Deaths of Despair or Drug Problems?

70 Pages Posted: 9 Jan 2018

See all articles by Christopher J. Ruhm

Christopher J. Ruhm

University of Virginia - Frank Batten School of Leadership and Public Policy; National Bureau of Economic Research (NBER); IZA Institute of Labor Economics

Date Written: January 2018

Abstract

The United States is in the midst of a fatal drug epidemic. This study uses data from the Multiple Cause of Death Files to examine the extent to which increases in county-level drug mortality rates from 1999-2015 are due to “deaths of despair”, measured here by deterioration in medium-run economic conditions, or if they instead are more likely to reflect changes in the “drug environment” in ways that present differential risks to population subgroups. A primary finding is that counties experiencing relative economic decline did experience higher growth in drug mortality than those with more robust growth, but the relationship is weak and mostly explained by confounding factors. In the preferred estimates, changes in economic conditions account for less than one-tenth of the rise in drug and opioid-involved mortality rates. The contribution of economic factors is even less when accounting for plausible selection on unobservables, with even a small amount of remaining confounding factors being sufficient to entirely eliminate the relationship. These results suggest that the “deaths of despair” framing, while provocative, is unlikely to explain the main sources of the fatal drug epidemic and that efforts to improve economic conditions in distressed locations, while desirable for other reasons, are not likely to yield significant reductions in drug mortality. 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. Put succinctly, the fatal overdose epidemic is likely to primarily reflect drug problems rather than deaths of despair.

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Suggested Citation

Ruhm, Christopher J., Deaths of Despair or Drug Problems? (January 2018). NBER Working Paper No. w24188. Available at SSRN: https://ssrn.com/abstract=3097980

Christopher J. Ruhm (Contact Author)

University of Virginia - Frank Batten School of Leadership and Public Policy ( email )

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HOME PAGE: http://batten.virginia.edu/cruhm.html

National Bureau of Economic Research (NBER) ( email )

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IZA Institute of Labor Economics ( email )

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