The East-West Divide of the U.S. Fentanyl Crisis and the Decline in Manufacturing Employment

Abstract

We document the historical segmentation of the U.S. heroin market near the Mississippi River: Black tar heroin is predominant in the West and largely absent in the East, where, instead, powder heroin is dominant. Because fentanyl is more easily mixed with powder heroin, the surge in synthetic opioid mortality was much faster in the East than in the West. These findings shed new light on the "deaths of despair" view of the opioid crisis: Historical differences in heroin type partly drive the correlation between manufacturing job losses (which are more widespread in the East) and synthetic opioid mortality.

Keywords: fentanyl, opioid crisis, manufacturing

JEL Classification: J21, I12, I18