Food Insecurity and the Opioid Crisis

• DOI: http://doi.org/10.1177/00027162221149287
• Published date: 01 September 2022
• Date: 01 September 2022

262 ANNALS, AAPSS, 703, September 2022

DOI: 10.1177/00027162221149287

Food Insecurity

and the Opioid

Crisis

By

COLLEEN HEFLIN

and

XIAOHAN SUN

1149287ANN THE ANNALS OF THE AMERICAN ACADEMYFOOD INSECURITY AND THE OPIOID CRISIS

research-article2022

The opioid epidemic has increased adult mortality,

disrupted families, and changed labor supply—all fac-

tors that are independently associated with poverty and

food insecurity. We explore the relationship between

the opioid crisis and food insecurity at the state level,

first by examining the relationship of drug-related mor-

talities to food insecurity, and then by exploiting cross-

state variations in OxyContin misuse prior to

reformulation of the drug to investigate whether food

insecurity increased as individuals with opioid use dis-

order transitioned from prescription to street drugs

such as heroin. Results provide further evidence of the

presence and size of the social consequences of the

opioid crises and the negative consequences associated

with drug reformulation for food security.

Keywords: drug reformulation; food insecurity; over-

dose; OxyContin; prescription opioids

As the opioid crises in America continue to

unfold, the connection between opioid use

disorder and another public health crisis—food

insecurity—is often left out of the headlines.

This is despite strong evidence that connects

substance use to food insecurity (Whittle etal.

2019; Werb et al. 2010; Weiser et al. 2009;

Nelson, Brown, and Lurie 1998; Normen etal.

2005; McLaughlin etal. 2012; Wang etal. 2013;

Colleen Heflin is an associate dean and professor in the

Maxwell School of Citizenship and Public Affairs at

Syracuse University. Her research focuses on food

insecurity, nutrition and welfare policy, and the

well-being of vulnerable populations. She has published

over 70 peer-reviewed academic articles and engages

with policy-makers at the federal, state, and local level

to redesign programs and improve accessibility.

Xiaohan Sun is a postdoctoral scholar working with

Colleen Heflin in the Maxwell School of Citizenship and

Public Affairs at Syracuse University. Her research

focuses on child well-being and health, policy analysis,

economics of education, and applied microeconomics.

Xiaohan received her PhD in agricultural and resource

economics from the University of Connecticut.

Correspondence: cmheflin@syr.edu

FOOD INSECURITY AND THE OPIOID CRISIS 263

Baer etal. 2015; Palar etal. 2016), which is defined by the U.S. Department of

Agriculture (2021a) as “a lack of consistent access to enough food for an active,

healthy life.” Food insecurity is a social problem that touched 13.8 million house-

holds at some point during 2020, and approximately 5.1 million U.S. households

experienced very low food security in 2020, meaning that there was a disruption

in these household’s eating patterns in which reported food intake was below

adequate levels.

Food insecurity is associated with a host of negative outcomes across the life

course. Individuals who experience food insecurity are more prone to poor physi-

cal health and mental health (including substance use disorders) and evince

reduced healthcare utilization, sometimes termed the “treat or eat” trade-off

(Herman etal. 2015; Berkowitz, Seligman, and Choudhry 2014; Gundersen and

Ziliak 2015). Oftentimes, individuals who experience food insecurity simultane-

ously experience other forms of material hardship, such as housing hardships,

utility hardships, or transportation hardships, and face the problem of having

“more month than money” (Edin etal. 2013; Heflin 2017). Food insecurity is

associated with reduced work productivity, school achievement, and cognitive

functioning when mental bandwidth becomes preoccupied with identifying a

food procurement strategy, leading to a decrease in executive functioning (Mani

et al. 2013). Food insecurity–related declines in executive functioning during

adolescence, in particular, may lead to an increase in risky or negative behaviors,

which translate into increased teen births, school suspensions, and high school

drop-out (Heflin, Kukla-Acevedo, and Darolia 2019; Heflin, Darolia, and Kukla-

Acevedo 2020). Finally, food insecurity also impacts personal relationships and

family formation: it is associated with a reduction in the probability that unmar-

ried parents will marry after the birth of a child and an increase in family dissolu-

tion among married or cohabiting partners with a young child (Lerman 2002).

Food insecurity is also a social challenge that can be significantly mitigated

through public policy and public investment. We know, for example, that families

participating in the U.S. Department of Agriculture’s Supplemental Nutritional

Assistance Program (SNAP, formerly known as food stamps) have a reduced risk

of food insecurity (Nord and Prell 2011). SNAP is the nation’s largest food assis-

tance program, reaching 35.7 million individuals in fiscal year 2019, with average

monthly benefits of $129.83 per person and a national cost of $60.4 billion (U.S.

Department of Agriculture 2021b) and is supportive of a wide range of positive

physical and mental health outcomes (Gundersen and Ziliak 2015; Heflin etal.

2019; Berkowitz etal. 2017).

In light of the size and growth of the population with opioid use disorders, it

is important to better understand the relationship between opioid use and food

insecurity. This article will describe the existing evidence for the direct connec-

tion between food insecurity and the opioid crises. Then, we posit a conceptual

model that describes the indirect mechanisms that connect the opioid crisis and

food insecurity, and we test this model using state-level data. Finally, we use

state-level data over time to investigate the possibility that a 2010 drug

reformulation—the introduction of an abuse-deterrent form of OxyContin by the

Food and Drug Administration (FDA)—increased levels of food insecurity at the