The opioid crisis in Appalachia: the effect of blue-collar employment

ABSTRACT

The effects of the American opioid crisis have been widespread, leading to increases in addictions, poor health outcomes, and death. We expect that these effects may vary across the workforce, in particular, that blue-collar employment, which generally requires more physically demanding labour, may be associated with a higher use of pain medication including opioids. This paper analyses the relationship between the share of blue-collar employment and the number of opioid prescriptions from 2014 to 2016 for the Appalachian region as compared to the contiguous US We find that there is a positive and statistically significant relationship in the Appalachian region.

KEYWORDS:

• Opioid prescriptions
• employment
• Appalachian region
• labor market

JEL CLLASIFICATION:

• I3
• J20
• J21

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes

¹ There was an upward trend in overdose deaths from opioid prescriptions beginning in the 1990s and a second surge beginning in 2012 (CDC 2017a, 2017b).

² ASAM lists types of opioid prescriptions as oxycodone, hydrocodone, codeine, morphine, and fentanyl (ASAM 2016).

³ Death rate is measured as the number of deaths per 100,000 by state adjusted for differences in age distribution and population size (CDC CDC NCHS 2018).

⁴ The data on opioid prescriptions also include the number of prescriptions for four additional categories, long-acting (LAER), low (<50), medium (50–90), and high (>90) daily dosages.

⁵ It was not possible to determine whether workers were in physically demanding labour or not using the NAICS employment categories, so industries with a large number of physically demanding jobs were categorized as blue-collar. (See Table 1).

⁶ Only West Virginia is entirely within the Appalachian region.

⁷ The GAR also includes Maryland and New York, but only a small part of each state is included so we excluded them.

⁸ The data on the share of rural individuals did not change over time and was excluded.

⁹ These results for all samples were largely consistent across all categories of OP including long-acting, high, medium, and low daily dosages.

¹⁰ The BCE remains significant if the per cent white and male variables are excluded.