Since the 1990s, the United States has seen increased prescription opioid consumption (POC) and an increase in the prevalence of opioid use disorders (OUD) and the opioid disorder death (ODD) rate. This paper examines three factors that may have fueled the opioid crisis: increased supply of prescription opioids, increased demand for opioids because of pain and economic related despair. A regression analysis of twenty-one OECD nations was used to examine the determinants of and the relationships between POC, OUDs, and ODDs. Over 1991-2019, consumption did not have a significant effect on OUDs or ODDs, but over 2003-2019 it had a positive significant effect on both. These results held if the US was removed from the sample, supporting some supply side effect across the panels after 2003. Furthermore, OUDs have a large, positive and significant effect on ODDs, indicating two possible pathways direct (straight from consumption) and indirect (through an effect on opioid use disorders) that POC relates to increased ODDs. One model estimates that 39% of the increase in US opioid fatalities is attributable to increased POC between 2003-2010.
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