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What Drives Risky Prescription Opioid Use?: Evidence from Migration
Amy Finkelstein1, Matthew Gentzkow2, Dean Li3
1MIT and NBER.
The Quarterly Journal of Economics
|December 17, 2025
Summary
Moving to states with higher risky opioid use increases addiction probability. State policies, like pain clinic laws, can significantly reduce risky prescription opioid use, especially when enacted early.
Area of Science:
- Health Economics
- Epidemiology
- Public Policy
Background:
- The opioid epidemic is driven by complex person- and place-specific factors.
- Understanding these drivers is crucial for effective policy interventions.
- State-level opioid policies have shown varying impacts.
Purpose of the Study:
- To develop and estimate a dynamic model of risky prescription opioid use.
- To identify person- and place-specific drivers of the opioid epidemic.
- To assess the impact of state opioid policies on risky use.
Main Methods:
- Dynamic modeling of risky prescription opioid use.
- Event studies analyzing adult disability insurance recipients (2006-2019).
- Potential outcomes framework to map model factors.
Main Results:
- Relocation to states with higher risky use rates causes immediate and gradual increases in risky opioid use.
- Place-specific factors significantly influence addiction transition and opioid availability.
- State pain clinic laws reduced risky use by 5%, with potential for 30% reduction if enacted earlier.
- A one standard deviation reduction in all place effects could decrease risky use by 40%.
Conclusions:
- Place-based factors are significant drivers of risky prescription opioid use and addiction.
- State opioid policies, particularly pain clinic laws, can effectively mitigate risky use.
- Early enactment of restrictive policies amplifies their impact on reducing opioid epidemic dynamics.
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