J. Travis Donahoe is an assistant professor of Health Policy and Management at the University of Pittsburgh School of Public Health. He has an unusual specialty: he studies the economics of substance use disorders. Since obtaining his Ph.D. in Health Policy and Economics from Harvard University in 2023, Dr. Donahoe has focused his research on the opioid epidemic in the United States.

Dr. Donahoe’s research was the subject of a deep-dive feature article last week in the Harvard Griffin GSAS News, a publication of Harvard University’s Kenneth C. Griffin Graduate School of Arts and Sciences. Dr. Donahoe’s Ph.D. thesis, Supplier Enforcement and the Opioid Crisis, has gotten much attention and been through one revision since publication. It deals with the effect of law enforcement actions on both the supply of opioids and the number of opioid overdose deaths from 2006 through 2014.

The relationship between enforcement action against suppliers and the supply of opioids is best illustrated in Figure 3 from the thesis, shown below:

The chart appears to show two critical events impacting the supply of illicit opioids in Mingo County, West Virginia, in 2009 and 2010. These incidents are shown as #2 and #3 on the chart, and are described by the author as follows:

2. The Drug Enforcement Administration raids and closes Sav-Rite Pharmacy #2 and Justice Medical Complex, arresting two physicians.

3. The Drug Enforcement Administration raids Mountain Medical Care Center and an orthopedic physician’s practice, arresting two physicians.

These pharmacies were associated with high-volume prescribers of opioids who were “writing prescriptions for millions of opioids.” Closing them down eliminated two-thirds of the illegal opioids on the market.

There was also a precipitous drop in both the illicit supply of opioids and the number of fatalities in the U.S. after “15 distribution facilities were shut down for supplying the high-volume pharmacies,” writes Dr. Donahoe. These distributors were not immediately replaced by new sources of supply. Dr. Donahoe explains: 

These actions sent a signal to other pharmacies in the market that they could lose their license or get tied up in an investigation. So, whatever quantity of opioids the bad actors would have been dispensing was a loss in the market.

While these actions cut the supply of prescription opioids, saving an estimated 6,000 lives between 2006 and 2014, they also pushed addicts to the illegal drug market where they encountered the synthetic opioid, fentanyl. University of California San Francisco professor Daniel Ciccarone has been tracking the spread of synthetic opioids in an National Institute of Health study, “Heroin in Transition.” In a piece for UC San Francisco Research, Dr. Ciccarone points out that fentanyl is made in a lab, not extracted  from a poppy, and is much easier to hide and transport.

Fentanyl is said to be 50 times as potent as heroin, and Dr. Donahoe attributes the high rates of overdose death to “heroin potency shocks.” He points to a shift in the supply chains as fentanyl has replaced heroin and is being sold illegally as “OxyContin” or “Xanax.” His research aims to take a fine-grained look at “the structural drivers of the opioid epidemic at a very local level in ways that the literature hasn’t done to date.”

Combining health data with economic data, Dr. Donahoe believes he will be able to show community leaders the main drivers of overdose deaths in their cities and recommend supply-side interventions to target the sources of illegal drugs. It’s a different angle on the opioid epidemic and much more cost effective than arresting and treating addicts.

Written by Steve O’Keefe. First published April 21, 2025.

Sources:

“No More Elegies: Research reveals forces driving opioid deaths — and the best ways to intervene,” Harvard Griffin GSAS News, April 10, 2025.

Supplier Enforcement and the Opioid Crisis, Ph.D. Thesis by J. Travis Donahoe, 2023 and 2024.

“What Fueled the Illicit Opioid Epidemic?,” SSRN Working Paper,  Last revised: February 27, 2025.

“Drug Wholesalers Drove Fentanyl’s Deadly Rise, Report Concludes,” UC San Francisco Research, December 4, 2018.

Image Copyright: Iakov Filimonov.