Association for Public Policy Analysis & Management

Past research indicates that physical health measures (such as all-cause mortality) improve when economic conditions temporarily deteriorate, but the relationship is unclear for behavioral health. The pro-cyclicality of mortality has declined in recent years at the same time that drug poisoning deaths have trended sharply upwards, suggesting a connection to the rising use of many types of drugs. We contribute new evidence to the literature by examining how severe, adverse outcomes related to use of opioid analgesics (hereafter abbreviated as opioids) and other drugs vary with short-term fluctuations in macroeconomic conditions. We use data on deaths and emergency department (ED) visits related to opioid and other drug poisonings together with information on state and county unemployment rates. We focus on opioids because they are a major driver of the recent, fatal drug epidemic. We use county level mortality data for the entire U.S. from 1999-2014, and state and county level ED data covering 2002-2014 from a subset of states. We find that as the county unemployment rate increases by 1 percentage point, the opioid death rate (per 100k) rises by 0.19 (3.6%) and the ED visit rate for opioid overdoses (per 100k) increases by 0.9 (7.0%). We also uncover statistically significant increases in the overall drug death rate that are mostly driven by increases in opioid deaths. These results also hold at the state level. In most specifications, both the county and state results are primarily driven by adverse events among whites. Additionally, we find that the relationship is relatively stable across time periods; thus, these results do not only pertain to recession years, but instead represent a more generalizable connection between economic development and the severe adverse consequences of substance abuse that has thus far been unexplored