What drives prescription opioid abuse? Evidence from migration

We investigate the role of person-specific and place-specific factors in the opioid epidemic by analyzing cross-county migration of disabled Medicare recipients and its relationship with prescription patterns associated with opioid abuse. We find that movement to a county with a 20 percent higher rate of opioid abuse (equivalent to a move from a 25th to 75th percentile county) increases rates of opioid abuse by 6 percent, suggesting that roughly 30 percent of the gap between these areas is due to place-specific factors. These effects are particularly pronounced for prior opioid users, who experience an increase in opioid abuse four times larger than the increase for opioid naives.