Alan Krueger on opioids and labor force participation

I haven’t had a chance to look at this one, but here is the headline summary from Brookings:

The new paper, published in the Fall 2017 edition of the Brookings Papers on Economic Activity, makes a strong case for looking at the opioid epidemic as one driver of declining labor force participation rates.

In fact, Krueger suggests that the increase in opioid prescriptions from 1999 to 2015 could account for about 20 percent of the observed decline in men’s labor force participation during that same period, and 25 percent of the observed decline in women’s labor force participation.

Here is the Brookings link.


An additional cost of treating medical care as just one more consumer product.

How do (most) people become addicted to opiods? Do people use them like other recreational drugs and become addicted or do they become addicted after using them for pain relief for some (originally) legitimate medical reason? If the latter, why are doctors not changing their prescription and/or patient monitoring practices to mitigate addiction risk? If the former, how is opiod addiction different from drug problems in previous eras (cocaine, crack, etc.), i.e., solvable primarily through education and old-fashioned Just Say No?

The Big Pharma companies have been lying to doctors about their opiod products.
They claim they are not addictive and they address the pain issues.
These are both false in many cases and large lawsuits have been filed and won.
When prescriptions are restricted, people addicted to prescription opioids turn to heroin
Big Pharma created a supply of users who now must maintain a habit These victims need medical help to deal with their addiction.
We need to stop prescribing these products to reduce the numbers of new addicts

I work for a premier drug and alcohol treatment provider. Jonny Bakho's summary is spot on.

So, now that doctors know better, should we see opioid addiction begin to decline?

I think so. Pain management and the opioid crisis is a huge topic of constant conversation in the medical profession.

Numbers from memory. Approx 2015.

USA doctors write almost 4 billion (!!!) prescriptions per year. 300 million of those are for opioids.

There is a culture of pill taking out there.

My nephew became addicted through Call of Duty. Kids would trade their drugs around. Kids with add would trade with kids who's parents or grandparents were on pain killers. There were enough ppl on Xbox live who were dealing Chinese product. At a certain point, you stop having the ability to choose whether you want to use or not.

If supply of money for Pharms dries up, there's heroin for 10 bucks a pop. Then it's all downhill from there.

Fortunately, there are ways out. But it's a hell of a road.

Definitely seems related, though I'll have to read it closely for his ideas on causation. It also notes that other people outside of the labor force claim that pain alone prevents them from getting a job, so perhaps some of them just need pain medication due to age? (Some of the change in LPF is an aging population.)

I have no doubt that many people get these on Medicare and Medicaid as well as private insurance, but opioids are also so cheap that I have a hard time imagining that insurance coverage is necessary for people who want them and can find a doctor to prescribe them to get them.

You are absolutely right that opiods can be purchased on the cheap. Heroin is readily available and can be purchased for about the cost of a Starbuck's Venti Latte.

Prescription opioids purchased legally with a doctor's script are very cheap: I had surgery on my foot last year and a Percoset Rx cost less than $5. However pills bought on the street are not cheap. A relative who had an addiction problem told me a few years back that oxycontin was going for $20 a pill.

Chicken or the egg? Perhaps people who are not participating in the economic life of a region seek the anodyne of opiates. What else is there for them to do? Disability is more secure than unemployment. Seeking to achieve disabled status causes focus on health and pain leading to medicalization of conditions that an employed productive person might tolerate and endure. Thus, prescriptions and addiction.
A couple of years ago, this site talked about low productivity individuals; they were called ZPGs or something like that. Dope is what they do.

+1 (file under: "correlation is not causation") filing needed -- one can very safely ignore anything and everything Krueger says

Correlation = Causation if and only if the variables in question fit one's preconceived faith-based belief system.

"Correlation = Causation if and only if the variables in question fit one’s preconceived faith-based belief system."

Sure, but life it about faith.

"What else is there for them to do?"

Oh, they could go fishing, do some gardening, haunt the library, dwell on the big eye, put ships in bottles and on and on.

Going fishing or gardening might jeopardize their Social Security Disability application. By the time you have proven yourself to be disabled which is defined as being down for six months, you might be hopelessly addicted. I am not saying that this is the way it is nor the way it should be, but I think that the relationship between unemployment and substance abuse is not a straight forward one-way street.

They could always play video games, watch Netflix, and post on blogs, twitter and Facebook.

You were speaking of "people who are not participating in the economic life of a region" before you moved on to those receiving disability. The most interesting recipients of disability benefits are law enforcement personnel, like this fellow: And, of course, these:

Its quaint that you think anyone checks on anybody.

The government just has a hurdle to get approval. Once that's done, there is no enforcement.

My "disabled" landlord re-did the electrical himself and also re-roofed the house himself.

You're not disabled if you can roof.

People on disability must periodically have their disability recertified by medical personnel, with condition-appropriate testing. I know someone whose disability (private, not SSDI) was cancelled because he was deemed no longer too disabled to work.

>private, not SSDI

And..... there you go.

"You’re not disabled if you can roof."

That's not necessarily true at all. There's a big difference between doing a few hours of work here and there on your own property at your own pace at your own time, and working consistently +30 hours a week at a company's schedule and all the other stresses that jobs entail. It's so common for people to have a complete misunderstanding of what it's like to live with some disabling conditions, or even completely forget that millions of people have illnesses that aren't visible.

The SSA sends spies or maybe drones around to check out people's back yards and see if they have a garden?


Social Security doesn't check. I have a close relative who has been on it for 35 years, not a single check done in that entire time. He might be that exceptional case, but it is unlikely.

Here's some info:

"When your application for Social Security disability benefits is approved, the disability determination representative who handled your claim will set the dates for your continuing disability reviews (these dates are sometimes called “diaries”). The Certificate of Award you received when your claim was approved should indicate when you can expect your first review. Generally speaking, CDRs are set at every three years or every seven years."

There is a lot for them to do as slugger says but there is evidence that for blue collar types idle hand can lead to early death:

" people who are not participating in the economic life of a region"

Unless they're dead everyone is participating in the economic life of a region.

It's also true that people who become severely addicted are generally unemployable. Some years back I watched a family member turn herself into a zombie with Vicodin. No way could she have held down a job in that state (she's recovered from the addiction, but has a degenerative back problem and remains unable to work at any job she'd have the skills for).

People who fail drug tests get fired.
People who cannot pass a drug test do not get hired.
We not only have an effect, we have a mechanism to explain the effect
The AlAnon NarcAnon is across the street from me and they get at least 2 ambulance runs a week. A city of 100K with almost one overdose per day. It is epidemic in the MidWest

"a strong case for looking at the opioid epidemic as one driver of declining labor force participation rates"

and vice-versa, no doubt ...

The way to disentangle the two is to use the findings in Sam Quinones' award-winning book "Dreamland." Quinones makes clear that a lot of the regional variation in the heroin epidemic is supply side driven by Mexican cartels choosing obscure white parts of the country that get little attention, and intentionally avoiding heavily black big cities due to fear of black violence, both directly and due to the attention it brings.

While heroin is an opioid, Krueger's study does not focus on heroin use or addiction:

"...Krueger suggests that the increase in opioid prescriptions from 1999 to 2015 could account for about 20 percent of the observed decline in men’s labor force participation during that same period, and 25 percent of the observed decline in women’s labor force participation.

I doubt very uch that Mexican cartel members are writing those prescriptions. Perhaps we should rather focus our blame on the AMA cartel.

Also, as regards causation, (and for the benefit of many of the commenters, above) Krueger had this to say (in the Brookings article):

"Krueger notes that, 'Regardless of the direction of causality, the opioid crisis and depressed labor force participation are now intertwined in many parts of the U.S.” He argues that finding a solution to the decades-long slide in labor force participation by prime-age men should be “a national priority.” Men who are outside the workforce, he writes, express very low levels of subjective well-being and report deriving relatively little meaning from their daily activities.'"

"finding a solution to the decades-long slide in labor force participation by prime-age men should be “a national priority.”

Why? If these guys have found a way to survive without being employed, without having a job to go to everyday, more power to them, especially if the job is physically demanding, dirty and tiring, unlike that of an economist studying labor force participation. The Puritan/Protestant obsession with work isn't embraced by everyone but those that reject it are stigmatized. Maybe that's why there's a correspondence to some extent between drug use and unemployment.

"If this guys have found a way to survive without being employed...more power to them..."

I can think of two primary ways the majority of "these guys" are finding a way to survive without being employed:

1. The various welfare and safety net programs that they are likely using, to wit, unemployment, Medicaid, SS disability, subsidized housing, food stamps, etc., etc.

2. Crime.

Perhaps a few are living from the generosity of family members and others (including taxpayer subsidized charities), but do you really think this is something one should respond to with "more power to you"?

I'm not even going to get into the pain "these guys" are frequently causing their family members and others close to them.

"The various welfare and safety net programs" aren't any different than subsidies to farmers, pentagon purchases, ostentatious government buildings and free transportation to members of congress. Why would you expect people uninterested in working to leave money on the street? It's not like they're becoming wealthy anyway. Much of the crime engaged in by those rejecting labor force participation is violation of regulations that govern untaxed cigarette sales, prostitution, and other black market activity. Not all of them engage in armed robbery.

Philosophically, why should a human born in a certain place be excluded from exploiting the resources of that place unless they have access to wealth from previous generations or are willing to become an employee? Actually, this situation is relatively new in human history. There was no such thing as a "job" as we know it until recently. No one should be surprised that some people have yet to conform to this new paradigm.

What else are they to do?--look for a job or improve skill sets in order to be hired.

The fact they have another option, opiods, that they choose hardly invalidates the claim that opiods are responsible for x% decline in the LF

Such is life in a country that decided to lay upon the altar of greedy the dearest and the best, sacrificing to the all-consuming Moloch their souls and selling their children into bondage in exchange for a mess of pottage. As famous Brazilian writer Lima Barreto wrote, Amerucan motto is, "make money, honestly if you can, but anyway makw money". America has become an indicting example of what happens when greedy is good and one worships the Almighty Dollar.

Because drugs are such a uniquely American problem.

Those are very different situations. The reason the richest country in the world has drugs comsumption comparable to Third World hells like Mexico, Iran and Afghanistan is the alienation of a populace who can stand anymore to be sacrificed to the greed Moloch.

I think you forgot to mention one of the Third World countries on that list .....

It is different. Unfortunately, the war against Paraguay, the 1924 Revolution and the collapse of the military rule (1964-1985) created budgetary concerns and public service issues. It is different f4pm the richest country mankind has ever known deciding throw its own citizens under a bus to buy vcheap undergarments and tinkertoys.

>Such is life in a country...

Hey, at least the food is good.

Brazilian food is much better and plentiful. Brazil has the biggest protein producer company in the world. Brazil is a big producer of soy, milk, rice, coffee, oranges, steel, airplanes, cars, beans, meat, eggs, greens and fruits.

No, I think you mean Uruguay

Well, clearly that whole war on decongestants was misguided.

What would the numbers be with "less regulation?"

Our society has become so rich (and so secular) that opiates are the opium of the people. This is called progress.

If we were a compassionate society we'd worry a lot more about why so many of our neighbors are desperately sad and lonely.

"If we were a compassionate society we’d worry a lot more about why so many of our neighbors are desperately sad and lonely."

Or even a sensible society that wanted to reduce drug abuse.

"Religion is the opium of the people" - paraphrase of Karl Marx

We are becoming less religious.

Nobody was saying this about the crack epidemic in the 1980s.
I wonder why.

Umm, yes they were. Oh generally, the crack epidemic was blamed more directly on high black unemployment, inequitable legal treatment and decaying inner cities. But those were generally considered failings of a compassionate society.

Really? Cause it seemed to me like it was blamed on criminal gangs - thus the three strikes your out zero tolerance policies, and heavier sentences for crack cocaine.

" thus the three strikes your out zero tolerance policies"

The three strikes laws were a 1990's phenomenon.

"In the United States, habitual offender laws (commonly referred to as three-strikes laws) were first implemented on March 7, 1994 and are part of the United States Justice Department's Anti- Violence Strategy.These laws require a person guilty of committing both a severe violent felony and two other previous convictions to serve a mandatory life sentence in prison.[5][6] The purpose of the laws is to drastically increase the punishment of those convicted of more than two serious crimes."

The 1980's was the time of the famous Nancy Reagan "Just Say No" campaign.

Which, when you think about it, is a very Libertarian solution to a drug addiction problem.

The crack epidemic was still going on in the early 1990s.

Policy always tends to lag events, and I think it's pretty fair to say that the three strikes laws were intended to address the increase in violence associated with the drug trade.

And of course the "War on Drugs" spanned the entire period, before and after the crack epidemic.

"Policy always tends to lag events, and I think it’s pretty fair to say that the three strikes laws were intended to address the increase in violence associated with the drug trade."

Sure, but it's also pretty clear there was plenty of steps in between. And the Three strikes laws were specifically going after the repeat offenders. IE the drug dealers. To claim that "no one" had compassion toward dysfunctional crack drug users during the 1980's is hyperbolic.

I can't wait for the Ivanka Trump Super Predator speech, I think it will really wake up the heartland.

It seems doubtful is she'll follow in the footsteps of one of Hillary Clinton's most notable gaffes from the 1990's.

""They are often the kinds of kids that are called 'super-predators,' " Clinton said in 1996, at the height of anxiety during her husband's administration about high rates of crime and violence. "No conscience, no empathy, we can talk about why they ended up that way, but first we have to bring them to heel.""

"Our society has become so rich (and so secular) that opiates are the opium of the people."
Great line there. I think I'll use it.

Trump supporters must have been high on something.

Methamphetamine abuse would certainly explain the paranoia.

Your tears are hilarious.

Just 3.5 more years, fellas! Or 7.5 tops! Hang in there!!!

And then, I will laugh at the tears continuing under President Pence for 8 more years!!

We tend to blame addicts: old people in pain, lazy ones without jobs. It's easy to feel that way after being hurt by an addict friend or family member. Yes, those individuals are responsible of their actions, but.....take a pause and think about the people that got into addiction by prescription.

The NCAA has an interesting opinion on opioids and young healthy people: " the risk painkillers pose to young athletes...injuries are natural to sport, and pain management is natural to recovery from many injuries. But there is another side to their use: the easy introduction to their potent high through initial prescriptions; ready access to more pills through black markets; and eventually, a pathway to dangerous street drugs."

This is a quite emotional opioid addiction story of a young athlete, it's just an anecdote but it can show another angle to the story:

In recent years the popular hypotheses about declining labor force participation seem to be either opioids or video games.

And what caused the increase in opioid use? Nobody who is gainfully employed and happily married just starts using opioids. I see opioid addicts and alcoholic patients every day, in most cases substance addiction is long term suicide. It is drawn out self-destruction brought on by hopelessness instead of an immediate end.

Nobody who is gainfully employed and happily married just starts using opioids.

I'm not sure this is true at all.
People can get started on opioids due to some sort of chronic pain, say back pain in their 1950s. The back pain then becomes an excuse to keep taking opioids, as long as their doctor keeps prescribing them.

The things I wonder how much of this opioid "epidemic" is really that big of a problem.
If someone remains gainfully employed and can pay for the drugs, and if it's not ruining their life, who cares?
We should only care about the addicts who can't handle their drugs.

What were they hoping for, that they have become hopeless about?

I wonder if this is because people are failing drug tests. There are high functioning addicts who can manage a drug addition and still be competent at their jobs. But if you flunk a drug test, you might not be able to get another job.

And expanded Medicaid contributes to the availability of opioids. Health insurance any not be good for everyone.

Economists are desperate to find excuses for their ineptitude.

This week, Stephen West's Philosophize This! covered Theodor Adorno/Max Horkheimer theory of leisure time and the culture industry. I realize this seems off topic but I cannot shake the feeling that boredom and apathy are at the root of this epidemic. We numb ourselves to cope with the monotony of our lives: TV, alcohol, food, drugs. Our leisure time is spent resting up or preparing for the next day of work. For those out of work, many spend their days playing video games or watching TV. We are inundated with products that will make our lives radically better but never really fill the gaping loneliness of modern life. Our current form of capitalism seems to be failing too many Americans. Or we can simply blame opioids and video games for low labor force participation among certain demographics.

Whatever truth to this there is, what exactly is the alternative? Ban TV and video games? What products will "really fill the gaping loneliness of modern life"?

The fact is for most of history almost everyone had almost zero leisure time. You got up, worked at the farm/factory until sundown, had dinner, and went to bed, then did it all again the next day. Sunday you went to church. Once in a while you got to have fun at a wedding. That was it.

There wasn't time to be bored or filled with anomie then. I'm not saying it's not a problem, but it's not the fault of the toys we use to fill the hours. If you are bored you can always help others with your free time.

If opioids are the cure, is work the disease.

A couple of personal anecdotes:

I had gall bladder surgery 2 years ago. The surgeon prescribed a double dose of hydrocordone and warned me to come back after I was done if I was still in pain. This fear caused me to fill one of the prescriptions, but I took exactly - 1 pill. I found that a few days of ibuprofin was all I needed. When I queried her about this, she said I was one of the few who didnt go through all the pills and come back for more. No, I dont have a high pain threshold.

One year ago I had a molar extracted. Same thing with the prescriptions, except I didnt fill it. I also queried the nurse in charge, and she said her office had recently done an extensive audit of their prescriptions, and found 59 of their ex-patients appeared to be serial abusers of opiates, so much that they had circulated through most of the "pain clinics" in Phoenix and Tucson after going through the prescriptions she wrote. She was pretty bummed.

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