Employment Outcomes for Social Security Disability Insurance Applicants Who Use Opioids

Abstract

In this paper, we examine the relationship between self-reported opioid use and employment outcomes among Social Security Disability Insurance (SSDI) applicants. We followed a sample of 2009 applicants to SSDI for four years after the Social Security Administration (SSA) determined their application outcome. We drew our sample from SSA’s Structured Data Repository (SDR) and supplemented the SDR with other SSA administrative data sources that provide information on application outcomes, annual earnings, and deaths. We used a machine-learning method to identify opioids in medication text fields in SDR data.
Our analysis addresses two questions: (1) How do employment and earnings patterns differ between SSDI applicants who did and did not use opioids at the time of application? and (2) What is the association between opioid use and employment outcomes among SSDI applicants? We estimated the association between opioid use at application and later employment outcomes through ordinary least squares regression, by using three measures of local opioid availability as instrumental variables and by a reduced-form ordinary least squares regression. Understanding these patterns and associations can improve understanding about the post-application economic well-being of SSDI applicants and may help policymakers identify ways to help this group.

The paper finds that:

• Applicants who self-reported opioid use at the time of application had lower employment rates in the first four years after determination compared to non-opioid users.
• Estimates from different estimation methods and for samples – including awarded and denied applicants – all suggest a negative and statistically significant association between (1) self-reported opioid use at application and (2) post-determination employment and earnings outcomes.
• Our results suggest that a 10 percent increase in the local opioid prescribing rate is associated with employment that is, at most, 0.3 of a percentage point lower, which is similar to the documented association among the broader U.S. population. While we know opioids are associated with lower employment, we do not know whether opioids per se contribute positively or negatively to this result.

 
The policy implications of the findings are:

• While we find that opioid use is associated with a similarly lower employment for SSDI applicants as for the broader population, the potential implications for SSDI applicants are particularly notable because opioid use is about 50 percent higher among SSDI applicants.
• More research on the role of opioids in determining employment outcomes may lead to a better understanding of employment trajectories for SSDI beneficiaries and of reapplication among denied applicants.