Research Links Auto Plant Closures to Opioid Overdoses

By Pat Anson, PNN Editor

A new study is adding to the growing body of evidence linking the opioid crisis to unemployment, depression, suicide and declining economic opportunities – the so-called epidemic of despair.

Researchers at the Perelman School of Medicine at the University of Pennsylvania and Massachusetts General Hospital looked at the closure of automotive assembly plants in the U.S from 1999 to 2016, primarily in the Midwest and Southeast. They found that opioid overdoses rose significantly in 29 counties where an auto plant shutdown.

Five years after the plants closed, opioid overdose rates among adults were 85 percent higher in counties where closures occurred compared to 83 counties where plants remained open.

"Major economic events, such as plant closures, can affect a person's view of how their life might be in the future. These changes can have a profound effect on a person's mental well-being, and could consequently influence the risk of substance use," said lead author Atheendar Venkataramani, MD, an assistant professor of Medical Ethics and Health Policy.

"Our findings confirm the general intuition that declining economic opportunity may have played a significant role in driving the opioid crisis."

The findings are published in JAMA Internal Medicine.

JAMA INTERNAL MEDICINE

The demographic group with the biggest increase in opioid overdose deaths after an auto plant closure was non-Hispanic white men between 18-34 years old, followed by non-Hispanic white men ages 35-65 years old. Opioid overdose rates also increased among young non-Hispanic white women.

Death rates involving heroin and other illicit opioids were higher for young white men and women than for prescription opioids, while older white men were more likely to die from prescription opioids.

"While we as clinicians recognize and take very seriously the issue of overprescribing, our study reinforces that addressing the opioid overdose crisis in a meaningful way requires concurrent and complimentary approaches to diagnosing and treating substance use disorders in regions of the countries hardest hit by structural economic change," Venkataramani said.

“Our findings should not be interpreted in such a way as to diminish the role of opioid supply, either from physician prescriptions or from illicitly made and supplied synthetic substances, in the US opioid overdose crisis.”

Princeton researchers Anne Case and Angus Deaton were the first to suggest in 2015 that the declining life expectancy of Americans was not caused by drug abuse alone, but linked to unemployment, poor finances, lack of education, divorce, depression and loss of social connections. They estimate that nearly half a million white Americans died due to a quiet epidemic of pain, suicide, alcohol abuse and opioid overdoses.

The epidemic of despair has also been cited as one of the reasons for the election of Donald Trump and for a “syndemic” of overdoses occurring in counties where the opioid crisis first erupted, particularly in mid-sized cities in Kentucky, Ohio and West Virginia. 

Did Chronic Pain Patients Help Elect President Trump?

By Pat Anson, Editor

Rates of opioid prescribing were significantly higher in counties that voted for Donald Trump in the 2016 presidential election, according to a new analysis published in JAMA Network Open.

Researchers at the University of Texas compared voting trends, census information and Medicare data for people who received opioid prescriptions for 90 days or more. Nearly 60 percent of U.S. counties that voted for Trump had an above average opioid prescribing rate in 2015. Counties with below average prescribing rates voted for Trump only 39 percent of the time.

The researchers cautioned that the study does not mean that chronic pain patients were more likely to vote for Trump. It’s more likely to indicate that economic, health and social problems that lead to opioid use – sometimes called the "epidemic of despair" -- played a role in Trump’s victory.

“Support for the Republican candidate in the 2016 election is a marker for physical conditions, economic circumstances, and cultural forces associated with opioid use,” wrote lead author Dr. James Goodwin, chair of geriatric medicine at the UT Medical Branch in Galveston. “This association is related to underlying county socioeconomic characteristics that are common to both chronic opioid use and voting patterns, particularly characteristics pertaining to income, disability, insurance coverage, and unemployment.”

The researchers created a map (above) showing counties with the highest rates of opioid prescribing in dark red, while a second map (below) shows counties that overwhelmingly voted for Trump in dark red. 

The maps have similarities, but they don’t align perfectly or prove a cause and effect relationship between prescribing and voting. For example, while Trump won unexpected victories in Michigan, Wisconsin and Pennsylvania, where opioid prescribing is high, he also won in North and South Dakota, where prescribing rates are relatively low. 

During the 2016 presidential campaign, Trump and Hillary Clinton both called for further restrictions on opioid prescriptions and expanded access to addiction treatment. Clinton also endorsed a proposed tax on opioid pain medication.

“Given that both candidates focused on opiate addiction as a major campaign issue, it is difficult to infer that opiate prescription rates are somehow linked with voting behavior based on the candidates’ respective campaign promises and/or platforms,” wrote James Rosenquist, MD, in an editorial also published in JAMA Open Network.

“These limitations aside, this article’s findings add to a growing body of literature showing the interrelationship between public health and society, including the all-important economic and political realms.”

The “epidemic of despair” was first documented by Princeton researchers Anne Case and Angus Deaton in 2015.  They believe that the reduced life expectancy of middle-aged white Americans is linked to substance abuse, unemployment, poor finances, lack of education, divorce, depression and loss of social connections.

"People who reach for an opioid might also reach for ... near-term fixes," Nancy Morden, PhD, a professor at the Dartmouth Institute for Health Policy and Clinical Practice, told NPR. "I think that Donald Trump's campaign was a promise for near-term relief."