Labor relations and the overdose crisis in the United States

Abstract

Background/Objective

To assess the impact of noted long-term changes in US labor relations and labor market structures on the rapid rise of overdose death in the United States.

Methods

State-level overdose death rates obtained from the Centers for Disease Control were combined with Bureau of Labor Statistics data on manufacturing employment, unionization and self-employment, as well as Census data on key demographic variables to construct a longitudinal dataset (N = 51, including Washington D.C.). Linear regressions were conducted on a logged transformation of overdose death rate increases from 1999 to 2017.

Results

Deindustrialization and low self-employment significantly predict state-level increases in overdose death rates across all models; union decline approaches significance. Together, these three factors explain nearly 40% of variance in overdose death change between 1999 and 2017, maintaining predictive power in the presence of controls.

Conclusion

Labor relations emerge as important predictors of overdose death and addiction. Specifically, worker autonomy—which is typically higher in manufacturing over frontline service, self-employed over dependent wage and salary, and unionized over nonunion jobs—appears to contribute in its decline to deleterious substance use.

Keywords:

• Overdose
• labor
• opioids
• unions
• employment
• United States

Acknowledgments

The author thanks Daniel Douglas, Margrethe Horlyck-Romanovsky and Samuel R. Friedman for their insightful comments and feedback on earlier versions of this article.

Disclosure statement

The author reports no conflicts of interest.