Works in Progress
Why Prescribe Off-label? Opioid Supply-Side Policies and Off-label Prescribing for Pain
(Job market paper - click for most recent version)
In the United States, the Food and Drug Administration (FDA) requires that drugs be proven safe and effective at treating some target condition, but physicians may prescribe them to treat alternative conditions in a practice known as off-label prescribing. Off-label therapies may lack evidence of efficacy, and yet they comprise up to one third of prescriptions (Radley, Finkelstein & Stafford 2006; Bradford, Turner & Williams 2018). In this paper, I investigate the role of off-label therapies in a physician’s choice set for the pharmacological treatment of pain. Using FDA label indications and the universe of ACA Exchange medical and pharmaceutical claims in Washington state, I estimate that 7.5% of pain-related physician visits result in an off-label anticonvulsant or antidepressant prescription over 2017-2019. I then exploit the implementation of a Washington policy that increases the hassle cost of prescribing opioids to detect substitution to off-label therapies. I find that physicians who face a high hassle cost of prescribing opioids reduce opioid prescribing by 6.2% and increase off-label prescribing by 12.7% relative to physicians who do not face these hassle costs upon policy implementation. I find no evidence that this substitution favors off-label therapies with evidence of efficacy, suggesting an ambiguous effect on patient welfare. My results provide novel evidence on the role of off-label therapies for the treatment of pain and speak to the future of pain management as physicians turn away from opioids.
The Effect of Must-Access Prescription Drug Monitoring Programs on Opioid-Related Payments to Physicians
Publications
Margerison, C. E., Roberts, M. H., Gemmill, A., & Goldman-Mellor, S. (2022). Pregnancy-Associated Deaths Due to Drugs, Suicide, and Homicide in the United States, 2010–2019. Obstetrics & Gynecology, 10-1097. https://pubmed.ncbi.nlm.nih.gov/34991132/
Montgomery BW, Roberts MH, Margerison CE, Anthony JC (2022) Estimating the effects of legalizing recreational cannabis on newly incident cannabis use. PLoS ONE 17(7): e0271720. https://doi.org/10.1371/journal.pone.0271720
Roberts, MH., Ainslie, M., Idzik, S., Bigley, MBB., Fogg, L., Schrader, KE., Buchholz, SW. (2025). Association Between Doctor of Nursing Practice Nurse Practitioner Staffing and Hospital Outcomes. Journal of the American Association of Nurse Practitioners. (accepted, in press)
Submissions
Martins, M., Roberts, M. H., & Egan, K. (2024) The Effect of Green Space Views and Home Elevation on Assessed Home Values: Evidence from a Homogenous Village. Revise & Resubmit, Journal of Environmental Economics & Policy