A Nation of Junkies? Study Eschews Economic Despair Opioid Theory

A volunteer cleans up needles used for drug injection that were found at a homeless encampment in Everett, Wash., on Nov. 8, 2017. (AP Photo/Ted S. Warren)

Why are so many Americans dying of drug overdoses? Maybe it’s because we’re a nation of junkies.

At least that seems to be the finding from a new study that flies in the face of the more widespread view that the opioid crisis is the result of a weak economy.

“The fatal overdose epidemic is likely to primarily reflect drug problems rather than the deaths of despair,” states a report published this month by the National Bureau of Economic Research.

Death toll rising 

In short, the research says addiction is the reason for the tens of thousands of drug deaths across the United States.

Identifying the correct cause or causes of the drug scourge is vital for two reasons.

First, any solution won’t be effective if the diagnosis of the epidemic is incorrect.

Second, the crisis has grown to a level that beggars belief. In 2016, more than 63,000 people died of drug overdoses, or almost four-fold the 16,849 deaths in 1999, according to data cited in the research paper “Deaths of Despair or Drug Problems?” by Chris Ruhm, professor of public policy and economics at the Frank Batten School of Leadership and Public Policy, University of Virginia.

The drugs involved include Oxycontin, Fentanyl, and heroin.

“At first glance, the particularly large rise in drug mortality in Appalachia and the rust belt seems consistent with the deaths of despair hypothesis,” the report states. “However, other areas not associated with declining economies have also experienced strong upsurges in overdose fatality rates.”

The idea that economic hardship is the cause gets further undermined by the fact that the drug deaths are way higher among whites than they are among non-whites despite the fact that minorities often face harsher economic problems.

Instead, the author, Rhum, forwards the idea that “the drug environment rather than the economy is the key driver.” In other words, are the drugs readily available?

In the case of opioids and the white population that is true, as such people “have been more widely prescribed opioids,” the report says.

Does the economy have any impact? Not much, says the author. “When you hold the different factors constant, then the contribution of the economy is less than 10 percent,” he says.

He also notes that there has been a change in the type of people dying from drug overdoses: “The people dying now are more male and younger” than they were.

More research needed?

Not everyone buys into the idea that despair was not a major part of the problem.

It might have been better to look at individuals who had died of a drug overdose and then investigate the individual circumstances of that person, says Robert Wright, professor of political economy at Augustana University in South Dakota.

Such research would likely mean investigating to see if the dead individuals had seen an income decline, and asking relatives and friends if they were actually in despair in the run-up to the overdose.

Ruhm acknowledges that such work could help: “I think it would be interesting to conduct this type of research, but it’s quite different than the kind of work that I do. I would view such research as complementary to my work (and that of other that is more quantitatively focused, but certainly not a replacement for it).”

Wright also notes that the improving economy could make people more despondent as they feel left behind their peer group. Peer group comparisons have more influence on self-esteem than absolute levels of income or wealth.

In response, Ruhm says, “Groups may be at differential risk of drug deaths, due to these types of factors.”

But the overriding factor for him is the drug environment and the availability of drugs.

“Efforts to stem drug deaths might be most effective (and rapid) if they target the drug environment rather than general economic and social factors,” he says.

In other words, more drugs on the street will lead to more overdose deaths. And, presumably, vice versa.