What Is Driving the Drug Overdose Epidemic in the United States?

The demand-side perspective argues that the drug overdose epidemic is a consequence of changes in the economy that leave behind working-class people who lack a college education. In contrast, the supply-side perspective maintains that the epidemic is primarily due to changes in the licit and illicit...

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Bibliographic Details
Published in:Journal of health and social behavior 2020-09, Vol.61 (3), p.275-289
Main Authors: Thombs, Ryan P., Thombs, Dennis L., Jorgenson, Andrew K., Braswell, Taylor Harris
Format: Article
Language:English
Subjects:
Attrition (Research Studies)
Drug abuse
Drug overdose
Drugs
Educational attainment
Epidemics
Income
Income inequality
Mortality
Mortality rates
Opioids
Original Article
Overdose
Socioeconomics
States
Supply & demand
Working class
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Summary:The demand-side perspective argues that the drug overdose epidemic is a consequence of changes in the economy that leave behind working-class people who lack a college education. In contrast, the supply-side perspective maintains that the epidemic is primarily due to changes in the licit and illicit drug environment, whereas a third, distinct perspective argues that income inequality is likely a key driver of the epidemic. To evaluate these competing perspectives, we use a two-level random intercept model and U.S. state-level data from 2006 to 2017. Contrary to the demand-side approach, we find that educational attainment is not associated with drug-related mortality. In support of the supply-side approach, we provide evidence indicating that opioid prescription rates are positively associated with drug-related mortality. We also find that income inequality is a key driver of the epidemic, particularly the lack of resources going to the bottom 20% of earners. We conclude by arguing that considerations of income inequality are an important way to link the arguments made by the demand-side and the supply-side perspectives.
ISSN:0022-1465
2150-6000
DOI:10.1177/0022146520939514