America’s opioid crisis is a terrible tragedy in itself. Increasingly, though, the evidence suggests that it’s behind another malaise: the growing ranks of prime-aged males dropping out of the labor force.
The epidemic of opioid and opiate drug abuse contrasts sharply with a broader improvement in Americans’ health. Violent crime, domestic violence and teen pregnancy are all way down. Cancer survival rates are up, and HIV is on the way out. Air and water pollution have decreased.
The trouble started in the early 1990s, with a boom in the prescription of opioid painkillers like oxycodone and hydrocodone. Then worries about rising addiction rates led doctors to cut patients off, which often sent them looking for street drugs like heroin instead. By the time prescriptions peaked in 2011, it was too late. A culture of addiction spread, supply networks developed, and powerful synthetic opioids like fentanyl became the top killers:
The main cost is counted in lives. Opioids now kill more Americans than car accidents or guns. Along with alcoholism and suicide (which may itself be partly driven by opioid addiction), opioids are part of the so-called deaths of despair phenomenon that has helped increase white American mortality rates since the turn of the century. And the epidemic is quickly spreading to African-Americans as well.
That said, the crisis also has economic costs. There’s of course the enormous expense of treating addicts. But opioids also burden the U.S. by taking workers out of the productive economy.
Men’s participation in the labor force has been declining for many years, but that trend seems to have accelerated since the turn of the century. Meanwhile, women’s participation, which had been rising for decades, plateaued in the late 1990s and has declined since 2009:
Much of the decline is due to educated people taking early retirement, or to people staying in school longer as education becomes more important. But a sizeable chunk may be due to drug problems, especially among men.
In 2017, Princeton University economist Alan Krueger noted a correlation between pain medication use and being out of the labor force. In the early 2010s, he found, 43.5 percent of men aged 25-54 who were out of the labor force reported using pain medication the previous day. For those who were employed or actively looking for the work, the number was only around 20 percent. Krueger also found that labor force participation had fallen more in counties where opioids were prescribed more heavily, even after controlling for a number of other local conditions.
But as Krueger noted, causality is hard to determine. It might be that people started using drugs because they were disabled or had no chance of finding a job, rather than the reverse. A new paper from economists Dionissi Aliprantis, Kyle Fee, and Mark Schweitzer at the Federal Reserve Bank of Cleveland attempts to disentangle cause from effect.
The researchers reason that if lack of a job causes opioid use, then areas hit harder by the Great Recession should have seen larger increases. Using a common indicator of labor market conditions, they didn’t find a relationship. This suggests that drug use is driving people to drop out of the labor force, not vice versa.