Working Papers
- The Last Mile to First Treatment: Search for Opioid Use Disorder MedicationLance GuiJob Market Paper, Draft available upon request , 2025
Despite growing policy support for buprenorphine, the leading medication for opioid use disorder, treatment uptake remains low. Administrative insurance data from Washington State show only half of first-time patients fill their buprenorphine prescriptions, well below rates for other chronic conditions. I find uptake is hindered by limited availability and patients’ inability to verify it beforehand. To quantify their impact, I develop a structural sequential search model in which patients are uncertain which pharmacies carry buprenorphine. Using purchase data alone, the model recovers search costs by assuming patients always visit their default (most frequently visited) pharmacy. This implies latent utility from the default depends only on preferences, while that from non-defaults reflects both preferences and search costs. I find fewer than 40% of patients search more than once. Counterfactual analysis shows that providing prescribers with real-time pharmacy inventory—to inform patients at the point of care—would increase buprenorphine uptake by approximately 45%.
- Closing the Opioid Use Disorder Treatment Gap: Expanding Nurse Practitioners’ Prescriptive AuthorityLance Gui2025
Buprenorphine, like nicotine gum for quitting smoking, provides a safe treatment for opioid withdrawal, yet access remains limited. The 2016 Comprehensive Addiction and Recovery Act (CARA) enabled Nurse Practitioners (NPs) to prescribe buprenorphine. Leveraging pre-existing state-level NP prescribing authority and comparing pre- and post-CARA periods, I find that allowing NPs to prescribe buprenorphine independently expands the pool of active buprenorphine prescribers, increases buprenorphine dispensation, and reduces opioid-related mortality by over 20%, without replacing specialized treatment. Gains were concentrated in underserved counties, with limited effects elsewhere. Finally, there is suggestive evidence of increased diversion into the secondary market.
- Anatomy of Opioid Diversion: Examining Supply-Side Curtailment2024
Pharmacies should act as gatekeepers of opioid distribution. However, rogue pharmacies divert opioids to non-medical users, worsening the opioid epidemic. We examine the spatial redistribution of opioids dispensed following targeted shutdowns by the Drug Enforcement Administration, employing comprehensive pharmacy-level opioid shipments and hospital diagnoses data in ten U.S. states. The displacement of local opioid shipments after removing a pharmacy unveils the extent of non-medical use: medical users can readily switch to competing local pharmacies, while non-medical users cannot. We develop and estimate a structural model to study medical and non-medical consumers’ substitution patterns facing changes in their consideration sets. We find that 8% of pharmacies sell non-medical use opioids with a probability greater than 90% and that over half of pharmacy-dispensed opioids are diverted to non-medical use. Aggressive pharmacy crackdowns, however, drive a substantial portion of non-medical users who lose access to the black market, which may lead to the rise of more dangerous narcotics such as heroin and fentanyl.
- Anatomy of a Scandal: #Batterygate and Consumer ChoiceLance GuiDraft available upon request , 2022
I link the Twitter activity of over 35,000 individuals to their offline phone purchasing decisions to examine the consumer response—across both existing and potential customers—to the Batterygate scandal. This incident refers to Apple’s 2017 decision to slow down iPhone processors without disclosing the reason, which was to preserve battery life. To address concerns about the parallel trends assumption, I use a novel trend-extrapolated Differences-in-Differences technique that assumes pre-existing trends for the treatment and control groups would have continued without intervention. My findings reveal that Batterygate negatively affected potential consumers but had no impact on the current user base. This suggests that consumer heterogeneity is a crucial factor in determining how customers respond to even uniformly negative media coverage.