Do Local Synthetic Opioid Overdose Deaths Affect Provider Prescribing of Buprenorphine?
NBER Working Papers · 2026 · Nicole Siegal、Sumedha Gupta、Matthew C. Aalsma、Stephen Crystal、Jennifer Miles、Hillary Samples
中文摘要
用于治疗阿片类药物使用障碍的丁丙诺啡处方规模仍远低于应对过量危机所需的水平。我们利用2013年至2023年合成阿片类药物在地域上的交错扩散，估计县级合成阿片类药物过量死亡冲击对丁丙诺啡治疗服务量的因果效应。我们将IQVIA纵向处方理赔数据与国家生命统计系统的死亡记录相链接，并在三种互补的暴露度量下，采用结合倾向得分匹配的双重差分估计量。在三种定义下，治疗量均显著增加，且没有证据表明处理前趋势存在差异；丁丙诺啡处方率的点估计介于处理前均值的5%至17%之间，效应在一至两个季度内显现，此后单调增长。我们的研究设计无法分别识别患者需求与医疗服务提供者行为的变化，但独立开方提供者数量的增加与供给方的响应相一致。这种响应主要集中于高级执业提供者、医疗补助（Medicaid）患者以及已具备丁丙诺啡治疗基础设施的县；基线处方量很少的县则未出现响应。当地死亡信息是治疗量的一个决定因素，其效应量级与旨在扩大治疗覆盖的重大立法干预相当，但仅在已具备处方能力的地区显现。
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.