Food Insecurity and the Opioid Crisis

AuthorColleen Heflin,Xiaohan Sun
Published date01 September 2022
Date01 September 2022
262 ANNALS, AAPSS, 703, September 2022
DOI: 10.1177/00027162221149287
Food Insecurity
and the Opioid
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.
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

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