Study on the Origins of the Opioid Crisis Published

 Almost two years ago, I wrote this post describing a pre-print paper on the origins of the opioid crisis. It was an interesting attempt, but I think it was fundamentally confused. For example, it supposedly finds that differences between states in opioid overdoses are driven (in part) by law differences. (So called "triplicate states" required doctors to fill out forms in triplicate when prescribing narcotics, other states did not.) Their punchline is that it's not the law difference itself that's driving the difference, but rather Purdue's response to the law. Specifically Purdue's decision not to market as enthusiastically in triplicate states caused the difference, according to their analysis. If triplicate states would have gotten the same results in overdose deaths if Purdue had decided to give them equivalent marketing attention, then what are the policy implications? The paper tries to suggest that other states should have had triplicate laws, but their own argument suggests that that strategy would have had limited success. Suppose all states were triplicate states. Doesn't that just mean Purdue would have said "Screw it, we're going to market just as hard everywhere."? Their causal story might be true, but their attempt to draw policy conclusions from it is hopelessly confused. 

There are other major problems with the paper, which I outlined in my earlier post. I have never seen any of the opioid alarmists grapple with the fact that there is no trend whatsoever in the number of users or addicts. An important link is broken in their chain of causation leading from opioid marketing to opioid overdoses. And they never seem to acknowledge that the "opioid epidemic" is just a continuation of a pre-existing trendline stretching back to 1979, at least. Also, by all accounts Purdue had a tiny market share of total opioids prescribed. So it's weird to single them out for blame.

I can't seem to find the published version of the paper online, so I can't see if the final version addressed my concerns. If I manage to get my hands on it, I'll do a follow-up post pointing out that my criticisms were answered.