My ongoing projects include examining the impacts of fentanyl on health outcomes, fentanyl test strips, safe supply programs and supervised injection sites. In addition to these, I am working on a project relating to state medical board disciplinary actions.

Works in progress

The Effects of Exposure to Fentanyl on Health Outcomes of People Who Use Substances

The fentanyl crisis is still ongoing in the U.S. In recent years, overdoses have increasingly involved combinations of opioids and other substances. While fentanyl misuse is becoming more common among people who use substances, little is known about how exposure to fentanyl affects people this population. They could be exposed to fentanyl either by using fentanyl and another substance together or separately, or unknowingly using something laced with fentanyl. Using individual-level medical insurance claims data covering commercial, Medicaid and Medicare Advantage beneficiaries from 2013 to 2024, I identify people who use substances and describe the population. With a difference-in-differences design that exploits variation in exposure to fentanyl in the drug supply, I find decreases in health care utilization for people who use opioids. These results suggest that the influx of fentanyl into the drug supply did affect the health outcomes of people who use substances.

Physician Regulation, with Colleen Carey and Jetson Leder-Luis

Physicians have considerable discretion in medical treatment. The opioid epidemic was driven by a small number of inappropriately-prescribing physicians. Different policies have attempted to stop this behavior, but only state medical boards (SMB) can stop them from practicing. We collect a novel dataset of SMB disciplinary actions to examine whether SMB discipline is well-targeted, how doctors respond to discipline and how policy responses were assisted by SMBs. There is work exploring the roots of the epidemic and policy responses, but this project is the first to our knowledge to assess the role of SMBs in the opioid epidemic. 

The Effect of Harm Reduction Policies on Overdoses: Evidence from Canada

Canada is at the forefront of harm reduction, an alternative to criminalization of substance use, to address the opioid epidemic it has been facing. In this paper, I focus on the effect of two specific harm reduction policies: safer opioid supply (SOS) and supervised consumption sites (SCS). SOS provides pharmaceutical-grade opioids to people who use drugs that are typically only obtainable on the unregulated market, and SCS are meant for the use of pre-obtained drugs in a safe environment under medical supervision. These programs aim to prevent overdoses by providing medical intervention when signs of overdose appear or limiting exposure to opioids contaminated with illicit fentanyl. Prior work on these programs cannot be generalized to the population due to limitations of study scope and size. To estimate the net effect of these programs on opioid overdose mortality, I exploit spatial and temporal variation in their openings across Canada with quasi-experimental approaches. I find that effects of SOS and SCS on opioid overdose death rates vary by program and type of opioid.