Beyond Mortality: The Effect of Triplicate Prescription Programs on Birth Outcomes

Abstract The prescription opioid crisis in the U.S. is often framed by mortality statistics, yet effects on survivors – particularly birth outcomes – remain underexplored. Using restricted-use birth certificate data and triplicate prescription programs as a natural experiment, we find that non-triplicate states exhibited increases in low birth weight (LBW) and other adverse birth outcomes as differential prescription opioid exposure grew, with LBW rates 3.5 % higher during 2001–2010 and 5.2 % higher during 2011–2016 than in triplicate states. We also find elevated mortality among women of reproductive age and higher preterm birth rates over the same periods. Effects were most robust among unmarried mothers, with larger effects among younger mothers confined to the earliest period, and less conclusive among non-White mothers. Taken together, this study provides suggestive evidence that the prescription opioid wave tied to OxyContin had broader effects on maternal and newborn health than mortality statistics alone reveal, underscoring the need for continued prescription oversight.