Free trade and opioid overdose death in the United States

Abstract

Opioid overdose deaths in the U.S. rose dramatically after 1999, but also exhibited substantial geographic variation. This has largely been explained by differential availability of prescription and non-prescription opioids, including heroin and fentanyl. Recent studies explore the underlying role of socioeconomic factors, but overlook the influence of job loss due to international trade, an economic phenomenon that disproportionately harms the same regions and demographic groups at the heart of the opioid epidemic. We used OLS regression and county-year level data from the Centers for Disease Controls and the Department of Labor to test the association between trade-related job loss and opioid-related overdose death between 1999 and 2015. We find that the loss of 1000 trade-related jobs was associated with a 2.7 percent increase in opioid-related deaths. When fentanyl was present in the heroin supply, the same number of job losses was associated with a 11.3 percent increase in opioid-related deaths.

Association Between Automotive Assembly Plant Closures and Opioid Overdose Mortality in the United States

“…We used commuting zones, which are contiguous groups of counties that are used to define local labor markets, 30 to define exposure because individuals may not necessarily reside in the same county in which they work. 23,31 In the 4 cases in which more than 1 automotive plant closure occurred within the commuting zone, exposure was assigned based on the date of the first closure.…”

“…[17][18][19][20] This lack of consensus may reflect the fact that standard economic measures do not adequately capture the fundamental and sustained decline in economic opportunity or the adverse socioeconomic and cultural climate that follows. 16, [21][22][23][24] Consistent with this hypothesis, studies based on other economic measures (eg, changes in employment opportunities owing to changes in international trade policy) have estimated strong associations with drug overdose mortality. [23][24][25] To reconcile the mixed findings in the literature, we conducted a study to estimate the association between automotive assembly plant closures and opioid overdose mortality among working-age adults.…”

“…16, [21][22][23][24] Consistent with this hypothesis, studies based on other economic measures (eg, changes in employment opportunities owing to changes in international trade policy) have estimated strong associations with drug overdose mortality. [23][24][25] To reconcile the mixed findings in the literature, we conducted a study to estimate the association between automotive assembly plant closures and opioid overdose mortality among working-age adults. We focused specifically on automotive assembly plant closures because they are often unexpected (to workers 26 ), discrete, and both culturally and economically significant events, thus providing a unique opportunity to estimate the potential consequences of an acute, sustained decline in economic opportunities.…”

Epidemiological and geospatial profile of the prescription opioid crisis in Ohio, United States

“…propose socioeconomic characteristics associated with the high-risk opioid overdose areas 10 . Health accessibility (primary care and mental health accessibility), unemployment rate, urbanicity, and availability of prescription vs. non-prescription opioids seem to be associated with high rates of opioid overdose mortality 7,8 . However, the reasons behind the uneven spatial distribution of the opioid epidemic in the US are still not well understood.…”

Housing, housing policy, and deaths of despair

“…Case and Deaton recently spurred a second complementary line of inquiry, hypothesizing that elevated rates of opioid overdose, suicide, and alcohol‐related mortality—collectively referred to as “deaths of despair”—have resulted from compounding social and economic disadvantage over the life course . Investigations of this hypothesis have focused on eroding economic conditions, such as sustained declines in employment owing to foreign trade competition or manufacturing plant closures …”