The opioid epidemic has become one of the deadliest drug crises in American history. In 2015, more people died from drug overdoses than in any year on record, and the majority of drug overdose deaths—more than six out of ten—involved an opioid.
A study of emergency rooms in the U.S. also found that since 1999, the number of overdose deaths involving opioids (including prescription opioid pain relievers and heroin) nearly quadrupled. Altogether nearly half a million people died from drug overdoses in the years from 2000-2015, and 91 more Americans die every day from an opioid overdose.
Last year the Nobel-prize winning economist Angus Deaton and his wife Anne Case wrote an influential paper claiming that the problem wasn’t with the opioids but with the social and economic conditions that lead people to take the drugs. They
attributed the rising mortality to “deaths of despair” which they consider a form of suicide that “respond(s) more to prolonged economic conditions than to short-term fluctuations, and especially social dysfunctions … that come with prolonged economic distress.”
A new study by University of Virginia economist Christopher Ruhm, however, finds that it’s the “drug environment” rather than the economy that is the key driver in rising drug fatalities.
A primary finding is that counties experiencing relative economic decline did experience higher growth in drug mortality than those with more robust growth, but the relationship is weak and mostly explained by confounding factors. In the preferred estimates, changes in economic conditions account for less than one-tenth of the rise in drug and opioid-involved mortality rates. The contribution of economic factors is even less when accounting for plausible selection on unobservables, with even a small amount of remaining confounding factors being sufficient to entirely eliminate the relationship. These results suggest that the “deaths of despair” framing, while provocative, is unlikely to explain the main sources of the fatal drug epidemic and that efforts to improve economic conditions in distressed locations, while desirable for other reasons, are not likely to yield significant reductions in drug mortality. Conversely, the risk of drug deaths varies systematically over time across population subgroups in ways that are consistent with an important role for the public health environment related to the availability and cost of drugs. Put succinctly, the fatal overdose epidemic is likely to primarily reflect drug problems rather than deaths of despair.