The Opioid Epidemic Was Not Caused by Economic Distress but by Factors That Could Be More Rapidly Addressed

• DOI: 10.1177/00027162211033833
• Date: 01 May 2021
• Published date: 01 May 2021
• Subject Matter: Pockets of Success and Distress

276 ANNALS, AAPSS, 695, May 2021

DOI: 10.1177/00027162211033833

The Opioid

Epidemic Was

Not Caused by

Economic

Distress but by

Factors That

Could Be More

Rapidly

Addressed

By

JANET CURRIE

and

HANNES SCHWANDT

1033833ANN The Annals of The American AcademyCauses of The Opioid Epidemic And Policy Responses

research-article2021

Without the opioid epidemic, American life expectancy

would not have declined prior to 2020. The epidemic

was sparked by the development and marketing of a

new generation of prescription opioids, and the behav-

ior of opioid providers is still helping to drive it. Little

relationship exists between the opioid crisis and con-

temporaneous measures of labor market opportunity:

cohorts and areas that experienced poor labor market

conditions do show lagged increases in opioid mortality,

but the effect is modest relative to the scale of the epi-

demic. We argue that specific policies and features of

the U.S. health care market, especially liberal prescrib-

ing of opioids, led to the current crisis. It will not be

possible to quickly reverse depressed economic condi-

tions, but it is possible to implement policies that would

reduce the number of new opioid addicts and save the

lives of many who are already addicted.

Keywords: opioids; life expectancy; prescription opi-

oids; labor markets

Deaths due to drug overdoses, mainly involv-

ing opioids, have more than tripled since

1999, and reached eighty-one thousand in the 12

months ending in May 2020 (Centers for Disease

Control and Prevention [CDC] 2020). The

United States leads the world in consumption of

opioids, accounting for 72.9 percent of sales of

Oxycodone and similar drugs (United Nations

2018). The number of deaths due to opioids

Janet Currie is the Henry Putnam Professor of

Economics and Public Affairs at Princeton University

and the codirector of Princeton’s Center for Health and

Wellbeing, and of the NBER’s Program on Children.

Hannes Schwandt is an assistant professor at Northwestern

University’s School of Education and Social Policy and is

also affiliated with NBER and IZA.

NOTE: We thank Ellen Meara, Molly Schnell, the edi-

tors, and conference participants from the conference,

“What Has Happened to the American Working Class

since the Great Recession?” for extremely helpful com-

ments. All opinions are solely those of the authors.

Correspondence: jcurrie@princeton.edu

CAUSES OF THE OPIOID EPIDEMIC AND POLICY RESPONSES 277

dwarfs the toll from previous drug epidemics in the United States. Figure 1 shows

that mortality from opioids is so great that without these deaths, U.S. life expec-

tancy would have continued to rise after 2013 instead of falling. Moreover, Figure

1 shows, perhaps surprisingly in view of the argument that opioid deaths are due to

economic conditions, that the Great Recession had a negligible impact on opioid

deaths. Deaths were rising prior to 2008–2009 and continued to do so afterward.

Has the epidemic had a disproportionate effect on the working class? Perhaps

the best examination of the relationship between socioeconomic status and over-

doses is Altekruse etal. (2020), who examine 4.5 million records from the 2008

American Community Survey that were linked to the National Death Index for

2008 to 2015. In models that focus on people 10 years and older in 2008 and

control for age, race, ethnicity, census division, and other variables, they find that

people in households with incomes less than 100 percent of the poverty line are

1.36 times more likely to overdose. But there is little difference between those at

100 to 299 percent, 300 to 499 percent, or above 500 percent of poverty.

Differences by education are starker: Those with less than a bachelor’s degree

have a risk 2.3 to 2.5 times greater, with little difference among those with less

than high school, high school, or some college. Figure 2 repeats that analysis in

Figure 1, constructing life expectancy for those with greater than 12 years of

education and those with less than or equal to 12 years of education. The figure

FIGURE 1

Actual and Counterfactual Life Expectancy without Deaths of Despair

SOURCE: Authors’ calculations based on Vital Statistics mortality data.

NOTE: The blue solid line shows actual life expectancy over time. The three lines with triangle,

square, and circle markers show counterfactual life expectancy estimates. The line with triangles

assumes constant death rates for suicides at their 2000 level; the line with squares shows con-

stant death rates for suicides and liver disease at their 2000 level; and the line with circles

assumes constant death rates for suicides, liver disease, and drug poisoning at their 2000 level.