What Drives Prescription Opioid Abuse? Evidence from Migration
Amy Finkelstein, Matthew Gentzkow, Heidi Williams

We investigate the role of person-specific and place-specific factors in the opioid epidemic by analyzing cross-county migration of disabled Medicare recipients and its relationship with prescription patterns associated with opioid abuse. We find that movement to a county with a 20 percent higher rate of opioid abuse (equivalent to a move from a 25th to 75th percentile county) increases rates of opioid abuse by 4.5 percent, suggesting that roughly 20 percent of the gap between these areas is due to place-specific factors. These effects are particularly pronounced for prior opioid users, who experience an increase in opioid abuse nearly 1.5 times larger than the increase for opioid naives.

We thank the National Institute on Aging (Finkelstein R01-AG032449), the National Science Foundation (Williams, 1151497), the Social Security Administration (Finkelstein RDR18000003) and the Stanford Institute for Economic Policy Research (SIEPR) for financial support. We are grateful to Alden Cheng, Paul Friedrich, Ken Jung, Geoffrey Kocks, Abby Ostriker, Anna Russo, and Yuci Zhou for excellent research assistance, and to Jonathan Gruber, Ellen Meara and Molly Schnell for helpful discussions. The research reported herein was performed pursuant to grant RDR18000003 from the US Social Security Administration (SSA) funded as part of the Retirement and Disability Research Consortium. The opinions and conclusions expressed are solely those of the author(s) and do not represent the opinions or policy of SSA, any agency of the Federal Government, or NBER. Neither the United States Government nor any agency thereof, nor any of their employees, makes any warranty, express or implied, or assumes any legal liability or responsibility for the accuracy, completeness, or usefulness of the contents of this report. Reference herein to any specific commercial product, process or service by trade name, trademark, manufacturer, or otherwise does not necessarily constitute or imply endorsement, recommendation or favoring by the United States Government or any agency thereof.