The OxyContin Reformulation Revisited: New Evidence From Improved Definitions of Markets and Substitutes

TL;DR

This study reevaluates the impact of OxyContin reformulation on opioid and heroin deaths, revealing that users shifted to generic oxycodone rather than heroin directly, and that the reformulation had limited overall effect.

Contribution

It introduces detailed sales data to distinguish substitution patterns, showing the role of generic oxycodone in the opioid epidemic and challenging prior conclusions.

Findings

Reformulation led to substitution from OxyContin to generic oxycodone.

No significant overall impact on opioid or heroin mortality.

Generic oxycodone was a key factor in the transition to heroin.

Abstract

The opioid epidemic began with prescription pain relievers. In 2010 Purdue Pharma reformulated OxyContin to make it more difficult to abuse. OxyContin misuse fell dramatically, and concurrently heroin deaths began to rise. Previous research overlooked generic oxycodone and argued that the reformulation induced OxyContin users to switch directly to heroin. Using a novel and fine-grained source of all oxycodone sales from 2006-2014, we show that the reformulation led users to substitute from OxyContin to generic oxycodone, and the reformulation had no overall impact on opioid or heroin mortality. In fact, generic oxycodone, instead of OxyContin, was the driving factor in the transition to heroin. Finally, we show that by omitting generic oxycodone we recover the results of the literature. These findings highlight the important role generic oxycodone played in the opioid epidemic and the limited effectiveness of a partial supply-side intervention.