Date of Award


Degree Type


Degree Name

Doctor of Philosophy (PhD)



Committee Chair

Jillian B. Carr

Committee Co-Chair

Kevin J Mumford

Committee Member 1

Timothy N. Bond

Committee Member 2

Justin L. Tobias


This dissertation examines the effects of pharmaceutical policies on various behavioral, health, and economic outcomes. The first chapter is The Effect of Prescription Drug Monitoring Programs on Opioid Prescriptions and Heroin Crime Rates. In response to growing abuse of prescription opioid painkillers, 50 U.S. states have implemented electronic prescription drug monitoring programs (PDMPs) that record patients into a state-wide registry when a prescription opioid is received. This paper uses a difference-in-differences regression framework and interactive fixed effects factor models to identify the effect of PDMPs and two related programs on the types and strengths of opioid painkiller prescriptions filled and on rates of heroin crimes. This paper is the first to identify differing policy effects on opioid prescriptions by dosage of pill, and the first to find a large and significant link between PDMPs without usage mandates and heroin outcomes. The implementation of PDMP databases caused an 8% decrease in the amount of oxycodone shipments, with results from Medicaid prescription data pointing to larger decreases within high dosage pills. PDMPs have heterogeneous effects on heroin crime incidents across counties depending on the county’s pre-policy level of prescription opioid milligrams per capita, with an 87% increase in heroin crime within the most opioid-dense counties. I find that non-Mandated PDMPs decrease access to high-dose oxycodone pills and cause an increase in heroin crime within the most opioid-dense counties.

The second chapter details a paper entitled The Effect of Pharmacist Refusal Clauses on Contraception, Sexually Transmitted Diseases and Birthrates. Emergency contraceptive drugs like Plan B are controversial, and there have been cases within at least 25 states of pharmacists refusing to provide the drug to patients. In response to pressure from activist groups on both sides of the debate, some states passed “Expand” laws which expand access to emergency contraception and protect patients’ rights to receive prescribed drugs regardless of pharmacists’ personal beliefs. Other states passed “Restrict” laws that restrict access to emergency contraception and favor pharmacists’ rights of refusal. This paper emphasizes substitution behavior among contraception spurred by the policies, and is the first study to examine the effects of pharmacist refusal clauses on contraceptive outcomes, rates of sexually transmitted infections, and birthrates. I find that the laws cause a 12-26% increase in the prescibing rate of regular birth control pills purchased through Medicaid, and cause decreases in purchases of condoms as well as over-the-counter Plan B. There is not evidence that the policies have effects on rates of sexually transmitted diseases, however the states that pass the Restrict policy (favoring pharmacists’ rights of refusal) realize a statistically significant and robust 1.16% decrease in the birthrate among black mothers. While I am not able to measure the effect of the policies on actual rates of pharmacist refusal, my findings suggest that thousands of cautious women change their behavior in response to the policies by adopting the birth control pill. The third and final chapter is comprised of the paper The Effect of Opioid Supply-Side Interventions on Opioid-Related Business Establishments. In response to climbing opioid abuse and overdoses, states passed several types of programs that target the supply side of the prescription opioid market, including Prescription Drug Monitoring Programs (PDMPs) which track patient histories, mandates that doctors use the programs, “Pill Mill Bills” that target over-prescribing offices, and abuse-deterrent versions of prescription opioids. This paper is the first to investigate the effects of these policies on opioid-related business establishment counts nationwide, and examines how the policies affect rehabilitation facilities, doctors’ offices and clinics, and pharmacies. I find that Pill Mill crackdowns reduce the number of establishments in a widely-defined category which includes pain management clinics. States that implement the Pill Mill Bills notice a statistically significant 6-7% reduction in the rate of clinics per capita in this category. The Pill Mill Bills are associated with fewer pharmacies, a 2.6% decrease, but this result is only statistically significant within counties that receive a high concentration of opioids. “Must Access” mandates are associated with a 1.5-2.5% rise in the rate of residential rehabilitation establishments. The policies are not found to significantly affect inpatient rehabilitation hospitals, outpatient rehabilitation clinics, doctors’ offices, medical labs, or drug wholesalers. While the effect of opioid policies on patient and physician behavior has been well-investigated, this paper provides evidence that policies have spillover effects on medical business establishments