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What Fueled the Illicit Opioid Epidemic?
Abstract:
In recent years, illicitly produced opioids—primarily heroin and fentanyl—have surpassed prescription opioids as the leading cause of overdose deaths in the United States. We identify a previously unexplored driver of this transition: heroin potency shocks following the integration of white powder heroin supply chains in Mexico and the adulteration of white powder heroin with fentanyl. Using a difference-in-differences framework that exploits the fact that white powder heroin markets were exposed to these potency shocks while black tar heroin markets were not, we find that they increased heroin and fentanyl death rates by approximately 230% and 890%, respectively, from 2012 to 2019. Previously studied legal market interventions cannot explain these effects, and our findings provide new insight into key aspects of the evolving epidemic that were thus far unexplained. We conclude that heroin potency shocks are a major determinant of the transition to the illicit opioid waves of the epidemic.
Bio:
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