1
|
Oh S, Cano M. Black Americans' Drug Mortality Increases and Local Employment Opportunities, 2010‒2021. Am J Public Health 2024; 114:729-732. [PMID: 38662973 PMCID: PMC11153948 DOI: 10.2105/ajph.2024.307646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2024] [Indexed: 05/04/2024]
Abstract
Objectives. To test the associations between local employment opportunities for the Black workforce and drug mortality among Black Americans, while examining the potential moderating effects of fentanyl seizure rates. Methods. We derived data from the National Center for Health Statistics' restricted-access Multiple Cause of Death file, linked with county-level job counts, drug supply, and other characteristics from the US Census Bureau and the Centers for Disease Control and Prevention. After examining the characteristics of counties by the magnitudes of increases in drug mortality from 2010‒2013 to 2018-2021, we conducted a first-differenced regression analysis to test the associations between the job-to-Black workforce ratio and age-adjusted drug mortality rates among Black Americans in US counties and test the moderating effects of state-level fentanyl seizure rates. Results. One more job per 100 Black workers was associated with 0.29 fewer drug overdose deaths per 100 000 Black Americans in the county. This negative association was stronger in the counties of the states with higher increases in fentanyl seizure rates. Conclusions. Increasing employment opportunities can be an important strategy for preventing Black Americans' drug mortality, especially among those living in areas with higher increases in fentanyl seizure rates. (Am J Public Health. 2024;114(7):729-732. https://doi.org/10.2105/AJPH.2024.307646).
Collapse
Affiliation(s)
- Sehun Oh
- Sehun Oh is with the College of Social Work, The Ohio State University, Columbus. Manuel Cano is with the School of Social Work, Arizona State University, Phoenix
| | - Manuel Cano
- Sehun Oh is with the College of Social Work, The Ohio State University, Columbus. Manuel Cano is with the School of Social Work, Arizona State University, Phoenix
| |
Collapse
|
2
|
Oh S, Cano M, Kim Y. County-level industrial composition of the labor force and drug overdose mortality rates in the United States in 2018-2021. Am J Ind Med 2024; 67:636-645. [PMID: 38770905 PMCID: PMC11168858 DOI: 10.1002/ajim.23612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 04/25/2024] [Accepted: 05/04/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND Drug mortality risks vary among industries, creating distinctive geographic patterns across US counties. However, less is known about how local labor market structure relates to drug overdose mortality amid the synthetic opioid era in the United States. This study investigates the relationship between industry-specific job composition and drug overdose mortality at the county level while exploring how fentanyl's presence in illicit drug supplies may moderate the relationship. METHODS Data were derived from the National Center for Health Statistics' Multiple Cause of Death files for the rates of drug overdose mortality of any intent, linked with four other sources on industry-specific job shares, drug supply, and county-level sociodemographic characteristics and opioid prescribing rates from the US Census Bureau, the CDC, and the Drug Enforcement Administration. Negative binomial regression models were employed to examine associations between county industry-specific job composition and drug overdose mortality, with tests for moderating effects of state-level fentanyl seizure rates. RESULTS Our models indicate negative associations between job shares of manufacturing, retail trade, and educational services industries and drug overdose mortality. Positive associations were found for arts/entertainment/recreation and public administration. State-level fentanyl seizure rates had moderating effects on administrative/support/waste management/remediation (A/S/WM/R) and educational services. CONCLUSION Counties with a higher concentration of arts/entertainment/recreation and public administration jobs need targeted efforts to mitigate drug-related overdose risks. Additionally, areas with higher concentrations of A/S/WM/R service jobs, particularly where fentanyl seizure rates are higher, may require proactive harm reduction strategies for reducing overdose risks.
Collapse
Affiliation(s)
- Sehun Oh
- College of Social Work, The Ohio State University, Columbus, OH, United States
| | - Manuel Cano
- School of Social Work, Arizona State University, Phoenix, AZ, United States
| | - Yeonwoo Kim
- Department of Kinesiology, The University of Texas at Arlington, Arlington, TX, United States
| |
Collapse
|
3
|
Fink DS, Schleimer JP, Keyes KM, Branas CC, Cerdá M, Gruenwald P, Hasin D. Social and economic determinants of drug overdose deaths: a systematic review of spatial relationships. Soc Psychiatry Psychiatr Epidemiol 2024; 59:1087-1112. [PMID: 38356082 PMCID: PMC11178445 DOI: 10.1007/s00127-024-02622-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 01/11/2024] [Indexed: 02/16/2024]
Abstract
PURPOSE To synthesize the available evidence on the extent to which area-level socioeconomic conditions are associated with drug overdose deaths in the United States. METHODS We performed a systematic review (in MEDLINE, EMBASE, PsychINFO, Web of Science, EconLit) for papers published prior to July 2022. Eligible studies quantitatively estimated the association between an area-level measure of socioeconomic conditions and drug overdose deaths in the US, and were published in English. We assessed study quality using the Effective Public Health Practice Project Quality Assessment Tool. The protocol was preregistered at Prospero (CRD42019121317). RESULTS We identified 28 studies that estimated area-level effects of socioeconomic conditions on drug overdose deaths in the US. Studies were scored as having moderate to serious risk of bias attributed to both confounding and in analysis. Socioeconomic conditions and drug overdose death rates were moderately associated, and this was a consistent finding across a large number of measures and differences in study designs (e.g., cross-sectional versus longitudinal), years of data analyzed, and primary unit of analysis (e.g., ZIP code, county, state). CONCLUSIONS This review highlights the evidence for area-level socioeconomic conditions are an important factor underlying the geospatial distribution of drug overdose deaths in the US and the need to understand the mechanisms underlying these associations to inform future policy recommendations. The current evidence base suggests that, at least in the United States, employment, income, and poverty interventions may be effective targets for preventing drug overdose mortality rates.
Collapse
Affiliation(s)
- David S Fink
- New York State Psychiatric Institute, New York, NY, USA.
- Columbia University Mailman School of Public Health, New York, NY, USA.
| | - Julia P Schleimer
- Violence Prevention Research Program, Department of Emergency Medicine, University of California Davis, Sacramento, CA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Katherine M Keyes
- Columbia University Mailman School of Public Health, New York, NY, USA
| | - Charles C Branas
- Columbia University Mailman School of Public Health, New York, NY, USA
| | - Magdalena Cerdá
- Department of Population Health, New York University, New York, NY, USA
| | - Paul Gruenwald
- Prevention Research Center, Pacific Institute for Research and Evaluation, Berkeley, CA, USA
| | - Deborah Hasin
- New York State Psychiatric Institute, New York, NY, USA
- Columbia University Mailman School of Public Health, New York, NY, USA
| |
Collapse
|
4
|
Beland LP, Huh J, Kim D. The effect of opioid use on traffic fatalities. HEALTH ECONOMICS 2024; 33:1123-1132. [PMID: 38498377 DOI: 10.1002/hec.4817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 10/16/2023] [Accepted: 02/22/2024] [Indexed: 03/20/2024]
Abstract
We use a difference-in-differences design to study the effect of opioid use on traffic fatalities. Following Alpert et al., we focus on the 1996 introduction and marketing of OxyContin, and we examine its long-term impacts on traffic fatalities involving Schedule II drugs or heroin. Based on the national fatal vehicle crash database, we find that the states heavily targeted by the initial marketing of OxyContin (i.e., non-triplicate states) experienced 2.4 times more traffic fatalities (1.6 additional deaths per million individuals) involving Schedule II drugs or heroin during 2011-2019, when overdose deaths from heroin and fentanyl became more prominent. We find no difference in traffic fatalities until after the mid-2000s between states with and without a triplicate prescription program. The effect is mainly concentrated in fatal crashes with drug involvement of drivers ages between 25 and 44. Our results highlight additional long-term detrimental consequences of the introduction and marketing of OxyContin.
Collapse
Affiliation(s)
| | - Jason Huh
- Rensselaer Polytechnic Institute, Troy, New York, USA
| | - Dongwoo Kim
- University of Memphis, Memphis, Tennessee, USA
| |
Collapse
|
5
|
Lowenstein C. "Deaths of despair" over the business cycle: New estimates from a shift-share instrumental variables approach. ECONOMICS AND HUMAN BIOLOGY 2024; 53:101374. [PMID: 38518546 PMCID: PMC11060774 DOI: 10.1016/j.ehb.2024.101374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 01/31/2024] [Accepted: 03/10/2024] [Indexed: 03/24/2024]
Abstract
This study presents new evidence of the effects of short-term economic fluctuations on suicide, fatal drug overdose, and alcohol-related mortality among working-age adults in the United States from 2003-2017. Using a shift-share instrumental variables approach, I find that a one percentage point increase in the aggregate employment rate decreases current-year non-drug suicides by 1.7 percent. These protective effects are concentrated among working-age men and likely reflect a combination of individual labor market experiences as well as the indirect effects of local economic growth. I find no consistent evidence that short-term business cycle changes affect drug or alcohol-related mortality. While the estimated protective effects are small relative to secular increases in suicide in recent decades, these findings are suggestive of important, short-term economic factors affecting specific causes of death and should be considered alongside the longer-term and multifaceted social, economic, and cultural determinants of America's "despair" epidemic.
Collapse
Affiliation(s)
- Christopher Lowenstein
- University of California, Berkeley School of Public Health, Division of Health Policy and Management, 2121 Berkeley Way, Room 5302, Berkeley, CA 94720, United States.
| |
Collapse
|
6
|
Casal B, Iglesias E, Rivera B, Currais L, Storti CC. Identifying the impact of the business cycle on drug-related harms in European countries. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 122:104240. [PMID: 37890393 DOI: 10.1016/j.drugpo.2023.104240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 09/24/2023] [Accepted: 10/18/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND The evidence resulting from the analysis of the association between economic fluctuations and their impact on the substance use is mixed and inconclusive. Effects can be pro-cyclical (drug-related harms are predicted to rise when economic conditions improve), counter-cyclical (drug-related harms are predicted to rise in bad economic times) or unrelated to business cycle conditions as different transmission mechanisms could operate simultaneously. METHODS The main aim of this study is to assess, from a macroeconomic perspective, the impact of economic cycles on illegal drug-related harms in European countries over the 2000-2020 period. To this end, the regime-dependent relationship between drug-related harm, proxied by unemployment, and the business cycle, proxied by overdose deaths will be identified. Applying a time dynamic linear analysis, within the framework of threshold panel data models, structural-breaks will also be tested. RESULTS The relationship between economic cycles (proxied by unemployment) and drug-related harms (proxied by overdose deaths) is negative, and therefore found to be pro-cyclical. One percentage point in the country unemployment rate is predicted to reduce the overdose death rate by a statistically significant percentage of 2.42. A counter-cyclical component was identified during the 2008 economic recession. The threshold model captures two effects: when unemployment rates are lower than the estimated thresholds, ranging from 3.92% to 4.12%, drug-related harms and unemployment have a pro-cyclical relationship. However, when unemployment rates are higher than this threshold, this relationship becomes counter-cyclical. CONCLUSIONS The relationship between economic cycles and drug-related harms is pro-cyclical. However, in situations of economic downturns, a counter-cyclical effect is detected, as identified during the 2008 economic recession.
Collapse
Affiliation(s)
- Bruno Casal
- Faculty of Economics and Business, Department of Economy. University of A Coruña, A Coruña, Spain
| | - Emma Iglesias
- Faculty of Economics and Business, Department of Economy. University of A Coruña, A Coruña, Spain
| | - Berta Rivera
- Faculty of Economics and Business, Department of Economy. University of A Coruña, A Coruña, Spain.
| | - Luis Currais
- Faculty of Economics and Business, Department of Economy. University of A Coruña, A Coruña, Spain
| | - Claudia Costa Storti
- European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Lisbon, Portugal
| |
Collapse
|
7
|
Cano M, Oh S, Osborn P, Olowolaju SA, Sanchez A, Kim Y, Moreno AC. County-level predictors of US drug overdose mortality: A systematic review. Drug Alcohol Depend 2023; 242:109714. [PMID: 36463764 DOI: 10.1016/j.drugalcdep.2022.109714] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 11/21/2022] [Accepted: 11/21/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND This systematic review summarized published literature on county-level predictors of drug overdose mortality in the United States (US). METHODS Peer-reviewed studies and doctoral dissertations published in English between 1990 and July 19, 2022 were identified from PubMed, Web of Science, ProQuest Dissertations & Theses, PsycINFO, CINAHL, and EconLit. Eligible studies examined at least one county-level predictor of drug overdose mortality in US counties. Two reviewers independently completed screening, quality assessment (with an adapted National Institutes of Health Quality Assessment Tool), and data extraction. Results were qualitatively summarized and grouped by predictor categories. RESULTS Of 56 studies included, 42.9% were subnational, and 53.6% were limited to opioid overdose. In multiple studies, measures related to opioid prescribing, illness/disability, economic distress, mining employment, incarceration, family distress, and single-parent families were positively associated with drug overdose mortality outcomes, while measures related to cannabis dispensaries, substance use treatment, social capital, and family households were negatively associated with drug overdose mortality outcomes. Both positive and negative associations were documented for smoking, uninsurance, healthcare professional shortage status, physicians per capita, unemployment, income, poverty, educational attainment, racial composition, and rurality. Findings within studies also differed by subpopulation (by race/ethnicity, gender, age, or rurality) and the type of drugs involved in overdose. CONCLUSIONS The findings of this review provide relatively mixed evidence regarding many county-level predictors of overdose mortality, several of which also vary between subpopulations, supporting the importance of additional research to elucidate pathways through which the county context may shape risk of fatal overdose.
Collapse
Affiliation(s)
- Manuel Cano
- School of Social Work, Arizona State University, USA.
| | - Sehun Oh
- College of Social Work, The Ohio State University, USA
| | | | | | - Armando Sanchez
- Department of Social Work, University of Texas at San Antonio, USA
| | - Yeonwoo Kim
- Department of Kinesiology, University of Texas at Arlington, USA; School of Social Work, University of Texas at Arlington, USA
| | - Alberto Cano Moreno
- Department of Public Policy, Universidad Autónoma del Estado de Hidalgo, México
| |
Collapse
|
8
|
Kim Y, Cano M, Oh S, Betz M. County-Level Economic Changes and Drug Mortality in the United States: Evidence from the Great Recession. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16261. [PMID: 36498334 PMCID: PMC9737402 DOI: 10.3390/ijerph192316261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 11/21/2022] [Accepted: 11/26/2022] [Indexed: 06/17/2023]
Abstract
We aimed at examining whether county-level economic changes were associated with changes in county-level drug mortality rates since the Great Recession and whether the association is equally distributed across major sociodemographic subgroups. Using the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research (2004-2019), combined with census data, we conducted fixed effects analyses by including county-level economic changes as primary exposures and county-level drug-related mortality rates (per 100,000 people) from 2004-2007 (i.e., prior to the recession) to 2008-2011, 2012-2015, and 2016-2019 as an outcome variable based on 1833 counties. Our findings showed that drug mortality rates increased from 13.9 (2004-2007) to 16.0 (2008-2011), 18.0 (2012-2015), and 23.0 (2016-2019). Counties experiencing smaller median household income growth during and/or after the recession were associated with greater increase in drug mortality than counties experiencing larger median household income growth among the total population and all sociodemographic subgroups. Counties experiencing larger increases in unemployment rates and percentage of vacant housing units were associated with greater increase in drug mortality than counties experiencing smaller or no increase in unemployment rates and percentage of vacant housing units among certain sociodemographic subgroups. Findings suggest the importance of local economic contexts in understanding drug mortality risk since the recession. Drug overdose prevention polices need to be formulated by taking local economic changes following a major recession into consideration.
Collapse
Affiliation(s)
- Yeonwoo Kim
- Department of Kinesiology, University of Texas at Arlington, Arlington, TX 76019, USA
| | - Manuel Cano
- School of Social Work, Arizona State University, Phoenix, AZ 85008, USA
| | - Sehun Oh
- College of Social Work, The Ohio State University, Columbus, OH 43210, USA
| | - Michael Betz
- Department of Human Sciences, The Ohio State University, Columbus, OH 43210, USA
| |
Collapse
|
9
|
Hochstetler A, Peters DJ, Monnat SM. Prescription Opioid Resiliency and Vulnerability: A Mixed-Methods Comparative Case Study. AMERICAN JOURNAL OF CRIMINAL JUSTICE : AJCJ 2022; 47:651-671. [PMID: 36407839 PMCID: PMC9660123 DOI: 10.1007/s12103-022-09701-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 08/23/2022] [Indexed: 06/16/2023]
Abstract
Despite declines in prescription opioid overdoses, rural areas continue to have higher prescription opioid overdose rates than urban areas. We aim to understand high overdose places were resilient to the prescription opioid overdose crisis (better than predicted), while others were vulnerable (worse than predicted). First, we predicted prescription opioid overdose mortality in 2016-18 for N = 2,013 non-metropolitan counties using multivariable regression accounting. Second, we constructed a resiliency-vulnerability typology using observed, predicted, and residual values from the regression. Third, we selected a high-overdose resilient and vulnerable community for case study analysis using interviews, focus groups, and observations. High-overdose resilient and vulnerable places had disability-dispensing-overdose pathways, legacies of mining, and polysubstance drug abuse. Resilient places were larger population micropolitans with extensive health and social services, norms of redemption and acceptance of addiction, and community-wide mobilization of public and non-profit resources. Vulnerable places were smaller, more remote, lacked services, and stigmatized addiction.
Collapse
Affiliation(s)
- Andy Hochstetler
- Department of Sociology and Criminal Justice, Iowa State University, 103 East Hall, Ames, IA 50011-1070 USA
| | - David J. Peters
- Department of Sociology and Criminal Justice, Iowa State University, 103 East Hall, Ames, IA 50011-1070 USA
| | - Shannon M. Monnat
- Maxwell School of Citizenship and Public Affairs Center for Policy Research, Syracuse University, Syracuse, NY USA
| |
Collapse
|
10
|
Boslett A, Hill E. Mortality during Resource Booms and Busts. JOURNAL OF ENVIRONMENTAL ECONOMICS AND MANAGEMENT 2022; 115:102696. [PMID: 36643912 PMCID: PMC9835077 DOI: 10.1016/j.jeem.2022.102696] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Using national data on county-level mortality, coal mining, and shale development, we examine the effects of resource booms and busts on mortality in the United States. We find evidence that decreases in operating coal mines increased total all-cause mortality, non-drug mortality, and opioid overdose mortality, especially for counties with greater than 10 operating coal mines in 2000. Our model results for drug overdose mortality and opioid overdose mortality are sensitive to the panel's start year. For shale development, the shale boom is associated with increases in non-drug suicides but otherwise had little impact on mortality. Our findings suggest a potential role for job-training programs and the cultivation of local healthcare resources in regions suffering coal busts and suicide prevention in areas with shale development.
Collapse
Affiliation(s)
- Andrew Boslett
- Dept. of Public Health Sciences, University of Rochester Medical Center, Rochester, NY 14620
- Rochester Data Science Consortium, Rochester, NY 14604
| | - Elaine Hill
- Dept. of Public Health Sciences, University of Rochester Medical Center, Rochester, NY 14620
| |
Collapse
|
11
|
Betz MR, Jones LE. Do opioid prescriptions lead to fatal car crashes? AMERICAN JOURNAL OF HEALTH ECONOMICS 2022; 8:359-386. [PMID: 36910277 PMCID: PMC9997667 DOI: 10.1086/718511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Widespread opioid misuse suggests a potential for increased fatal car crashes. However, opioid use may not necessarily lead to additional crashes if drivers respond to opioid prevalence by substituting away from more inebriating intoxicants like alcohol. Combining data on local opioid prescription rates and car crashes from the Fatality Analysis and Reporting System, we use two-way fixed effects models to test the direction of the association between prescribing intensity and crash fatalities between 2007 and 2016. We estimate that a 10 percent increase in the local prescription rate is associated with a 1 percent increase in the number of driver deaths in motor vehicle accidents. The association is robust to several model specifications, and isolated to drivers most affected by the opioid crisis: males and 25 to 34 year-olds.
Collapse
Affiliation(s)
- Michael R Betz
- Department of Human Sciences, The Ohio State University, 171A Campbell Hall, 1787 Neil Ave., Columbus, Ohio, 43201
| | - Lauren E Jones
- Department of Human Sciences and John Glenn College of Public Affairs, The Ohio State University, 115E Campbell Hall, 1787 Neil Ave., Columbus, Ohio, 43201
| |
Collapse
|
12
|
Cano M, Agan A, Bandoian L, Larochelle L. Individual and County-Level Disparities in Drug and Opioid Overdose Mortality for Hispanic Men in Massachusetts and the Northeast United States. Subst Use Misuse 2022; 57:1131-1143. [PMID: 35459423 DOI: 10.1080/10826084.2022.2064507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND This study aimed to identify individual- and county-level inequalities that may underlie disparities in drug overdose mortality for Hispanic men in Massachusetts and the broader Northeast region. METHODS The study first used data from the State Unintentional Drug Overdose Reporting System to compare the 635 Hispanic and 3593 Non-Hispanic (NH) White men who died of unintentional/undetermined opioid-related overdoses in Massachusetts in 2016-2018. Next, the study used 2015-2019 data from the Multiple Cause of Death online platform to: a) compare rates of drug overdose mortality in Hispanic versus NH White men in 54 counties in the Northeast United States; and b) examine associations with inequalities in poverty, educational attainment, unemployment, and uninsurance (from 2015-2019 American Community Survey data). RESULTS At the individual level, in Massachusetts, Hispanic and NH White men who died of opioid-related overdose differed in terms of educational attainment, birthplace, urbanicity, substance use disorder treatment history, and specific drugs involved in death. At the county level, in the Northeast region, each one-standard deviation increase in the ratio of the Hispanic to NH White poverty rate was associated with a 27% increase in the ratio of Hispanic to NH White male overdose mortality; each one-standard deviation increase in the ratio of the Hispanic to NH White unemployment rate was associated with a 43% increase in the ratio of Hispanic to NH White male overdose mortality. CONCLUSIONS Findings underscore the importance of equitable interventions and efforts to address inequalities in social determinants of health for Hispanic populations in the Northeast.
Collapse
Affiliation(s)
- Manuel Cano
- Department of Social Work, The University of Texas at San Antonio, San Antonio, Texas, USA
| | - Anna Agan
- Massachusetts Department of Public Health, Boston, Massachusetts, USA
| | - Lisa Bandoian
- Massachusetts Department of Public Health, Boston, Massachusetts, USA
| | - Lauren Larochelle
- Massachusetts Department of Public Health, Boston, Massachusetts, USA
| |
Collapse
|
13
|
Park S, Powell D. Is the rise in illicit opioids affecting labor supply and disability claiming rates? JOURNAL OF HEALTH ECONOMICS 2021; 76:102430. [PMID: 33524644 PMCID: PMC7965359 DOI: 10.1016/j.jhealeco.2021.102430] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 01/04/2021] [Accepted: 01/05/2021] [Indexed: 05/13/2023]
Abstract
This paper examines how the recent transition of the opioid crisis from prescription opioids to more prevalent misuse of illicit opioids, such as heroin and fentanyl, altered labor supply behavior and disability insurance claiming rates. We exploit differential geographic exposure to the reformulation of OxyContin, the largest reduction in access to abusable prescription opioids to date, to study the effects of substitution to illicit markets. We observe meaningful reductions in labor supply measured in terms of employment-to-population ratios, hours worked, and earnings in states more exposed to reformulation relative to those less exposed. We also find evidence of increases in disability applications and beneficiaries.
Collapse
Affiliation(s)
- Sujeong Park
- RAND, 1776 Main St., Santa Monica, CA, 90407, United States.
| | - David Powell
- RAND, 1200 S. Hayes St., Arlington, VA, 22202, United States.
| |
Collapse
|
14
|
Seltzer N. The economic underpinnings of the drug epidemic. SSM Popul Health 2020; 12:100679. [PMID: 33319025 PMCID: PMC7725949 DOI: 10.1016/j.ssmph.2020.100679] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 10/09/2020] [Accepted: 10/10/2020] [Indexed: 12/20/2022] Open
Abstract
U.S. labor markets have experienced transformative change over the past half century. Spurred on by global economic change, robotization, and the decline of labor unions, state labor markets have shifted away from an occupational regime dominated by the production of goods to one characterized by the provision of services. Prior studies have proposed that the deterioration of employment opportunities may be associated with the rise of substance use disorders and drug overdose deaths, yet no clear link between changes in labor market dynamics in the U.S. manufacturing sector and drug overdose deaths has been established. Using restricted-use vital registration records between 1999 and 2017 that comprise over 700,000 drug deaths, I test two questions: First, what is the association between manufacturing decline and drug and opioid overdose mortality rates? Second, how much of the increase in these drug-related outcomes can be predicted by manufacturing decline? The findings provide strong evidence that the restructuring of the U.S. labor market has played an important upstream role in the current drug crisis. Up to 92,000 overdose deaths for men and up to 44,000 overdose deaths for women are predicted by the decline of state-level manufacturing over this nearly two-decade period. These results persist in models that adjust for other social, economic, and policy trends changing at the same time. Critically, the findings signal the value of policy interventions that aim to reduce persistent economic precarity experienced by individuals and communities, especially the economic strain placed upon the middle class.
Collapse
Affiliation(s)
- Nathan Seltzer
- Department of Demography, Berkeley Population Center, University of California, Berkeley, USA
| |
Collapse
|
15
|
Peters DJ, Monnat SM, Hochstetler AL, Berg MT. The Opioid Hydra: Understanding Overdose Mortality Epidemics and Syndemics Across the Rural-Urban Continuum. RURAL SOCIOLOGY 2020; 85:589-622. [PMID: 33814639 PMCID: PMC8018687 DOI: 10.1111/ruso.12307] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
The rapid increase of fatal opioid overdoses over the past two decades is a major U.S. public health problem, especially in non-metropolitan communities. The crisis has transitioned from pharmaceuticals to illicit synthetic opioids and street mixtures, especially in urban areas. Using latent profile analysis, we classify n = 3,079 counties into distinct classes using CDC fatal overdose rates for specific opioids in 2002-2004, 2008-2012, and 2014-2016. We identify three distinct epidemics (prescription opioids, heroin, and prescription-synthetic opioid mixtures) and one syndemic involving all opioids. We find that prescription-related epidemic counties, whether rural or urban, have been "left behind" the rest of the nation. These communities are less populated and more remote, older and mostly white, have a history of drug abuse, and are former farm and factory communities that have been in decline since the 1990s. Overdoses in these places exemplify the "deaths of despair" narrative. By contrast, heroin and opioid syndemic counties tend to be more urban, connected to interstates, ethnically diverse, and in general more economically secure. The urban opioid crisis follows the path of previous drug epidemics, affecting a disadvantaged subpopulation that has been left behind rather than the entire community. County data on opioid epidemic class membership are provided.
Collapse
Affiliation(s)
| | - Shannon M Monnat
- Maxwell School of Citizenship and Public Affairs, Syracuse University
| | | | - Mark T Berg
- Department of Sociology and Criminology, University of Iowa
| |
Collapse
|
16
|
Nicewonder JA, Buros AF, Veltri CA, Grundmann O. Distinct kratom user populations across the United States: A regional analysis based on an online survey. Hum Psychopharmacol 2019; 34:e2709. [PMID: 31347212 DOI: 10.1002/hup.2709] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 06/03/2019] [Accepted: 06/05/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Kratom preparations have raised concerns of public health and safety in the United States. This paper analyzed the patterns and predictors of kratom use by four U.S. regions according to the U.S. Census. METHOD An anonymous cross-sectional online survey yielded 8,049 valid responses. The data were categorised by regions (Northeast, South, Midwest, and West) and analyzed for the following predictors: age, gender, marital status, ethnicity, employment status, insurance coverage, education, and household income. RESULTS After adjusting for state population, the survey response rates were highest from Oregon, Idaho, and Florida. Kratom use was significantly lower for both prescription drug dependency and acute or chronic pain in the Northeast region than the rest of the country. Multiple logistic regression models found that gender, employment, and education were significant on the regional level. Higher education was associated with lower kratom use for an illicit drug dependency (p = .002) independent of region whereas men were less likely to use kratom for acute or chronic pain in the Northeast (p < .001) but more likely in the Midwest (p = .041). CONCLUSIONS The regional pattern of kratom use differed from opioid use data in both demographics and trend direction warranting further investigation.
Collapse
Affiliation(s)
- Jessica A Nicewonder
- Department of Pharmaceutical Sciences, College of Pharmacy, Midwestern University, Glendale, Arizona, United States
| | - Amy F Buros
- Office of Research and Sponsored Programs, Midwestern University, Glendale, Arizona, United States
| | - Charles A Veltri
- Department of Pharmaceutical Sciences, College of Pharmacy, Midwestern University, Glendale, Arizona, United States
| | - Oliver Grundmann
- Department of Pharmaceutical Sciences, College of Pharmacy, Midwestern University, Glendale, Arizona, United States.,Department of Medicinal Chemistry, College of Pharmacy, University of Gainesville, Florida, United States
| |
Collapse
|