Opioids and labor market participation

The onset of the opioid crisis coincided with the beginning of nearly 15 years of declining labor force participation in the US. Furthermore, the areas most affected by the crisis have generally experienced the worst deteriorations in labor market conditions. Despite these time series and cross-sectional correlations, there is little agreement on the causal effect of opioids on labor market outcomes. I provide new evidence on this question by leveraging a natural experiment which sharply decreased the supply of hydrocodone, one of the most commonly prescribed opioids in the US. I identify the causal impact of this decrease by exploiting pre-existing variation in the extent to which different types of opioids were prescribed across geographies to compare areas more and less exposed to the treatment over time. I find that areas with larger reductions in opioid prescribing experienced relative improvements in employment-to-population ratios, driven primarily by an increase in labor force participation. The regression estimates indicate that a 10 percent decrease in hydrocodone prescriptions increased the employment-to-population ratio by about 0.7 percent. These findings suggest that policies which reduce opioid misuse may also have positive spillovers on the labor market.

That is from a job market paper by David Beheshti at the University of Texas at Austin.


Typical economist point of view. The highest good is GNP growth. The more people work, and for more hours, the better. Sure, deprived of sedatives, people may work more. I have a better idea yet: let's re-introduce flogging for the shirkers, the otiose, for those lazy sailors and laborers, so they will work more.

The increase in opioid use began when Obama was elected. These are simply people who hated Obama's policies so much they had to zone out.

It's hard to escape the feeling that escalating usage rates of opiods are a symptom of economic, cultural, social and political decay

China experienced a similar situation beginning in late 18th century effects lasting till Mao's time...it's ironic that China today is the main source of fentanyl used by Americans...

That's not true though. Opioid use peaked under Obama (c. 2011-2013 depending on the specific drug) but the run up began back in the 90s and was in full swing in the 00s. I remember when it seemed like any discomfort I reported at the doctor office led to a script for Vicodin, and not to physical therapy which might have benefited me more- but also cost a lot more. With serious dental work I'd end up with a Rx for a month's supply even if I only needed it for a day or two. Luckily I don't enjoy the side effects of continued use of such drugs and never abused them. But millions of people found themselves in ersatz nirvana.

Misuse of opioids had a negative spillover in the pain management labor market. The reduction in opioid misuse is already having a positive spillover in the pain management labor market. [Why do economists write that way? Anyway, pain management involves the use of anesthesia to create "nerve blocks" to alleviate pain, usually done by an anesthesiologist.]

The synthetic opioids were designed to get the basic molecule through the blood brain barrier with efficiency. Result: greater brain damage.

This addiction is brain damage, any MD should have known or been informed. That they did not get the connection leads me to believe most pain doctors were not well educated in neuro transmitters and chemistry. That kind of ignorance is not MD material.

I only skimmed paper, so he might have addressed these. But 2 concerns: 1) I'm not sure he adequately controlled for substitution of hydrocodone with other opioids, and 2) I didn't see him mention anything about controlling for institution of a state drug prescription monitoring database. His time frame (2014) is right around when some states (so possible his population was not impacted by this) started instituting these drug monitoring programs (which have been shown to decrease opioid prescribing behaviors).

To Matt Young, easy to type that, try saying in person to a patient who is telling you they would rather die than continue living with their pain. As a palliative care physician, who prescribes very high doses of these medications, I agree that health care clinicians definitely contributed to opioid crisis by over-prescribing and lax oversight. But the major driver in prescribing opioids, for pain related to non-terminal diseases, is clinician's desire to help people. We really don't have many good options for pain relief, so opioids, especially when they were first marketed as "safe" alternatives, were an easy choice. Also, molecules crossing the BBB is not brain damage. The process of developing tolerance, dependence and then addiction is complicated and most MD's don't have a PhD in neurochemistry.

More importantly, the vast majority (>90%) of opioid prescriptions came from NON-pain clinicians (i.e, people's PCPs). Which, again, goes back to clinicians desire to help their patients with very limited time to see their patients. In hindsight, maybe we as a society need to become OK with experiencing some pain as we grow older. But that's really hard as an individual clinician to say to an individual who is telling you they are in pain.

Is it really the people who are in serious pain that are being removed from the labor force due to their opioid abuse? My guess is that most of those folks are not working due to their condition - if anything the opioids might increase labor force participation in that set. The people not working due to opioids are somehow getting these drugs through unofficial channels or perhaps fooling their physician. Personally I am fine if there are people, of sound mind, who who want to sedate themselves with opioids. I think the real problem is caused by making it illegal to take them, so people cannot take them in a controlled way, that why we end up with so many overdoses.

Granted: most credentialed medical doctors are not also equipped with doctorates in neurochemistry.

How much training in neurochemistry do licensed American MDs typically receive? Has exposure to neurochemistry in medical schools increased or decreased over, say, the past four decades?

If these licensed and credentialed medical professionals typically operate (so far) outside and beyond the competency that their medical training permits, how typical a professional behavior might we have evidence for here, that could be extrapolated safely to show how many members of other professional classes of trained, credentialed Americans typically operate well beyond the competency that their training and credentialing accorded them?

What is the measure, that is, of "credentialed incompetence" in the US today? Which professional classes (besides "medical professionals") are the most egregiously afflicted? (Which class of incompetent American professionals earns the most compensation for its practice of class-incompetence?)

How many trained and credentialed American professionals in any class are stripped of their dear credentials when their incompetent professionalism comes to light? (Granted, legal and jurisprudential incompetence could complicate finding the apt metrics.)

“reduced opioid misuse may have positive spillovers on the labor market”
Wow, who would have thought so?

Not sure this is so obvious ex ante. Example: Joe is in such severe pain that he cannot focus at work. A friend gives him some leftover opioids. Joe is "misusing" them but his work performance improves, because he can now focus at work. (Not saying this is the modal case, just saying it's not obvious that it isn't.)

One can easily argue that he's got cause and effect backward. Unemployment leads to depression and disruption, which causes discomfort and possibly some sort of injury. Recurring pain sets in -- doctor prescribes opioids.

The effects of free drugs by Medicare and Medicaid...

Most (all?) of the common opioids are off patent and the generics are very cheap, so the "free" factor is fairly nominal.
Are drugs free under Medicare? Don't they have copays just as with regular insurance?

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