Woman in a dark place

Behavior

Opioids Make it Harder, Not Easier to Work

The twin goals of prescribing opioids to workers with a bad back or arthritis are to alleviate their pain and keep them employed.

But the use and abuse of opioids can cause poor memory, extreme drowsiness, and an inability to engage in normal social interactions – all of which limit workers’ ability to function. Opioids also have serious physical effects outside of the dependence itself.

The resulting detachment from the labor market, revealed in a new research study, calls into question any benefits the medications have.

Between 2012 and 2018, average employment declined by nearly 2 percent for every 10 additional opioid prescriptions per 100 adults in a county-sized area, the researchers found. Wages also dropped by 6 percent, indicating that the opioid users who do remain employed are less productive.

The painkillers had more permanent consequences, too, when workers, unable to cope, left the labor market for good. The rate of applications for federal disability benefits increased sharply in the areas with higher prescribing rates, according to the study funded by the U. S. Social Security Administration, which runs the disability program. …Learn More

Behavior

Disability Applicants’ Opioid Use in Decline

A big drop in opioid use among people applying for federal disability benefits seems like encouraging news, even if they do still use the drugs at considerably higher rates than the general population.

A Big Drop in Use in Just 5 YearsNew research finds that opioid use fell from one in three disability applicants in 2013 to one in four 2018 applicants. And the improvements were across the board: opioid use declined regardless of age, education level, sex, or region, according to the study funded by the U.S. Social Security Administration, which administers the program.

The researchers wanted to get as accurate a picture as possible of use and abuse in the disability community, a source of one in four hospitalizations for opioid overdoses. To tease out opioid use in Social Security’s records, they combed through applicants’ own free text descriptions of their medications for every conceivable name they might’ve used, including generic and brand names. The researchers even included misspellings – for example, oxycotin for oxycontin – and excluded cough suppressants with an opioid as an ingredient. …Learn More

Opioids

Research

Opioids are in the Disability Community Too

Opioids fueled a record of nearly 100,000 drug overdose deaths in the United States last year.

The biggest cause of overdose deaths was dangerous synthetic opioids, such as fentanyl. But the epidemic involving illegal chemicals grew out of the abuse of highly addictive prescription opioids. A spate of new research reveals that the use and abuse of these prescription drugs have plagued people with disabilities, who often start taking them to treat painful musculoskeletal conditions such as arthritis or a bad back.

A 2017 analysis featured in this blog provided the first estimate of opioid use among people who have disabilities that limit their ability to work. The researchers found that about one in four people applying for federal disability benefits used the medications – a much higher rate than in the U.S. population overall.

Painkillers often do more harm than good because they can increase society’s dependence on disability benefits by impairing lung function, aggravating existing conditions like rheumatoid arthritis, or causing addiction. According to 2021 research by RAND that followed older workers over several years, the opioid users in the study were much more likely to wind up on disability than their counterparts who did not take them.

“Although the pain relief is an important health goal,” the researchers concluded, “the consequences to workers and social programs of powerful prescription painkillers are substantial and long-lasting.”

The isolation and stresses caused by the pandemic are believed to have fueled the dramatic rise in overdose deaths last year. But a long-running cause, prior to COVID, was the decline in U.S. manufacturing employment. Research reported in this blog directly tied the movement of robots onto factory floors to the rise in deaths of despair – from drug addiction, alcoholism, and suicide – among men between ages 30 and 54. The study found that automation accounts for nearly one in five overdose deaths in manufacturing counties, which are concentrated in the heavily industrialized Midwest. The researchers said the rate of applications for disability benefits is also higher in these counties.

Opioid abuse in the disability community is happening for the same reason it is pervasive in society: an ample supply of the addictive drugs. …Learn More

Pain in different areas of the body

Behavior

Opioids: Cause or Consequence of Disability?

Opioid painkillers are a double-edged sword for older workers. The medications allow them to keep working through their joint or back pain. But a slide into addiction would interfere with doing their jobs.

A new RAND study of workers over age 50 has identified some of the negative consequences of relying on opioids. Rather than promoting work, the researchers found that opioids can cause or exacerbate disabling health conditions, hindering users’ ability to work and making them increasingly dependent on federal disability benefits over time.

Bad results from opioid overuse may seem predictable, given that doctors prescribe them to people who are in worse physical condition in the first place. But older workers’ health is already in decline, just by virtue of their age, so it’s not always clear how, or to what extent, opioids are affecting them.

The researchers sorted this out using a 2009 survey of older Americans in the long-running Health and Retirement Study (HRS). They matched people who didn’t take the medications with similar people who did – similar in everything from their functional limitations and sociodemographics to their labor market histories. The HRS continued to interview both groups over the next decade, allowing the researchers to compare the opioids’ effects over a longer period than prior studies.

For example, although the opioid users and non-users were in similar health in 2008, things changed dramatically – and quickly – the researchers found. As early as 2012, the opioid users were significantly more likely to have developed a disabling condition that limited their work capacity.

Opioid use or abuse is linked to myriad health problems. Overuse can exacerbate autoimmune conditions such as rheumatoid arthritis. Users also have less healthy lifestyles and are prone to infectious diseases and mental illness, and opioids can impair lung function. …Learn More

medication

Research

Opioid Use Higher for Disability Applicants

With the nation still in the midst of an opioid crisis, a new study provides the first estimate of opioid use among people who apply for disability.

One out of every four applicants used opioids in 2017 – below the peak in 2012 but still significantly more than in the general population, according to researchers at Mathematica and the U.S. Social Security Administration.

And the researchers may be underestimating the extent of opioid use. Their data come from Social Security’s disability application forms. The forms ask applicants to list their prescriptions, including opioids taken for musculoskeletal pain such as a bad back, as well as their non-prescription drug use, and the stigma around use and abuse may encourage underreporting.

To estimate opioid use required creating a database because none existed. The researchers mined the text fields in each disability application using machine learning to find information about opioid use and then entered the information into the database.

Some interesting demographic trends emerged from the study. Opioid use is most prevalent in middle age, at around 30 percent of disability applicants in their 40s and 50s. “This is notable,” the researchers said, because if Social Security grants their requests for benefits, they “may remain on the [disability rolls] for 25 years.”

In a breakdown by education levels, the biggest opioid users had attended college but didn’t get a degree. Women’s use exceeded men’s throughout the study’s 10-year period, mirroring the population as a whole. And a state-by-state breakdown shows that applicants’ opioid use fell across the nation during that time. But Alabama, Arkansas, Michigan, and Nevada still had particularly high rates in 2017. …Learn More

Photo of a pill bottle

Behavior

Opioids and Workers with Disabilities

Everyone knows about the dangers of opioid addiction. But prescription opioids can be useful to people with physical disabilities if they ease their pain so they can hold down a job.

A new study finds that this might be occurring in certain parts of the country where more opioid prescriptions are written.

But this finding is at odds with other evidence in the study that these same areas also see increased enrollment in Social Security’s disability program. A possible increase in employment is puzzling, since this program has strict limits on how much people can earn.

Adibah Abdulhadi at the University of Wisconsin reconciled her seemingly contradictory findings this way: some people with disabilities, including some who rely on opioids, may be working more – but if they are, they’re mostly in part-time jobs.

Under Social Security’s benefit rules, workers on disability can keep their benefits if their earnings do not exceed the program limit of $1,260 per month in 2020. A part-time job can be a way to stay below this income threshold.

The impact of opioid use on the labor market was analyzed on a county-by-county basis. In counties with higher opioid prescription activity, the unemployment rate fell by eight-tenths of 1 percentage point over the study’s four-year period, though this result wasn’t conclusive.

The decline was also confined to the most urban counties, which tend to have more robust job markets than rural areas and also more employers that can accommodate workers’ disabilities. Strikingly, the higher prescription activity was also linked to an increase in part-time employment.

While the impact of prescription activity on employment is inconclusive, the impact on disability is clear. “Greater use of opioids consistently leads to greater use” of disability insurance, Abdulhadi said.

To read this study, authored by Adibah Abdulhadi, see “The Effects of Opioids on Labor Market Outcomes and Use of Social Security Disability Insurance.”Learn More

Photo of pills

Behavior

Opioid Abuse Tied to Where People Live

In 2019, the U.S. Attorney’s Office in northern Oklahoma detained one doctor charged with operating a pill mill that prescribed opioids to addicts for the simple reason that he presented “a danger to our community.”

While mental illness and unemployment are familiar culprits in the opioid crisis sweeping the country, the environment that people live in – including the prevalence of unscrupulous doctors – is actually important as well.

That’s one conclusion in a new study that found that people are more likely to become addicts if they move from an area with a relatively low level of prescription opioid abuse to a high-abuse area.

The research looked at more than 3 million people on federal disability insurance (DI) – a group that uses opioids at much higher rates than the general population. More than half of DI recipients are prescribed opioids in a given year. And since they are covered by Medicare, the researchers had access to the prescription records for Oxycontin, Vicodin, and morphine.

To gauge the impact of moving to a new location, the researchers created an index that estimated the extent of prescription opioid abuse in each U.S. county. The index took into account several factors, including the amount of opioids prescribed to patients and their use of multiple prescribers.

When DI recipients moved from a county at the low end of this index – the 25th percentile – to the high end – the 75th percentile – their rate of prescription opioid use increased nearly 5 percent, according to the study conducted for the Retirement and Disability Research Consortium.

People with a prior history of prescription opioid use were at particularly high risk of prescription opioid abuse if they moved to a high-use area. …Learn More

drug treatment artwork

Behavior

Aging Minorities Struggle in Drug Treatment

For baby boomers who have abused drugs or alcohol for years or decades, the negative health consequences of addiction are particularly damaging.

But information about older Americans’ success in substance abuse programs is sparse, even though people between 55 and 75 now make up 22 percent of all U.S. overdose deaths, up from 9 percent in the late 1990s. And virtually no racial breakdown of treatment outcomes is available for this age group.

A new study by Jevay Grooms at Howard University and Alberto Ortega at Indiana University fills this gap. The researchers find that the number of older Black, white and Hispanic Americans admitted to treatment facilities and programs is steadily increasing.

The biggest growth in Black admissions was in cocaine and heroin treatment, while the rise for whites was concentrated in prescription opioids and alcohol treatment. The largest increase for Hispanics was for heroin addiction.

Amid rising admissions, however, the share of people 50 and older who completed treatment has generally trended down for each group during the period of this analysis, 2006 through 2017, though the rates bounce around quite a bit from year to year.

To gauge how each group fared over the period, the analysis controlled for various factors that determine success or failure, including education levels, employment status, and past attempts at treatment.

Older Blacks – and, to a lesser extent, Hispanics – are not as likely as older whites to successfully finish a substance abuse program. One reason is that minorities are more likely to be terminated by a treatment facility or program. Just as worrisome, however, are the widening disparities in the rates of treatment completion between each older minority group and their white counterparts – even as the disparities were closing for Blacks and Hispanics under 50.

The researchers did not dissect the reasons for treatments being terminated but noted that “lack of insurance, social stigma, distrust, lack of diversity and cultural incompetence among providers” are likely contributing factors in the racial differences. …Learn More