Demographic Divergence: The Legacy of the Opioid Epidemic

We study how the opioid epidemic shaped local population dynamics in the United States. Exploiting variation in exposure that stems from Purdue Pharma's targeted marketing of OxyContin to high-cancer-mortality areas, we find that more exposed commuting zones experienced lower population growth. By 2020, a one-standard-deviation increase in exposure reduced population growth among individuals aged 18 to 64 by 2.4 percentage points. Direct mortality from drug-induced deaths made only a limited contribution to these changes. Instead, population losses were primarily driven by migratory responses: exposure increased out-migration rates, especially among college-educated individuals. These responses are consistent with the opioid epidemic operating as a disamenity shock, deteriorating local quality of life. Working in the opposite direction, we also document a rise in fertility rates that, by 2020, partially counteracts these population losses. Our findings show that the opioid epidemic reshaped local demographic composition and contributed to the long-run divergence in population dynamics across U.S. commuting zones.