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

• In Event: Dying for Care: How Policy Shapes Opioid Mortality and Treatment Access

Abstract

Despite strong evidence supporting buprenorphine as a first-line pharmacotherapy for opioid use disorder (OUD), prescribing remains far below levels commensurate with the scale of the 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. We construct three complementary measures of local crisis exposure: first occurrence, acute escalation, and sustained entry. Using IQVIA Longitudinal Prescription Claims data linked to National Vital Statistics System mortality records, we implement a difference-in-differences estimator with propensity score matching. Across all three shock definitions, buprenorphine prescribing increases significantly following local synthetic opioid crisis onset, with no evidence of differential pre-trends. Point estimates range from 5 to 17 percent increase relative to pre-treatment means. Effects emerge within one to two quarters and grow monotonically over subsequent quarters, consistent with a durable local response. Our design does not support strong conclusions about how much of the response reflects patient presentation for care versus provider decisions. We find suggestive evidence of at least some provider component: the number of unique prescribers rises following a shock, consistent with prior evidence that prescribers individually notified of a patient's fatal overdose reduce their opioid prescribing. These findings identify a channel through which local crisis conditions expand treatment volume, complementing a literature focused on regulatory and administrative barriers to buprenorphine prescribing. The response is concentrated among advanced practice providers, Medicaid patients, counties with pre-existing buprenorphine infrastructure, and counties east of the Mississippi River, where the synthetic opioid supply arrived earliest; counties with little baseline prescribing showed no significant response, indicating the organic channel amplifies existing treatment capacity rather than creating it anew. These results are consistent with local mortality information acting as a determinant of treatment volume: effects of a magnitude similar to those reported for major legislative interventions arise here without any formal policy change, and only where prescribing capacity already exists.

Author

• Nicole Y Siegal, Indiana University
  Presenting Author