The Early Opioid Epidemic and Medicaid

John Anders

American Journal of Health Economics, 2025, vol. 11, issue 1, 91 - 123

Abstract: Is the opioid epidemic attributable to prescription painkillers becoming more accessible? I find that, for an average county, Medicaid expansions under the Affordable Care Act caused approximately 175,000 more opioid units to be prescribed per year, and 4 additional opioid-related deaths per year. Medicaid expansions explain nearly one-sixth of the overall death toll from 2012 to 2016. These results are driven largely by deaths of White men aged 18–65, and vary by local access to marijuana (an opioid substitute). Results are robust to treatment heterogeneity concerns. After estimating the interactive impact of Medicaid expansions and marijuana legalization on opioid-related deaths, I conclude that opioid mortality can be reduced without restricting opioid access.

Date: 2025
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