Did Medicare Part D Contribute to the Rise in Opioid Overdose Deaths in the U.S.?

Drug overdose deaths are the leading cause of deaths from injuries in the United States, exceeding deaths from motor vehicle accidents since 2009 (Paulozzi, 2012; CDC 2013).  Deaths involving opioid analgesics have experienced a particularly significant rise, steadily increasing  from 1999-2005, jumping 20% in a single year between 2005 and 2006, and then returning to its previous study rate of increase for 2006-2010. 

This paper examines whether Medicare Part D, which started in January of 2006, has contributed to the rise in prescription drug overdose deaths.  We make use of formulary coverage and enrollment data from CMS for the period 2006 – 2010 to understand specific prescriptions frequently prescribed and covered under Medicare Part D, and link this information through state identifiers to both the Drug Enforcement Agency’s Automation of Reports and Consolidated Orders System (ARCOS) and the CDC’s National Vital Statistics data.  The ARCOS data contains quarterly information from 1997 onward on the legal distribution of prescription drugs to each state, making it possible to identify how roll out of Medicare Part D affected the availability of specific prescription drugs in each state.  We exploit differences across states in the proportion of Medicare beneficiaries that reside in the state and enrollment in Medicare Part D to determine the extent to which the introduction and roll out of this program led to higher rates of overdose deaths. Analyses control for other state policies that are also known to influence access to prescription drugs.