Opioid Abuse Tied to Where People Live

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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.

Policies that restrict access to opioids, the study concluded, “could potentially reduce opioid abuse” in high-use areas. 

To read this study, authored by Amy Finkelstein, Matthew Gentzkow, and Heidi Williams, see “What Drives Prescription Opioid Abuse? Evidence from Migration.” 

The research reported herein was derived in whole or in part from research activities performed pursuant to a grant from the U.S. Social Security Administration (SSA) funded as part of the Retirement and Disability Research Consortium.  The opinions and conclusions expressed are solely those of the authors and do not represent the opinions or policy of SSA, any agency of the federal government, or Boston College.  Neither the United States Government nor any agency thereof, nor any of their employees, make any warranty, express or implied, or assumes any legal liability or responsibility for the accuracy, completeness, or usefulness of the contents of this report.  Reference herein to any specific commercial product, process or service by trade name, trademark, manufacturer, or otherwise does not necessarily constitute or imply endorsement, recommendation or favoring by the United States Government or any agency thereof.

Geoffrey Hewitt

Let’s not forget that many of these Doctors had stipends and conferences paid for and hidden by many of these opioid producers for years.

Edward Hoffer

The problem is multifactorial. Clearly opioid deaths are one of the “deaths of despair” that spike among the unemployed and impoverished. The Joint Commission showed us the “law of unintended consequences” when they mandated that hospital patients be assessed for pain and that hospitals be rated based on how well they controlled patients’ pain. Doctors and dentists in the US over-prescribe narcotics routinely – the rate by dentists in the US is five times higher than in Europe. Finally, yes, there are sadly unscrupulous doctors who run “pill mills.”

Peter Blanchette

Contrary to what this article is implying, the abuse of opioids is not primarily the result of a few bad doctors. Many opioid users are the result of workplace injuries that are treated often inappropriately by the physicians licensed by the state that treats them. States regulate workers compensation insurance companies that pay for the treatment of workplace injuries. For many years I worked for the largest insurer in my state. Insurers like mine do very little to monitor the treatment of people on opioids. There are many claimants that are on opioids for years and years. After these opioid users are dropped by the insurers then they go on federal disability. The result of this is the crisis that is happening now.

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