How does opioid prevalence affect surgery decisions?

Abstract

This paper studies how the prevalence of opioids affects joint physician–patient decisions over medical procedures. Following Alpert et al. (2022), we utilize variation in opioid exposure due to state policies that affected OxyContin’s marketing and market entry. Our results suggest that higher availability of opioids led to a substantial (21%) increase in the number of elective surgical discharges, such as knee replacements, hip replacements, and back surgeries. We also consider effects for non-elective surgical discharges — procedures where we expect a much smaller response to the availability of opioids — and find a statistically insignificant increase of 1%. Finally, we investigate medical discharges — procedures where no response is expected — and find no detectable effect. This increase in elective procedures is consistent with a model of physician behavior that incorporates patient pain and post-surgical well-being into surgical decisions and where decreases in the “hassle” of prescribing pain-reducing medication pushes marginal patients to undergo surgeries that they might not otherwise elect. Our results highlight an important tradeoff: while liberal opioid prescribing has led to widespread misuse and abuse, the availability of opioids may allow some patients to undergo quality-of-life improving surgeries that would otherwise be too painful.