Research traces primary cause of opioid epidemic—it's not despair

January 26, 2018 by Caroline Newman, University of Virginia
Credit: CC0 Public Domain

Why did America become so addicted to opioids?

That question is at the heart of University of Virginia economist Christopher Ruhm's research on overdoses from 1999 to 2015. What he found sheds new light on what has been characterized in the media as a mostly economic problem – so-called "deaths of despair," driven by economic downturns in certain parts of the country like the Rust Belt or Appalachia.

Ruhm, a professor of public policy and economics in UVA's Frank Batten School of Leadership and Public Policy, tracked fatal overdoses at the county level across the country and compared those rates with economic factors like labor market conditions, income levels, housing prices and international trade exposure in each county.

His research – currently a working paper – concludes that account for less than 10 percent of drug-related fatalities, which have increased by more than 210 percent from 1999 to 2015.

"It was less than 10 percent; possibly much less given the presence of other factors," Ruhm said.

Though economic conditions are certainly important for overall quality of life, Ruhm found that changes in the drug environment – the availability and cost of legal and illegal drugs – are the primary drivers of the .

He identified several trends supporting this conclusion as he traced the rise and fall of different opioids in the U.S. over 16 years.

For example, prescription opioids accounted for the largest number of opioid fatalities from 1999, when Ruhm's study began, to about 2010.

"From the late 1990s through around 2010 or 2011, the number of opioid prescriptions being written in the U.S. skyrocketed," Ruhm said. "OxyContin came out in the late 1990s and was marketed very aggressively over the next decade."

However, around 2010, abuse of prescription opioids flattened and use of illegal opioids like heroin "accelerated dramatically," Ruhm said.

He attributes the shift to policy and other changes that made it more difficult to obtain legal opioids, and to the rising availability of heroin as dealers honed more widespread and less costly distribution methods.

"Essentially, the country was awash in cheap heroin," he said. "Then, around 2013, we started seeing a dramatic increase in synthetic opioids like fentanyl." Fentanyl, a potent drug originally used for cancer patients and others in extreme pain, is up to 50 times as powerful as heroin.

If economic conditions were the primary driver, Ruhm reasoned, the same economically depressed users who had been abusing prescription opioids would turn to heroin or fentanyl as it became cheaper.

"Individuals self-medicating for their 'despair' would simply switch to the newly more available types of drugs," he wrote in the paper.

However, his data showed that the two types of opioids attracted significantly different users, supporting his theory that the drug environment – not economic conditions – were primarily to blame for rising deaths.

Women and middle-aged adults, between about ages 40 and 60, were more likely to overdose on prescription opioids, while men and younger adults – traditionally more likely to engage in risky behaviors – were more likely to overdose on heroin or fentanyl.

"When you look at the data, you see a pretty sharp change in who is affected right around the time that and fentanyl were coming in," he said. "There seems to be a fairly tight relationship between which drugs are driving the epidemic – the drug environment – and who is being affected."

Further supporting his argument, Ruhm notes that other countries, regardless of their economic condition, have not experienced an opioid epidemic on the scale of that in the U.S.

"That's not to say that other countries don't have this problem – opioid abuse is increasing in many places – but it is an order of magnitude greater in the U.S.," he said. "The number of opioid prescriptions per capita are far, far higher here than in other countries."

Already, he said, stronger regulation of opioid has helped reduce abuse of drugs like OxyContin, as seen with the shift away from in 2010. Other measures to regulate the illegal environment – now peddling even more deadly drugs, like the large-animal tranquilizer carfentanyl – could help stem the flow of drugs into the country, and a strong public health education campaign could help prevent abuse.

"This is an extremely serious crisis," Ruhm said. "We need a comprehensive strategy to alert people to the risks of these drugs, in much the same way we have done with the dangers of smoking."

Explore further: Fentanyl in more than half of opioid deaths in 10 states

Related Stories

Fentanyl in more than half of opioid deaths in 10 states

October 27, 2017
A federal report says the powerful painkiller fentanyl was involved in more than half of the recent opioid overdose deaths in 10 states.

CDC launches opioid campaign in hard-hit states

September 26, 2017
(HealthDay)—The U. S. Centers for Disease Control and Prevention has launched a campaign to reduce overdose deaths from prescription opioid painkillers.

Nearly one-third of Canadians have used opioids: study

January 9, 2018
Nearly one in three Canadians (29 percent) have used "some form of opioids" in the past five years, according to data released Tuesday as widespread fentanyl overdoses continue to kill.

Fentanyl drives rise in opioid-linked deaths in U.S.

August 31, 2017
(HealthDay)—Fentanyl, a synthetic narcotic, is a key player in America's continuing epidemic of opioid-related overdose deaths, two new studies report.

Expert says opioid epidemic is even worse than we thought

August 22, 2016
In the last two decades, drug overdoses have slowly overtaken motor vehicle fatalities as the leading cause of death in the United States. In Virginia alone, the Office of the Attorney General estimates that more than 900 ...

Fighting overdose epidemic, US bans all fentanyl-type drugs

November 9, 2017
The US Justice Department on Thursday announced a ban on all fentanyl-like drugs amid skyrocketing rates of overdoses from the synthetic opioids.

Recommended for you

Researchers publish study on new therapy to treat opioid use disorder

May 22, 2018
Better delivery of medications to treat opioid use disorder (OUD) is key to addressing the opioid crisis and helping the 2.6 million Americans affected by the disease.

Could nonprofit drug companies cut sky-high prices?

May 17, 2018
(HealthDay)—Generic prescription drugs should be cheap, but prices for some have soared in the United States in recent years. Now a group of U.S. hospitals thinks it has a solution: a nonprofit drug maker.

Fewer antibiotics for kids, but more ADHD drugs

May 15, 2018
(HealthDay)—American kids are taking fewer prescription medications these days—but certain drugs are being prescribed more than ever, a new government study finds.

Opioid makers' perks to docs tied to more prescriptions

May 14, 2018
Doctors who accept perks from companies that make opioid painkillers are more likely to prescribe the drugs for their patients, new research suggests.

Less is more when it comes to prescription opioids for hospital patients, study finds

May 14, 2018
In a pilot study published in JAMA Internal Medicine, Yale researchers significantly reduced doses of opioid painkillers given to hospital patients. By delivering the opioids with a shot under the skin or with a pill instead ...

Generic options provide limited savings for expensive drugs

May 7, 2018
Generic drug options did not reduce prices paid for the cancer therapy imatinib (Gleevec), according to a Health Affairs study released today in its May issue.

1 comment

Adjust slider to filter visible comments by rank

Display comments: newest first

BubbaNicholson
1 / 5 (2) Jan 28, 2018
Setting up a trial for anti-opioid addiction substance with FDA approval (pending). If anyone with a patient population is interested, you are welcome to contact Nicholson Science @ info@NicholsonScience.com

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.