What Is Driving the Drug Overdose Epidemic in the United States?

Abstract

The demand-side perspective argues that the drug overdose epidemic is a consequence of changes in the economy that leave behind working-class people who lack a college education. In contrast, the supply-side perspective maintains that the epidemic is primarily due to changes in the licit and illicit drug environment, whereas a third, distinct perspective argues that income inequality is likely a key driver of the epidemic. To evaluate these competing perspectives, we use a two-level random intercept model and U.S. state-level data from 2006 to 2017. Contrary to the demand-side approach, we find that educational attainment is not associated with drug-related mortality. In support of the supply-side approach, we provide evidence indicating that opioid prescription rates are positively associated with drug-related mortality. We also find that income inequality is a key driver of the epidemic, particularly the lack of resources going to the bottom 20% of earners. We conclude by arguing that considerations of income inequality are an important way to link the arguments made by the demand-side and the supply-side perspectives.

The Unsustainable State: Greenhouse Gas Emissions, Inequality, and Human Well-Being in the United States, 1913 to 2017

“…We also find some evidence of a long-run negative effect of inequality, and we investigated if income inequality moderates the relationship between emissions and life expectancy. Consistent with the results of prior research (Chetty et al 2016; Hill et al 2019; Kaplan et al 1996; Thombs et al 2020), in two of three models we find that the effect of GHG on life expectancy becomes more negative as income inequality increases. However, these findings are somewhat inconsistent across the analysis.…”

“…A related body of research reveals direct associations between income inequality and worsened population health outcomes (e.g., Anderson, Bjorklund, and Rambotti 2019; Mishra and Carleton 2015; Pickett and Wilkinson 2015), including reduced life expectancy (e.g., Chetty et al 2016; Hill and Jorgenson 2018; Thombs et al 2020). Inequality directly affects population health because relative deprivation in living standards is associated with lower social-emotional outcomes, maladaptive coping mechanisms, and lower subjective well-being (Oishi, Kesebir, and Diener 2011; Payne, Brown-Iannuzzi, and Hannay 2017; Wilkinson and Pickett 2010).…”

The Roles of Adolescent Occupational Expectations and Preparation in Adult Suicide and Drug Poisoning Deaths within a Shifting Labor Market

“…There is some evidence at the community or county level that changes in unemployment and financial resources link economic recessions to increased suicide and drug poisoning rates (Chang et al 2013; dos Santos et al 2016; Gunnell and Chang 2016; Haw et al 2015; Hodwitz and Frey 2016; Thombs et al 2020). Even short-term economic changes can have a long-term impact on individuals’ social status, financial resources, and mental and physical health.…”

“…Although one study found that deaths by suicide and drug poisoning are concentrated in areas with high economic distress (Monnat 2018), another focusing on areas with high industrialization that were more vulnerable to shocks to economic opportunities in blue-collar occupations found the opposite; suicide and drug poisoning mortality was lower in the more vulnerable areas (Bound et al 2018). Indeed, the processes involved in access to means for self-inflicted deaths, the labor market, and inequality are complex; individual-level positions within their communities are important to consider (Peters et al 2020; Pickett and Wilkinson 2015; Thombs et al 2020).…”

“…Labor market shifts over the past few decades increased inequality (Dwyer 2013; Mouw and Kalleberg 2010), job precarity (Kalleberg 2009), and physical and mental health problems, which may feed into feelings of hopelessness and despair (Goldman, Glei, and Weinstein 2018) that increase vulnerability to suicide and drug poisoning deaths (Durkheim [1897] 1951). Evidence at the aggerate level shows that increases in suicide and drug poisoning rates are associated with economic downturns, high unemployment rates, inequality in resources, and significant changes in jobs (Burgard and Kalousova 2015; Chang et al 2009; Haw et al 2015; Luo et al 2011; Platt 2016; Thombs et al 2020). These findings are consistent with some of the earliest and most impactful research on suicide and mental health—namely, Emile Durkheim’s ([1897] 1951) Suicide —that showed a compelling link between societal forces and individual rates of severe mental health problems.…”