Behavior

May 3, 2022

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

March 24, 2022

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.

New 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

Research

January 6, 2022

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

Behavior

August 5, 2021

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

Research

July 27, 2021

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

Research

June 3, 2021

The rise in opioid addiction has created an epidemic of drug overdose deaths in the United States. But what increases the risk that people develop the disorder in the first place?

Automation of the U.S. economy turns out to be a contributing factor, as workers lose good jobs to industrial robots and despair about being disengaged from the labor force, conclude researchers at the University of Pennsylvania and Yale in a study funded by the U.S. Social Security Administration.

Manufacturing jobs, often in unionized industries, used to be a major route to the middle class. But millions of factory jobs disappeared as U.S. companies moved operations overseas. Compounding the job losses, corporate employers began installing robots in their remaining domestic operations. Automation was blamed in one study for eliminating more than 700,000 jobs and causing wage stagnation in the 1990s and early 2000s.

Prior research has connected the flight of manufacturing to increasing deaths from drug overdoses. Now, the new study specifically ties technology – measured as an increase in robots per 1,000 workers – to the increase in overdose deaths.

The men who are most affected by the rise of automation are in their prime working years, and they are concentrated in more industrialized areas. Automation accounted for nearly one in five of their overdose deaths in manufacturing counties. For women, automation was responsible for one in 10 overdose deaths in manufacturing counties. …Learn More

Behavior

November 12, 2020

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