Economics

Another Reason to Fight Opioid Addiction: Economics

Painkiller abuse keeps people from working. Think about the low U.S. labor-participation rate.

Jobs program.

Photographer: John Moore/Getty Images

One of the worst U.S. social problems might also be one of its chief economic woes. I’m talking about the epidemic of opioid and opiate abuse.

While unemployment is low in the U.S., labor-force participation is also low. Lots of people who are of working age are choosing not to work:

Discouraged Workers

Labor force participation rate of 25- to 54-year-old Americans

Source: Federal Reserve Bank of St. Louis

Many reasons have been suggested for this -- competition from foreign trade, automation, an overly generous welfare system, a decreased work ethic or the lingering economic damage of the Great Recession. But one simple, classic factor that is often overlooked is health. A less healthy population works less.

Besides obesity, the biggest health problem afflicting the U.S. in recent years has been opioid and opiate abuse. In a recent note, Goldman Sachs reported that the U.S. stands out from other countries in its level of opioid painkiller abuse. And opioid abuse often leads to the use of illegal alternatives like heroin -- when a doctor cuts an addicted patient off, the patient often turns to more dangerous and debilitating street drugs.

This is a recent problem. A 2016 study by the Centers for Disease Control found that overdose deaths from opioids and heroin tripled between 2000 and 2014. In 2014, 28,647 Americans died from using these drugs. The rate of heroin-overdose deaths almost quadrupled.

Much of this is certainly due to increasing prescription of opioid painkillers, which doubled over that same period:

Killing Pain

Opioid prescriptions in the U.S.

Source: National Institute on Drug Abuse

Research has shown that when doctors prescribe more opioids, more addiction follows. The recession may also have been a factor, as people abused painkillers to reduce the stress and depression of unemployment. Job losses to Chinese competition may have had a similar effect.

Opioid painkiller prescriptions actually peaked in 2011 before starting to fall as the federal government cracked down. But that may have driven some addicts to heroin, as well as encouraging a black market in painkiller pills. A recent study by the RAND Corporation claims that the introduction of a new, hard-to-abuse form of the painkiller OxyContin in 2010 caused large numbers of Americans to switch to heroin.

All this drug abuse is bound to have a deleterious impact on Americans’ ability to work. A 2015 paper by the economist Alan Krueger found that nearly half of prime-age men not in the labor force take pain medication every day, much of it prescription strength. For some, it’s probably because injuries or illnesses make them unable to work. But there’s no obvious reason why so many more prime-age men should have become injured and sick in recent years. It seems likely that abuse of painkillers -- and, later, addiction to heroin -- makes many people not want to work.

So to fix the country’s long-term economic problems, it would help to fix the heroin and opioid epidemic. If President Donald Trump managed to address this problem successfully, it would also be a big help to the working-class white voters who supported him. Research by the economists Anne Case and Angus Deaton found in 2015 that the recent drug problem is far more severe for white Americans without college educations. One approach is to give heroin users an alternative, less dangerous drug like suboxone. Another is to treat overdoses aggressively with naloxone. But these medicines don't take away addiction, they just reduce the risks of overdose.

The best way to fight the problem is to prevent the next generation from becoming addicts. Harsh measures, like a war on heroin suppliers and an even stronger crackdowns on home use of opioids, will be tempting. But one surprisingly effective (and far less harsh) policy is legalization of marijuana. Far from acting as a “gateway drug,” as its detractors fear, marijuana appears to be a substitute for opioids. A 2015 paper by the economists David Powell, Rosalie Liccardo Pacula and Mireille Jacobson found that “states permitting medical marijuana dispensaries experience a relative decrease in both opioid addictions and opioid overdose deaths.”

So the Trump administration should think twice about cracking down on states that allow medical marijuana. Fortunately, Attorney General Jeff Sessions has agreed to hear the evidence.

This column does not necessarily reflect the opinion of the editorial board or Bloomberg LP and its owners.

(Clarifies uses of addiction-fighting drugs and corrects misspelling of naloxone in 10th paragraph.)

    To contact the author of this story:
    Noah Smith at nsmith150@bloomberg.net

    To contact the editor responsible for this story:
    Jonathan Landman at jlandman4@bloomberg.net

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