Do Local Synthetic Opioid Overdose Deaths Affect Provider Prescribing of Buprenorphine?

Nicole Siegal, Sumedha Gupta, Matthew C. Aalsma, Stephen Crystal, Jennifer Miles, Hillary Samples, Allen Campbell, Kosali Simon and Rosalie Pacula

No 35648, NBER Working Papers from National Bureau of Economic Research, Inc

Abstract: Buprenorphine prescribing for opioid use disorder remains far below the scale of the overdose crisis. We estimate the causal effect of county-level synthetic opioid overdose mortality shocks on the volume of buprenorphine treatment delivered, exploiting the staggered geographic diffusion of synthetic opioids from 2013 to 2023. Linking IQVIA Longitudinal Prescription Claims to National Vital Statistics System mortality records, we implement a difference-in-differences estimator with propensity score matching under three complementary exposure measures. Treatment volume increases significantly under all three definitions, with no evidence of differential pre-trends; point estimates for buprenorphine prescribing rates range from 5 to 17 percent of pre-treatment means, emerge within one to two quarters, and grow monotonically thereafter. Our design does not separately identify changes in patient demand and provider behavior, but the increase in unique prescribers is consistent with a provider-side response. The response is concentrated among advanced practice providers, Medicaid patients, and counties with pre-existing buprenorphine infrastructure; counties with little baseline prescribing show no response. Local mortality information acts as a determinant of treatment volume, with effects comparable in magnitude to major legislative interventions aimed at expanding treatment, but appear only where prescribing capacity already exists.

JEL-codes: I10 I12 (search for similar items in EconPapers)
Date: 2026-08
Note: EH
References: Add references at CitEc
Citations:

Downloads: (external link)
http://www.nber.org/papers/w35648.pdf (application/pdf)
Access to the full text is generally limited to series subscribers, however if the top level domain of the client browser is in a developing country or transition economy free access is provided. More information about subscriptions and free access is available at http://www.nber.org/wwphelp.html. Free access is also available to older working papers.

Related works:
This item may be available elsewhere in EconPapers: Search for items with the same title.

Export reference: BibTeX RIS (EndNote, ProCite, RefMan) HTML/Text

Persistent link: https://EconPapers.repec.org/RePEc:nbr:nberwo:35648

Ordering information: This working paper can be ordered from
http://www.nber.org/papers/w35648
The price is Paper copy available by mail.

Access Statistics for this paper

More papers in NBER Working Papers from National Bureau of Economic Research, Inc National Bureau of Economic Research, 1050 Massachusetts Avenue Cambridge, MA 02138, U.S.A.. Contact information at EDIRC.
Bibliographic data for series maintained by ().