# Evaluation of U.S. Early Response to the Opioid Epidemic In response to the rising opioid prevalence and attendant morbidity, state and local policymakers enacted new programs and policies. Federal policies to respond to the opioid epidemic have included access to treatment, education for prescribers, and regulation of drug formulations. The federal government took substantive strides towards addressing the crisis as early as 2000, when the Drug Addiction Treatment Act (DATA) allowed waivered physicians to prescribe buprenorphine to up to 30 patients in office-based settings ([Stein et al., 2015][1]). In 2010, the Food and Drug Administration (FDA) approved a reformulation of OxyContin designed to reduce the potential for abuse ([Alpert et al., 2018][2]). In 2016, the Centers for Disease Control and Prevention (CDC) released voluntary opioid guidelines for treating chronic pain ([Bohnert et al., 2018][3]), while Congress authorized $1 billion in grants to augment state-level opioid prevention and treatment programs ([Levin, 2017][4]). Many policies that target the clinical causes of the epidemic were also implemented at the state level ([Schuler, Heins, et al., 2020][5]). Though smaller in scale than the federal response, state-level policies can target responses to specifically address local conditions and context. Their actions also add salience to the issue: by prioritizing opioids, trusted local officials convey its severity and encourage communities to mobilize. Though responses to the opioid epidemic vary, two common categories of approaches to regulating supply emerged: prescription drug monitoring programs (PDMPs; [Haffajee et al., 2018][6]) and opioid prescription limits ([Chua et al., 2019][7]). In this study, we investigate the impact of these two state-level policies on the opioid epidemic. We analyze changes in opioid prescribing and opioid-related overdose deaths, to answer the following research question: did passage of state-level laws mandating PDMP use by prescribers and/or instituting opioid prescribing limits, lead to changes in opioid prescribing and mortality? If these policies were effective, we would expect to see a reduction in opioid prescribing rates in states that implement such policies, and, potentially, subsequent reductions in the number of opioid-related deaths, compared to states that had not yet implemented those policies. [1]: https://doi.org/10.1016/j.jsat.2014.07.010 [2]: https://doi.org/10.1257/pol.20170082 [3]: https://doi.org/10.7326/M18-1243 [4]: https://doi.org/10.1176/appi.pn.2017.1a10 [5]: https://doi.org/10.1016/j.drugalcdep.2020.108137 [6]: https://doi.org/10.1377/hlthaff.2017.1321 [7]: https://doi.org/10.1001/jama.2019.0010