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

Health Effects of Local-Area Exposure to Fentanyl on People Who Use Drugs

The fentanyl crisis is still ongoing in the U.S. In recent years, overdoses have increasingly involved combinations of opioids and other types of drugs. While fentanyl misuse is becoming more common among people who use drugs, little is known about how exposure to fentanyl affects this population. They could be exposed to fentanyl either by using both drugs together or separately, or unknowingly using a drug contaminated with fentanyl. Using individual-level medical insurance claims data, I identify people who use drugs and estimate effects of local-area fentanyl shocks on health outcomes of people who use drugs. With a difference-in-differences design that exploits variation in exposure to fentanyl in the drug supply, I find increases in opioid-related health outcomes including use and overdose for both opioid users and non-opioid users. Opioid users experience a decrease in health care use, likely driven by compositional change. These results suggest that the fentanyl shocks to the drug supply affected non-mortality health outcomes for opioid and non-opioid users.

Physician Regulation, with Colleen Carey and Jetson Leder-Luis

Physician regulation must allow autonomy in physician practice while restricting treatments with social harms. We examine the performance of the principal physician regulatory institution, state medical boards, during a recent episode of dangerous medical treatment: high-risk opioid prescribing in the United States. Using a novel dataset of nationwide disciplinary records, we assess the intensity of discipline on physicians with high-risk prescribing patterns. We document that disciplinary action for high-risk prescribing was rare and frequently occurred after many years of high-risk prescribing. We show that when boards chose to act, their disciplinary tools were successful in substantially reducing opioid prescribing. Turning to patient outcomes, we demonstrate that disciplinary action dramatically improved the health of the patients of high-risk prescribers, as compared to the patients of never-disciplined high-risk prescribers, without impairing their access to non-opioid services. Patients whose physicians faced discipline began to consume fewer opioids, received appropriate care for opioid use disorder, and were less likely to die.

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.