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Abandoned by Coal, Swallowed by Opioids?


  • Gilbert E. Metcalf
  • Qitong Wang


Opioid addiction and mortality skyrocketed over the past decade. A casual look at the geographic incidence of opioid mortality shows sharply higher mortality rates in the Appalachian region, especially in coal-mining areas. This has led observers to make a link that was characterized by one newspaper as “abandoned by coal, swallowed by opioids.” We test that theory using restricted death data and mine level coal production data. Specifically, we examine whether higher reliance on coal mining in a county’s economy leads to higher or lower opioid mortality. We find a positive relationship between the share of coal miners among total local labor force and county-level opioid mortality rates. This contradicts the “abandoned by coal, swallowed by opioids” story. Rather our results suggest that the higher rates of injury in underground coal mining (in particular) lead to greater amounts of opioid consumption and mortality. An implication is that the decline in coal mining in the United States may have a positive spillover in the form of reduced mortality from opioid use.

Suggested Citation

  • Gilbert E. Metcalf & Qitong Wang, 2019. "Abandoned by Coal, Swallowed by Opioids?," NBER Working Papers 26551, National Bureau of Economic Research, Inc.
  • Handle: RePEc:nbr:nberwo:26551
    Note: EEE HE

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    JEL classification:

    • I1 - Health, Education, and Welfare - - Health
    • Q32 - Agricultural and Natural Resource Economics; Environmental and Ecological Economics - - Nonrenewable Resources and Conservation - - - Exhaustible Resources and Economic Development
    • Q35 - Agricultural and Natural Resource Economics; Environmental and Ecological Economics - - Nonrenewable Resources and Conservation - - - Hydrocarbon Resources

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