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Overdosing on Regulation: How Government Caused the Opioid Epidemic

March 1, 2019 in Economics

By Jeffrey Miron, Laura Nicolae

Jeffrey Miron and Laura Nicolae

Opioid overdose deaths have risen dramatically in the United
States over the past two decades. The standard explanation blames excessive prescribing by physicians and
aggressive marketing by pharmaceutical companies, beginning in the

This explanation — “more prescribing, more deaths­”
— has spurred increased legal restrictions on opioid
prescribing. Most states now have Prescription Drug
Monitoring Programs (electronic prescription databases that attempt
to reduce doctor shopping), and many states cap prescription doses. The federal government
limits opioid production and raids pain management facilities
deemed to be overprescribing. In October, the federal government
enacted legislation that increases monitoring
of prescribers and funds hospitals that attempt to reduce
prescribing. Supporters believe these restrictions will reduce the
supply of prescription opioids and thereby decrease overdose

The evidence suggests, however, that the opioid overdose
epidemic has resulted from too many restrictions on prescribing,
not too few. In a recent paper for the Cato Institute, we document this
“more restrictions, more deaths” explanation for the
opioid overdose epidemic.

The risk of overdose from proper medical use of prescription
opioids is low: in published studies, the rate of opioid addiction
in chronic pain patients has averaged less than 8 percent. Patients receiving long-term
stable doses rarely overdose because they quickly develop

Worse, regulations push users from prescription opioids to
diverted or illicit opioids, which are far more dangerous. Quality
control is poor in underground markets because reliable suppliers
cannot legally advertise their goods and consumers cannot sue for
damages from faulty or mislabeled products. Diverted or illicit
drugs do not come with warning labels, and users cannot discuss
safe use with their physicians. Underground opioid markets are also
more likely to supply hyper-potent products, such as heroin or
fentanyl. Consumers cannot easily determine the potency of such
products and so face elevated risks of overdose.

Since 2011, rapidly increasing deaths from heroin and synthetic
opioids such as fentanyl have driven up the opioid overdose death rate
despite reduced prescribing. In 2017, heroin
and synthetic opioids accounted for more than three quarters of all
opioid overdose deaths. Many young heroin users reporttransitioning to heroin from prescription
opioids when these became more difficult to acquire.

Attempts to curb overdoses by reducing the abuse potential of
prescription opioids have proven counterproductive. In 2010, Purdue
Pharmaceuticals introduced an abuse-deterrent version of OxyContin,
which made the drug less appealing to opioid abusers. Regulations
limiting access to other prescription opioids caused many users to
then substitute to heroin, leading to
an increase in heroin-overdose rates.

The federal government also …read more

Source: OP-EDS

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