There is significant interest in understanding labor market consequences of the opioid epidemic, but little is known about how opioid use affects on-the-job performance. We analyze the impact of opioid initiation on job performance using linked medical and personnel data for active-duty military members. Exploiting quasi-random assignment of patients to physicians in the emergency department, we find that military members assigned to high-intensity opioid prescribing physicians have a higher likelihood of long-term opioid use, are less likely to receive promotions, and are more likely to receive disciplinary actions and leave their jobs. Our results demonstrate productivity costs of opioid use.

Overdose deaths involving opioids have increased dramatically since the 1990s, leading to the worst drug overdose epidemic in U.S. history, but there is limited empirical evidence about the initial causes. In this article, we examine the role of the 1996 introduction and marketing of OxyContin as a potential leading cause of the opioid crisis. We leverage cross-state variation in exposure to OxyContin's introduction due to a state policy that substantially limited the drug's early entry and marketing in select states. Recently unsealed court documents involving Purdue Pharma show that state-based triplicate prescription programs posed a major obstacle to sales of OxyContin and suggest that less marketing was targeted to states with these programs. We find that OxyContin distribution was more than 50% lower in "triplicate states" in the years after the drug's launch. Although triplicate states had higher rates of overdose deaths prior to 1996, this relationship flipped shortly after the launch and triplicate states saw substantially slower growth in overdose deaths, continuing even 20 years after OxyContin's introduction. Our results show that the introduction and marketing of OxyContin explain a substantial share of overdose deaths over the past two decades.