Do states with higher imports per resident have higher fentanyl overdose deaths?
Core argument: Using CDC mortality and U.S. Census import data for 2008–2020, the authors find a positive relationship between states' imports per resident and drug overdose death rates that begins in 2013 and accounts for 15,000–20,000 deaths per year over 2017–2020.
Legal trade is a key factor driving fentanyl supply. We assess the empirical relationship between imports and fentanyl overdoses at the state level, with the idea that supply frictions result in overdoses disproportionately occurring near smuggling locations. Specifically, using CDC mortality data and U.S. Census import data for 2008-2020, we show that there is a positive relationship between states’ imports per resident and drug overdose death rates that begins in 2013. The relationship increases over time and accounts for 15,000-20,000 deaths per year over the 2017-2020 period. Results show that states with above-and below-median imports have similar drug overdose trends in the first five years of the sample period (2008-2012). Their drug overdose rates diverge sharply thereafter; by 2017, drug overdose deaths per resident are approximately 40% higher in states with above-median import levels than in other states. These differences, which persist through 2020, are driven by fentanyl overdoses. Summary estimates for the 2017-2020 period imply that a 10% higher value of imports per resident is associated with a 5.5% higher opioid death rate and an 8.1% higher fentanyl death rate.




