November 8, 2022

A New Link Between Opioids and Disability

Picture a worker who has an injury so traumatic that he or she is rushed to the emergency room. A doctor prescribes an opioid to ease the pain.

A new working paper adds to the growing evidence that taking opioids, even when necessary, can have serious long-term consequences for workers’ career paths.

Michael Dworsky at RAND found that workers who received prescription opioids after visiting Colorado emergency rooms were far more likely to enroll in Medicare before turning 65 than people who didn’t get a prescription to treat an injury. Starting Medicare before 65 almost always indicates that someone has left the labor force and is receiving benefits from Social Security Disability Insurance, the primary social program for workers with disabilities.

Dworsky reached similar findings in three different analyses, which used Medicare enrollment within four years of an emergency room visit as a rough proxy for whether workers are receiving the federal disability benefits.

People who had taken opioids prior to being injured were the most likely to leave the labor force. After an emergency room visit resulted in a new opioid prescription, more than 2 percent of the previous users wound up on Medicare and disability – a rate that is four times higher than for traumatic-injury patients who had never previously taken opioids.

Dworsky also examined the morphine-equivalent doses that were dispensed to patients over time. The probability of receiving prescription opioids spiked immediately after workers’ injuries and then stabilized at a higher level than before the injuries. …Learn More

November 12, 2020

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

May 14, 2020

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 25^th percentile – to the high end – the 75^th 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