Deaths of Despair or Drug Problems?

Ruhm, Christopher J.

doi:10.3386/w24188

Cited by 86 publications

(77 citation statements)

References 56 publications

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“…Courtemanche, Marton, Ukert, Yelowitz, & Zapata, 2017;Kaestner, Garrett, Chen, Gangopadhyaya, & Fleming, 2017) and a number of studies that examine factors that might be responsible for rising opioid deaths (e.g. Ruhm, 2018). Several studies examine the effect of Medicaid expansion on opioid-related outcomes.…”

Section: Literaturementioning

confidence: 99%

Medicaid expansion and opioid deaths

2019

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The United States is in the midst of an opioid epidemic, and drug overdose deaths are becoming a leading cause of death. Meanwhile, in 2010, the United States passed comprehensive health care reform providing access to care for millions of individuals who previously lacked care. Part of the new access came from expanding Medicaid, the insurance program for low‐income individuals. Expanding Medicaid was optional for states. Those individuals living in expansion states gained prescription drug coverage and hence more access to opioid pain‐relievers that are known to be addictive. However, they also gained access to medication‐assisted treatment for addiction. This paper uses a difference‐in‐differences approach and state‐level data from 2010 to 2017 to compare opioid death rates in expansion and non‐expansion states to determine if Medicaid expansion was a potential cause of rising opioid deaths. We find no evidence that Medicaid expansion is related to opioid deaths.

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Section: Literaturementioning

confidence: 99%

Medicaid expansion and opioid deaths

2019

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“…5–8 This theory may explain the income gradient observed in the opioid epidemic; across the racial/ethnic spectrum, higher overdose rates are observed in lower-income communities. 6 However, given continued racial/ethnic disparities in income and employment status, this theory alone cannot account for the preponderance of the epidemic among white communities.…”

mentioning

confidence: 99%

Assessment of Racial/Ethnic and Income Disparities in the Prescription of Opioids and Other Controlled Medications in California

et al. 2019

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IMPORTANCE Most drug epidemics in the United States have disproportionately affected nonwhite communities. Notably, the current opioid epidemic is heavily concentrated among low-income white communities, and the roots of this racial/ethnic phenomenon have not been adequately explained. OBJECTIVE To examine the degree to which differential exposure to opioids via the health care system by race/ethnicity and income could be driving the observed social gradient of the current opioid epidemic, as well as to compare the trends in the prevalence of prescription opioids with those observed for stimulants and benzodiazepines. DESIGN, SETTING, AND PARTICIPANTS This population-based study used 2011 through 2015 records from California’s prescription drug monitoring program (Controlled Substance Utilization Review and Evaluation System), which longitudinally tracks all patients receiving controlled substance prescriptions in the state and contained unique records for 29.7 million individuals who received such a prescription from 2011 to 2015. Data were analyzed between January and May 2018. EXPOSURES A total of 1760 zip code tabulation areas (ZCTAs) in California, with associated racial/ethnic composition and per capita income. MAIN OUTCOMES AND MEASURES The percentage of individuals receiving at least 1 prescription each year was calculated for opioids, benzodiazepines, and stimulants. RESULTS A nearly 300% difference in opioid prescription prevalence across the race/ethnicity-income gradient was observed in California, with 44.2% of adults in the quintile of ZCTAs with the lowest-income/highest proportion-white population receiving at least 1 opioid prescription each year compared with 16.1% in the quintile with the highest-income/lowest proportion-white population and 23.6% of all individuals 15 years or older. Stimulant prescriptions were highly concentrated in mostly white high-income areas, with a prevalence of 3.8% among individuals in the quintile with the highest-income/highest proportion-white population and a prevalence of 0.6% in the quintile with the lowest-income/lowest proportion-white population. Benzodiazepine prescriptions did not have an income gradient but were concentrated in mostly white areas, with 15.7% of adults in the quintile of ZCTAs with the highest proportion-white population receiving at least 1 prescription each year compared with 7.0% among the quintile with the lowest proportion-white population. CONCLUSIONS AND RELEVANCE The race/ethnicity and income pattern of opioid overdoses mirrored prescription rates, suggesting that differential exposure to opioids via the health care system may have induced the large, observed racial/ethnic gradient in the opioid epidemic. Across drug categories, controlled medications were much more likely to be prescribed to individuals living in majority-white areas. These discrepancies may have shielded nonwhite communities from the brunt of the prescription opioid epidemic but also represent disparities in treatment and access to all medications.

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“…OxyContin. In addition, mortality data shows a sharp rise in deaths involving illicit opioids after 2010 (Ruhm (2018). If prescription opioids were less frequently abused after 2010, this could lead our estimates to understate the strength of the relationship pre-2010 and overstate the relationship post-2010.…”

Section: Implications Of Increasing Illegal Opioid Usage After 2010mentioning

confidence: 94%

“…15 Ruhm (2018) finds that medium-term economic conditions do not appear to be the main driver opioid deaths.…”

Section: Reverse Causality: the Impact Of Unemployment Shocks On Opiomentioning

confidence: 99%

Opioids and the Labor Market

Aliprantis

Fee

Schweitzer

2019

Working Paper (Federal Reserve Bank of Cleveland)

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This paper studies the relationship between local opioid prescription rates and labor market outcomes. We improve the joint measurement of labor market outcomes and prescription rates in the rural areas where nearly 30 percent of the US population lives. We fi nd that increasing the local prescription rate by 10 percent decreases the prime-age employment rate by 0.50 percentage points for men and 0.17 percentage points for women. This eff ect is larger for white men with less than a BA (0.70 percentage points) and largest for minority men with less than a BA (1.01 percentage points). Geography is an obstacle to giving a causal interpretation to these results, especially since they were estimated in the midst of a large recession and recovery that generated considerable crosssectional variation in local economic performance. We show that our results are not sensitive to most approaches to controlling for places experiencing either contemporaneous labor market shocks or persistently weak labor market conditions. We also present evidence on reverse causality, fi nding that a short-term unemployment shock did not increase the share of people abusing prescription opioids. Our estimates imply that prescription opioids can account for 44 percent of the realized national decrease in men's labor force participation between 2001 and 2015.JEL Classifi cation Codes: I10, J22, J28, R12.

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Deaths of Despair or Drug Problems?

Cited by 86 publications

References 56 publications

Medicaid expansion and opioid deaths

Medicaid expansion and opioid deaths

Assessment of Racial/Ethnic and Income Disparities in the Prescription of Opioids and Other Controlled Medications in California

Opioids and the Labor Market

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