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Drivers of the fatal drug epidemic

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  • Ruhm, Christopher J.

Abstract

This study examines the contributions of the medium-run evolution of local economies and of changes in the “drug environment’ in explaining county-level changes in drug and related mortality rates from 1999 to 2015. A primary finding is that drug mortality rates did increase more in counties experiencing relative economic decline than in those with more robust growth, but that the relationship is weak and mostly accounted for by confounding factors. In the preferred estimates, less than one-tenth of the rise in drug and opioid-involved fatality rates is explained and the contribution is even smaller, quite possibly zero, when allowing for plausible selection on unobservables. Conversely, the risk of drug deaths varies systematically over time across population subgroups in ways that are consistent with an important role for the public health environment related to the availability and cost of drugs. In particular, the relative risk and share of drug mortality increased rapidly for males and younger adults, compared to their counterparts, when the primary driver of the fatal drug epidemic transitioned from prescription to illicit opioids. These results suggest that efforts to improve local economies, while desirable for other reasons, are not likely to yield significant reductions in overdose mortality, but with greater potential for interventions directly addressing the drug environment.

Suggested Citation

  • Ruhm, Christopher J., 2019. "Drivers of the fatal drug epidemic," Journal of Health Economics, Elsevier, vol. 64(C), pages 25-42.
  • Handle: RePEc:eee:jhecon:v:64:y:2019:i:c:p:25-42
    DOI: 10.1016/j.jhealeco.2019.01.001
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    2. Casey B. Mulligan, 2020. "Deaths of Despair and the Incidence of Excess Mortality in 2020," NBER Working Papers 28303, National Bureau of Economic Research, Inc.
    3. Mateus Dias & Luiz Felipe Fontes, 2020. "The Effects of a Large-Scale Mental Health Reform: Evidence from Brazil," Working Papers 09, Instituto de Estudos para Políticas de Saúde.
    4. Janet Currie & Hannes Schwandt, 2020. "The Opioid Epidemic Was Not Caused by Economic Distress But by Factors that Could be More Rapidly Addressed," NBER Working Papers 27544, National Bureau of Economic Research, Inc.
    5. Dionissi Aliprantis & Mark E. Schweitzer, 2018. "Opioids and the Labor Market," Working Papers (Old Series) 1807, Federal Reserve Bank of Cleveland.
    6. Cotti, Chad D. & Gordanier, John M. & Ozturk, Orgul D., 2020. "The relationship of opioid prescriptions and the educational performance of children," Social Science & Medicine, Elsevier, vol. 265(C).
    7. Grossmann, Volker & Strulik, Holger, 2021. "Illicit drugs and the decline of the middle class," Journal of Economic Behavior & Organization, Elsevier, vol. 183(C), pages 718-743.
    8. Julien Silhol & Bruno Ventelou & Anna Zaytseva, 2020. "How French general practitioners respond to declining medical density: a study on prescription practices, with an insight into opioids use," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 21(9), pages 1391-1398, December.
    9. Casey B. Mulligan, 2020. "Deaths of Despair and the Incidence of Excess Mortality in 2020," Working Papers 2020-185, Becker Friedman Institute for Research In Economics.
    10. Dias, Mateus & Fontes, Luiz Felipe, 2020. "The Effects of a Large-Scale Mental-Health Reform: Evidence from Brazil," MPRA Paper 104753, University Library of Munich, Germany.
    11. McGranahan, David A. & Parker, Timothy S., 2021. "The Opioid Epidemic: A Geography in Two Phases," USDA Miscellaneous 310390, United States Department of Agriculture.
    12. Casey B. Mulligan, 2020. "Prices and Federal Policies in Opioid Markets," Working Papers 2020-10, Becker Friedman Institute for Research In Economics.
    13. Casey B. Mulligan, 2020. "Prices and Federal Policies in Opioid Markets," NBER Working Papers 26812, National Bureau of Economic Research, Inc.
    14. Dow, William H. & Godøy, Anna & Lowenstein, Christopher & Reich, Michael, 2020. "Can Labor Market Policies Reduce Deaths of Despair?," Journal of Health Economics, Elsevier, vol. 74(C).
    15. David M. Cutler & Edward L. Glaeser, 2021. "When Innovation Goes Wrong: Technological Regress and the Opioid Epidemic," NBER Working Papers 28873, National Bureau of Economic Research, Inc.

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