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.

The upshot is that opioid users were far more likely to wind up in the federal disability insurance program, despite claims of the potential of opioids to effectively manage chronic pain. By 2016, the participation of opioid users in the disability program had surged from 11 percent to 40 percent – dramatically higher than the rate for non-users.

Opioids, not surprisingly, caused a sharp increase in mortality, which also unfolded quickly. The mortality rate for people on the drugs started to rise more rapidly than the non-users’ rate in 2010 and the gap continued to grow through 2018.

The “consequences to workers and [disability] programs of powerful prescription painkillers are substantial and long-lasting,” the study concluded.

To read this study, authored by Philip Armour, Rosanna Smart, and Elliott Brennan, see “The Causes and Consequences of Opioid Use among Older Americans: a Panel Survey Approach.”

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.