid-related outcomes, and federal actions, including Medicare reimbursement reform and regulatory actions, were initiated to restrict opioid prescribing. The current manuscript is a description of those actions, the effect of those actions on opioid prescribing and related patient outcomes. We also describe our proposal of methods of expanding these efforts as an important piece to further reduce opioid-related misuse, dependence, and overdose death.

Supply-side resilience as practice bundles: a critical incident study

2016 ◽  
Vol 36 (8) ◽  
pp. 948-970 ◽  
Author(s):  
Mandar Dabhilkar ◽  
Seyoum Eshetu Birkie ◽  
Matti Kaulio
Keyword(s):  
Critical Incident ◽  
Dynamic Capabilities ◽  
Empirical Support ◽  
Current Theory ◽  
Supply Side ◽  
Content Type ◽  
Supply Disruptions ◽  
Operations Performance ◽  
Practice Bundles ◽  
Resilience Capabilities

Purpose – The purpose of this paper is to conceptualize a typology of supply-side resilience capabilities and empirically validates these capabilities and their constituent bundles of practices. Design/methodology/approach – The study is primarily qualitative, employing the critical incident technique to collect data across 22 firms and seeking to validate how and why practice bundles form and relate to operations performance. It contains a frequency of occurrence analysis for the purpose of triangulation, a minor statistical part to provide some additional evidence of bundle formation and correlation between adoption of bundles of practices and recovered operations performance after upstream supply chain disruptions. Findings – Four supply-side resilience capabilities are conceptualized along two dichotomous dimensions – “proactive/reactive” and “internal/external” – in a 2×2 matrix as proactive-internal, proactive-external, reactive-internal and reactive-external resilience capabilities. Empirical support for the conceptualized typology is found. Bundles of specific practices that can be associated with each capability are identified. Moreover, the study finds a relationship between these practice bundles and recovered operations performance. Research limitations/implications – The statistical part is used just to provide some additional evidence through factor and regression analyses that these capabilities exist and do benefit adopting firms. Practical implications – Specifies practices that lead to recovered operations performance in the event of supply disruptions. Originality/value – Advances current theory by operationalizing resilience as a set of dynamic capabilities in terms of practice bundles that aid in recovering operations performance upon supply disruptions.

Fentanyl analogue overdose: Key lessons in management in the synthetic opioid age

2019 ◽  
Vol 15 (5) ◽  
pp. 428-432
Author(s):  
Amer Raheemullah, MD ◽  
Neal Andruska, MD, PhD
Keyword(s):  
Addiction Treatment ◽  
Opioid Use Disorder ◽  
Prescription Opioid ◽  
Opioid Overdose ◽  
Health Departments ◽  
Opioid Use ◽  
Public Health Departments ◽  
Disorder Treatment ◽  
Fentanyl Analogues ◽  
Overdose Deaths

Fentanyl overdoses are growing at an alarming rate. Fentanyl is often mixed into heroin and counterfeit prescription opioid pills without the customer’s knowledge and only detected upon laboratory analysis. This is problematic because fentanyl analogues like carfentanil are 10,000 times more potent than morphine and pose new challenges to opioid overdose management. A 62-year-old male with an overdose from a rare fentanyl analogue, acrylfentanyl, was given two doses of intranasal 2 mg naloxone with improvements in respiratory rate. In lieu of more naloxone, his trachea was intubated and he was admitted to the intensive care unit. He subsequently developed ventilator-associated pneumonia and then a pulmonary embolism. He did not receive any opioid use disorder treatment and returned back to the emergency department with an opioid overdose 21 days after discharge.We are encountering an unprecedented rise in synthetic opioid overdose deaths as we enter the third decade of the opioid epidemic. Thus, it is imperative to be aware of the features and management of overdoses from fentanyl and its analogues. This includes protecting against occupational exposure, administering adequate doses of naloxone, and working with public health departments to respond to fentanyl outbreaks. Additionally, fentanyl overdoses represent a critical opportunity to move beyond acute stabilization, start buprenorphine or methadone for opioid use disorder during hospitalization, link patients to ongoing addiction treatment, and distribute naloxone into the community to help curb the overdose epidemic.

The effect of state laws designed to prevent nonmedical prescription opioid use on overdose deaths and treatment

2017 ◽  
Vol 27 (2) ◽  
pp. 294-305 ◽  
Author(s):  
Ioana Popovici ◽  
Johanna Catherine Maclean ◽  
Bushra Hijazi ◽  
Sharmini Radakrishnan
Keyword(s):  
Prescription Opioid ◽  
Opioid Use ◽  
State Laws ◽  
Prescription Opioid Use ◽  
Overdose Deaths

Using a Collective Impact Approach to Prevent Prescription Opioid Misuse, Addiction, and Overdose Deaths

2018 ◽  
Vol 27 (4) ◽  
pp. 237-239
Author(s):  
Andrew J. Knighton ◽  
Kimberly D. Brunisholz ◽  
Kristen Reisig ◽  
Lisa Nichols
Keyword(s):  
Collective Impact ◽  
Prescription Opioid ◽  
Opioid Misuse ◽  
Prescription Opioid Misuse ◽  
Overdose Deaths

Opioids and Public Health: The Prescription Opioid Ecosystem and Need for Improved Management

2021 ◽  
Author(s):  
Evan D. Kharasch ◽  
J. David Clark ◽  
Jerome M. Adams
Keyword(s):  
Public Health ◽  
Prescription Opioid ◽  
Supply Side ◽  
Demand Side ◽  
Opioid Prescribing ◽  
The Past ◽  
New Approaches ◽  
Opioid Deaths

While U.S. opioid prescribing has decreased 38% in the past decade, opioid deaths have increased 300%. This opioid paradox is poorly recognized. Current approaches to opioid management are not working, and new approaches are needed. This article reviews the outcomes and shortcomings of recent U.S. opioid policies and strategies that focus primarily or exclusively on reducing or eliminating opioid prescribing. It introduces concepts of a prescription opioid ecosystem and opioid pool, and it discusses how the pool can be influenced by supply-side, demand-side, and opioid returns factors. It illuminates pressing policy needs for an opioid ecosystem that enables proper opioid stewardship, identifies associated responsibilities, and emphasizes the necessity of making opioid returns as easy and common as opioid prescribing, in order to minimize the size of the opioid pool available for potential diversion, misuse, overdose, and death. Approaches are applicable to opioid prescribing in general, and to opioid prescribing after surgery.

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