By Brooks Johnson
Heroin doesn’t care about the numbers on your paycheck. Hydrocodone doesn’t know class lines.
So why does the opioid crisis hit the poor the hardest?
“Some individuals are more susceptible to drug use and addiction than others, not only because of genetic factors but also because of stress and a host of other environmental and social factors in their lives that have made them more vulnerable,” says a report from the National Institute on Drug Abuse released in October. “People living in poverty are especially at risk for addiction and its consequences.”
Poverty, social isolation and untreated health issues can all make the powerful high presented by opioids an attractive alternative to a seemingly bleak existence, even though drug use and addiction will have even worse long-term effects. Treating the opioid epidemic, then, means treating poverty and its causes as well.
“We cannot hope to abate the evolving crisis without also addressing the lost hope and opportunities that have intensified the demand for drugs among those who have faced loss of jobs and homes due to economic downturns,” the report said.
Those are long-term solutions, but the problem is immediate.
“We jump in with quick solutions almost the same way people with pain jump into opioids for quick relief,” said Dave Swenson, a professor at the College of St. Scholastica in Duluth who has a doctorate in psychology. “Part of it is coming up with a social support system for people who are disadvantaged.”
Princeton economists Anne Case and Angus Deaton have found that a recent rise in mortality rates among middle-aged whites, while mortality rates for other demographics fall, is tied to substance abuse and suicide. Which is in turn tied to economic opportunity.
“We don’t think people abuse alcohol or drugs, or pick up a gun, if their lives are going well,” Case told the Federal Reserve Bank of Minneapolis in a recent interview. “So you’ve got a fragile home life, a job without prospects, and you put those together with a change that also happened in the U.S. where … the kinds of pillars that used to help people in community are absent.”
Case also pointed to the disappearance of career paths available to those without a college education or advanced training.
“It was the early 1970s when it became less and less the case that people with just a high school degree could get on a job ladder that had on-the-job training and benefits, and the potential to make a middle-class life,” she told the Minneapolis Fed.
If opioid abuse has economic causes, it also has economic consequences.
A study from the Brookings Institute this year found that in counties where more opioids were prescribed, more people were dropping out of the workforce — that is, neither working nor looking for work.
“Labor force participation has fallen more in areas where relatively more opioid pain medication is prescribed, causing the problem of depressed labor force participation and the opioid crisis to become intertwined,” Alan B. Krueger wrote in the paper, adding that about half of working-age men not in the labor force report taking pain medication daily.
The Minnesota Prescription Monitoring Program found that at least 3.5 million opioid prescriptions were written in the state last year, with hydrocodone, oxycodone and tramadol making up the bulk of those prescriptions.
While that number is falling slightly, the Centers for Disease Control and Prevention says that “76 percent of nonmedical users report getting drugs that had been prescribed to someone else,” which is illegal.
Those convicted of a drug crime, especially a felony, can have a harder time escaping the poverty that could have prompted an opioid dependency in the first place.
“It really is a vicious cycle,” Swenson said. “The lost productivity and the huge amount of money going into drug treatment and law enforcement … We have to change the situations that drive people to desperation.”
The National Institute on Drug Abuse said that both supply and demand remain a problem and addressing issues like housing instability, education, quality health care and economic disparities could go a long way to preventing opioid misuse, abuse and deaths in the first place.
“When people have strong family or community relationships, these can act as protective factors against the risk of becoming addicted, and can facilitate recovery among those striving to achieve it.”