Addictions, Disorders and Nutrition: What Shapes the Health of Children and Working-Age Adults?

Paper Session

Saturday, Jan. 7, 2017 10:15 AM – 12:15 PM

Hyatt Regency Chicago, Plaza A
Hosted By: Health Economics Research Organization
  • Chair: Jody Sindelar, Yale University

Why Did ADHD Explode?

Anna Chorniy
,
Princeton University
Janet Currie
,
Princeton University
Lyudmyla Sonchak
,
State University of New York-Oswego

Abstract

In 2012, there were 6.4 million U.S. children who had been diagnosed with attention-deficit/hyperactivity disorder (ADHD), a 45% increase from 2003. The majority of them are taking medications. Evidence from the Medical Expenditures Panel Survey suggests that most of this trend is generated by Medicaid patients. This paper contributes to the previous literature that looked at school incentives when explaining the explosion in ADHD by exploring two additional channels: inclusion of fourteen newly-approved drugs to treat the condition in Medicaid formulary and roll-out of managed care. Between 2003 and 2013, the South Carolina (SC) Medicaid bill for ADHD prescription medications increased by 217% in real terms. Drug innovation is one of the drivers of this trend. In this study, we first ask whether pharmaceutical innovation has affected the number of Medicaid children receiving ADHD medications, and then we ask whether it led to improved outcomes among children and teens diagnosed with the condition. Since newly approved drugs generally come with at least some improvement over the older drugs, more of previously diagnosed children take medication and/or switch to new drugs. We look at the informational spillovers of this effect within the treated children’s networks. Using 1998-2015 SC Medicaid claims supplemented with Vital Statistics and Department of Education records, we find that the probability of an individual to be taking prescription drugs is positively related to the fraction of individuals in her network who were on the medicines in the past year. Different features of new drugs produce varying effects. For example, extended release property corresponds to 13 pp, and easy-to-take formulation for 39 pp, increase. Interestingly, new drugs with low abuse have an opposite effect of 11 pp. Second, we explore the effect of roll-out of Managed care in SC Medicaid between 2007 and 2011 on the number of children

Supply-Side Drug Policy in the Presence of Substitutes: Evidence from the Introduction of Abuse-Deterrent Opioids

Abby Alpert
,
University of California-Irvine
Rosalie Pacula
,
RAND Corporation
David Powell
,
RAND Corporation

Abstract

Overdose deaths from prescription opioid pain relievers nearly quadrupled between 1999 and 2010, making this the worst drug overdose epidemic in U.S. history. In response, numerous supply-side interventions have aimed to limit access to opioids. However, these supply disruptions may have the unintended consequence of increasing the use of substitute drugs, including heroin. We study the consequences of one of the largest supply disruptions to date to abusable opioids – the introduction of an abuse-deterrent version of OxyContin in 2010. Our analysis exploits across state variation in exposure to the OxyContin reformulation. Using data from the National Survey on Drug Use and Health (NSDUH), we show that states with higher pre-2010 rates of OxyContin misuse experienced larger reductions in OxyContin misuse, permitting us to isolate consumer substitution responses. We estimate large differential increases in heroin deaths immediately after reformulation in states with the highest initial rates of OxyContin misuse. We find less evidence of differential reductions in overall opioid-related deaths, potentially due to substitution towards other opioids, including more harmful synthetic opioids such as fentanyl. Our results imply that a substantial share of the dramatic increase in heroin deaths since 2010 can be attributed to the reformulation of OxyContin.

The Effect of Food Stamps on Children's Health: Evidence from Immigrants' Changing Eligibility

Chloe East
,
University of Colorado Denver

Abstract

The Food Stamp program is currently one of the largest safety net programs in the United States and is especially important for families with children: 25% of all children received Food Stamp benefits in 2011. The existing evidence on the effects of Food Stamps on children's and families' outcomes is limited, however, because it is a federal program with little quasi-experimental variation. I utilize a large and previously unexplored source of quasi-experimental variation--changes in immigrant families' eligibility across states and over time from 1996 to 2003--to estimate the effect of Food Stamps on children's health. I analyze how access to Food Stamps from the time children are in utero to their fifth birthday affects their medium-run health outcomes. I find that an additional year of eligibility in early life leads to large improvements in health outcomes at ages 6-16, providing some of the first evidence that early-life resource shocks impact later-life health as early as school age.
Discussant(s)
Genevieve Kenney
,
Urban Institute
David Meltzer
,
University of Chicago
Diane Schanzenbach
,
Northwestern University
JEL Classifications
  • I1 - Health