D. Mark Anderson, Ron Diris, Raymond Montizaan, Daniel I. Rees, 28 January 2022

There is evidence that physicians suffer disproportionately from substance use disorders, but no clear understanding of whether the phenomenon is causal. This column uses data from Dutch medical school applicants to examine the effects of becoming a physician on prescription drug use. Leveraging variation from lottery outcomes that determine admission into medical schools, it finds that the choice to become a physician – as opposed to individual-level traits such as personality, intelligence, or perseverance – increases the use of antidepressants, opioids, anxiolytics, and sedatives, especially for women.

Catherine Maclean, Justine Mallatt, Christopher J. Ruhm, Kosali Simon, 20 December 2020

Opioid misuse in the US is estimated to cost over $500 billion annually, with fatalities from opioid overdoses exceeding the American death count from the Vietnam War. This column examines the causes and consequences of the opioid crisis, based on a review of more than 100 economic studies. Policies such as prescription drug monitoring programmes, pill mill laws, prescribing limits, and doctor-shopping laws reduce opioid prescribing. However, their effects may be more limited in environments where many have already become addicted to opioids. 

Robert Kaestner, Engy Ziedan, 26 September 2019

Since 1999, the US has experienced a three-fold rise in opioid prescriptions, a four-fold rise in prescription opioid-related mortality, and a ten-fold rise in non-prescription opioid deaths. In response, many states have enacted laws to monitor opioid-prescribing behaviour. This column finds little evidence that such laws have had significant effects on wellbeing or mortality. Recognising the grave risks associated with prescription opioids, the column also considers their benefits: the reduction in pain and consequent salutary effects associated with responsibly used prescription opioids. 

Carolina Lopez, Anja Sautmann, Simone Schaner, 29 January 2019

Healthcare systems around the world battle high rates of overtreatment. This column investigates the role of patient demand in this, using a randomised evaluation of malaria treatment at public health clinics in Mali. It finds no evidence of doctors attempting to increase treatment rates or intensity, instead heightened demand from patients sometimes pressured doctors into going against their own professional judgement and writing a prescription anyway. In such situations, interventions that make it easier for doctors to resist patient demands could help sustain subsidies and reduce overtreatment.

Tomas Philipson , Eric Sun, 03 January 2008

From an economic perspective, two critical issues are the speed-safety tradeoff in drug approval and the overlap of regulation and product liability. Research on the US experience suggests that regulatory agencies have historically erred on the “safety” side of the speed-safety balance and there would be gains from better integration of government regulation and product liability laws.


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