Economic Conditions and Drug and Opioid Overdose Deaths

Brown, Ezequiel; Wehby, George L.

doi:10.1177/1077558717722592

Cited by 22 publications

(17 citation statements)

References 20 publications

(25 reference statements)

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“…These results are in line with a prior study that found that as county unemployment rates increased, the opioid death rate and opioid overdose emergency department visit rate both increased [27]. Additionally, prior studies reported increases in alcoholrelated disorders and problematic drinking during the recession, particularly among households experiencing unemployment [9,28]. A recent Spanish study also found an increase in marijuana and cocaine use during the great recession [29].…”

Section: Discussionsupporting

confidence: 89%

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Unemployment rate, opioids misuse and other substance abuse: quasi-experimental evidence from treatment admissions data

et al. 2021

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Background The relationship between economic conditions and substance abuse is unclear, with few studies reporting drug-specific substance abuse. The present study examined the association between economic conditions and drug-specific substance abuse admissions. Methods State annual administrative data were drawn from the 1993–2016 Treatment Episode Data Set. The outcome variable was state-level aggregate number of treatment admissions for six categories of primary substance abuse (alcohol, marijuana/hashish, opiates, cocaine, stimulants, and other drugs). Additionally, we used a broader outcome for the number of treatment admissions, including primary, secondary, and tertiary diagnoses. We used a quasi-experimental approach -difference-in-difference model- to estimate the association between changes in economic conditions and substance abuse treatment admissions, adjusting for state characteristics. In addition, we performed two additional analyses to investigate (1) whether economic conditions have an asymmetric effect on the number of substance use admissions during economic downturns and upturns, and (2) the moderation effects of economic recessions (2001, 2008–09) on the relationship between economic conditions and substance use treatment. Results The baseline model showed that unemployment rate was significantly associated with substance abuse treatment admissions. A unit increase in state unemployment rate was associated with a 9% increase in treatment admissions for opiates (β = 0.087, p < .001). Similar results were found for other substance abuse treatment admissions (cocaine (β = 0.081, p < .001), alcohol (β = 0.050, p < .001), marijuana (β = 0.036, p < .01), and other drugs (β = 0.095, p < .001). Unemployment rate was negatively associated with treatment admissions for stimulants (β = − 0.081, p < .001). The relationship between unemployment rate and opioids treatment admissions was not statistically significant in models that adjusted for state fixed effects and allowed for a state- unique time trend. We found that the association between state unemployment rates and annual substance abuse admissions has the same direction during economic downturns and upturns. During the economic recession, the negative association between unemployment rate and treatment admissions for stimulants was weakened. Conclusion These findings suggest that economic hardship may have increased substance abuse. Treatment for substance use of certain drugs and alcohol should remain a priority even during economic downturns.

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Section: Discussionsupporting

confidence: 89%

“…The self-medication model of drinking suggests that alcohol is used to cope with psychological distress. Economic hardship has been associated with depression, anxiety, and psychological distress [28,32,33]. Based on our results, this theory may also extend to illicit drug use.…”

Section: Discussionsupporting

confidence: 62%

Unemployment rate, opioids misuse and other substance abuse: quasi-experimental evidence from treatment admissions data

et al. 2021

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“…2015; Hasegawa et al, 2014;Cochran et al, 2017;Meiman et al, 2015), where insurance type (enrollment in or eligibility for Medicaid in most cases) was positively associated with overdose. All of the included studies had samples from the US population, and all of them except one (Brown and Wehby, 2019) measured health insurance at the individual level, typically comparing those with Medicaid to those with other types of insurance or to a non-Medicaid population. All but one study used administrative data to link health insurance to overdose, and the study that used self-reported insurance and overdose history did not find evidence of a significant association (Dunn et al, 2016).…”

Section: Health Insurancementioning

confidence: 99%

Socioeconomic marginalization and opioid-related overdose: A systematic review

Draanen

Tsang

Mitra

et al. 2020

Drug and Alcohol Dependence

120

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Background: Socioeconomic marginalization (SEM) is an important but under-explored determinant of opioid overdose with important implications for health equity and associated public policy initiatives. This systematic review synthesizes evidence on the role of SEM in both fatal and non-fatal overdose among people who use opioids. Methods: Studies published between January 1, 2000 and March 31, 2018 were identified through searching electronic databases, citations, and by contacting experts. The titles, abstracts, citation information, and descriptor terms of citations were screened by two team members. Data were synthesized using the lumping technique. Results: A total of 37 studies met inclusion criteria and were included in the review, with 34 of 37 finding a significant association between at least one socioeconomic factor and overdose. The included studies contained variables related to eight socioeconomic factors: criminal justice system involvement, income, employment, social support, health insurance, housing/homelessness, education, and composite measures of socio-economic status. Most studies found associations in the hypothesized direction, whereby increased SEM was associated with a higher rate or increased likelihood of the overdose outcome measured. The review revealed an underdeveloped evidence base. Conclusions: Nearly all reviewed studies found a connection between a socioeconomic variable and overdose, but more research is needed with an explicit focus on SEM, using robust and nuanced measures that capture multiple dimensions of disadvantage, and collect data over time to better inform decision making around opioid overdose.

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“…1,48,49 Last, because this study evaluated the effect of income inequality, the relative and absolute calculations presented are notably high and are likely representative of the many risks for opioid-related harms associated with income disparities. [10][11][12][13][14]…”

Section: Limitationsmentioning

confidence: 99%

“…Furthermore, unemployed people and those living in poverty are especially at risk for opioid-related harms: studies have shown increased poisonings occurring after income assistance payments, and deaths during economic downturns. [10][11][12][13][14] Our objectives in the present study were twofold. The first was to identify long-term trends in the prevalence of multiple indicators of opioid-related harms -neonatal abstinence syndrome, opioid poisoning (emergency department visit, hospital admission and death) and nonpoisoning opioid-related events (emergency department visit and hospital admission) -in Ontario from 2003 to 2016.…”

mentioning

confidence: 99%

Relation between opioid-related harms and socioeconomic inequalities in Ontario: a population-based descriptive study

Cairncross

Herring

Ingen

et al. 2018

cmajo

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Background: Negative health outcomes associated with the use of both prescribed and nonprescribed opioids are increasingly prevalent. We examined long-term trends in opioid-related harms in Ontario across a set of 6 indicators and the relation between harms and neighbourhood income in 2016. Methods: We examined rates of neonatal abstinence syndrome, opioid poisoning (fatal and nonfatal) and nonpoisoning opioidrelated events from 2003 to 2016 in Ontario using population-based health administrative databases. We conducted descriptive analyses for harm indicators across neighbourhood income quintiles in 2016 (2015 for death). We examined social inequalities in opioid-related harms on both relative (prevalence ratio) and absolute (potential rate reduction) scales. Results: Rates of opioid-related harms increased dramatically between 2003 and 2016. In 2016, neonatal abstinence syndrome and opioid poisoning and nonpoisoning events showed a strong social gradient, with harm rates being lowest in higher-income neighbourhoods and highest in lower-income neighbourhoods. Prevalence ratios for the lowest-income neighbourhoods compared to the highest-income neighbourhoods ranged from 2.36 (95% confidence interval [CI] 2.15-2.58) for emergency department visits for opioid poisoning to 3.70 (95% CI 2.62-5.23) for neonatal abstinence syndrome. Potential rate reductions for opioid-related harms ranged from 34.8% (95% CI 29.1-40.1) to 49.9% (95% CI 36.7-60.5), which suggests that at least one-third of all harmful events could be prevented if all neighbourhoods had the same socioeconomic profile as the highest-income neighbourhoods. Interpretation: Rates of opioid-related harms increased in Ontario between 2003 and 2016, and people in lower-income neighbourhoods experienced substantially higher rates of opioid-related harms than those in higher-income neighbourhoods. This finding can inform planning for opioid-related public health interventions with consideration of health equity.

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Economic Conditions and Drug and Opioid Overdose Deaths

Cited by 22 publications

References 20 publications

Unemployment rate, opioids misuse and other substance abuse: quasi-experimental evidence from treatment admissions data

Unemployment rate, opioids misuse and other substance abuse: quasi-experimental evidence from treatment admissions data

Socioeconomic marginalization and opioid-related overdose: A systematic review

Relation between opioid-related harms and socioeconomic inequalities in Ontario: a population-based descriptive study

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