Cheap Drugs, Not Economic Woes, Drive Opioid Overdose Deaths, Paper Argues

Economic conditions may play less of a role in the scourge of recent opioid overdose deaths than the easy availability and low cost of the illicit drugs, according to a new paper. The study by University of Virginia economist Christopher Ruhm disputes the idea that areas in economic decline experience a higher rate of “deaths of despair,” and argues “the drug environment rather than economy is the key driver in rising drug fatalities.” “Deaths of despair” is a term coined by two Princeton economists in 2015, who published a landmark paper showing that mortality was rising for white, middle-aged Americans after decades of decline, a startling development for an economically advanced nation. Driving the uptick were increases in deaths from drugs, alcohol-related liver diseases and suicide, as well as a slowdown in progress against death in middle age from heart disease and cancer, the nation’s biggest killers, wrote Anne Case Nobel Prize-winning economist Angus Deaton, her husband. The economists have attributed the trend to a number of factors, but in particular “the social dysfunctions, such as loss of meaning in the interconnected worlds of work and family life, that come with prolonged economic distress.” Mr. Ruhm’s new paper takes a different look at that hypothesis. He argues that changes in the “drug environment” are a main cause of rising overdose deaths. An example of those changes is the type of drugs driving higher overdose deaths over time. The paper noted a rise in opioid analgesic mortality from 1999 to 2011, followed by “explosive growth in illicit opioid death rates after 2010.” Mr. Ruhm also noted supply-side changes, like opioid prescribing patterns in the U.S. and the introduction of new drugs such as OxyContin in 1996. Counties in economic decline from 1999  to 2015 did experience larger increases in drug, suicide or alcohol mortality than those with more robust economic growth, the paper found. “However, the relationship was fairly weak and mostly due to county characteristics spuriously correlated with changes in economic conditions,” Mr. Ruhm argues. The study suggests that the “deaths of despair” arguments, “while provocative, probably do not explain the main sources of the fatal drug epidemic,” and “efforts to improve economic conditions in distressed locations, while desirable for other reasons, are unlikely to yield significant reductions in drug mortality.” Ms. Case and Mr. Deaton rejected Mr. Ruhm’s argument in a statement earlier this week, stating that their work has never offered a purely economic explanation for deaths of despair. Mr. Ruhm “doesn’t seem to understand that when he looks at the impact (or lack of impact) of changes in economic conditions between 1999 and 2015 on mortality between 1999 and 2015, and finds none, he is simply repeating what we found, albeit at the county level.” “There is a lot more going on than just the opioid epidemic, including prescription drugs, heroin, and fentanyl, and we continue to believe that the broader epidemic, including opioids, is linked to the longterm decline of working class lives, and that while economic decline is part of the story, it is only a part,” they wrote. Mr. Ruhm’s earlier work has looked at the underreporting of fatal opioid and heroin overdoses. An August 2017 paper by the economist found that because death certificates sometimes don’t identify the specific drug involved, state mortality rates often are underreported. Seeking to correct the figures, researchers concluded that mortality rates nationally involving opioids were 24% greater than reported rates in 2014. His latest study comes weeks after separate research, by Michael Betz and Lauren Jones of Ohio State University, found that stronger wage growth among low earners is correlated with fewer overdose deaths in rural regions. In nonmetro areas, a five percentage point increase in the rate of wage growth leads to a 10% decline in overdose rates, according to the paper. Deaths from drug overdoses surged 21% to more than 63,600 in 2016, spurred by widespread black-market availability of deadly synthetic opioids including fentanyl, according to the Centers for Disease Control and Prevention. Those deaths drove a decline in U.S. life expectancy in 2016 for the second year in a row—the first consecutive-year fall since the early 1960s. President Donald Trump in October declared addiction to opioids like fentanyl, heroin and oxycodone a public health emergency. In November, the White House Council of Economic Advisers estimated that the economic cost of the opioid crisis was $504 billion in 2015, or 2.8% of gross domestic product. RELATED: Federal Judge Seeks Speedy Resolution of Opioid Lawsuits (Jan. 8, 2018)
Overdose Deaths Drive Down US Life Expectancy—Again (Dec. 21, 2017)
Sobering Testimony for Lawmakers Searching for Answers on Opioid Crisis (June 8, 2017)

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