The closed Studebaker automobile factory in South Bend, Indiana. The loss of industry preceded middle America’s vast opioid problem. | Photo by David Wilson

The Economic Despair Underpinning America’s Drug Epidemic

There’s an opioid crisis in America that urgently needs attention. President Trump is finally turning to it, though simply declaring it a public health emergency is not enough.

As many as 65,000 people died from overdoses in the U.S. last year. It’s the leading cause of death among Americans under 50. The opioid overdose death rate has surpassed every other public health concern in recent memory, including gun deaths (which peaked at almost 40,000 in 1993), AIDS deaths (approximately 50,000 in 1995), and car crash deaths (55,000 in 1972).

But it’s the accompanying statistics that paint a grim and telling economic picture.

Research by Anne Case and Angus Deaton of Princeton University, for instance, has shown these overdoses contributed to measurably higher midlife mortality rates in the United States, particularly among white men and women. Economist Alan Krueger, also of Princeton, estimates that opioids could account for about one-fifth of the decline in the labor force participation rate since 1999. With the unemployment rate so low, the participation rate has become a primary concern, and now we know at least one of the causes. The economic consequences of this epidemic are profound.

As Case and Deaton note, however:

“Opioids are like guns handed out in a suicide ward; they have certainly made the total epidemic much worse, but they are not the cause of the underlying depression.”

The underlying cause is despair.

The despair in believing a new job will never come, wages will never rise, and the social fabric of the family and community damaged by layoffs will never be repaired. Since the turn of this century in communities across America, tens of thousands of factories vanished, and nearly one-in-three manufacturing workers was handed a pink slip.

The odds of finding a new and comparable job are stacked against workers in their 40s, and especially against those in their 50s. Some of what black communities experienced in the 1970s after urban deindustrialization, locked into place by housing discrimination, is now seen in these smaller manufacturing communities — except underwater mortgages and other impediments to mobility are now the cause. For different reasons, people are stuck in place.

Is there a cure for this despair?

In the aftermath of the Great Depression in the 1930s, the cure was a massive public jobs program, creation of a social safety net, and the construction of dozens of public policy experiments to see what stuck and what didn’t.

All of that seems unlikely today. Even a modest infrastructure package is on the backburner. Many in the majority party want to weaken the social safety net, and the federal government isn’t about trying new things to help working people.

Still, the forgotten men and women of these opioid-riddled communities voted for a radical change in leadership, and based on my observations continue to give President Trump a wide berth. Nothing has yet worked for them, but if the president keeps on disrupting, that’s fine by most of his supporters.

The challenge is that these distressed communities are likely to become even more distressed in the coming years based on the latest Labor Department job forecasts.

It’s hard to believe things could get worse before they get better, but that’s a distinct possibility unless we change course. Tweets won’t erase economic despair. Nor will the politics of resentment.

Which makes this a good time to recall one of the lessons of our founders: America can build the economy it wants and needs, and public policy is vital to its success. We can shape our future. This ideal has been shared by Democrats and Republicans over the decades, but that lesson seems to have disappeared from our political memories.

It’s time we recapture it. Putting workers first, delivering true reform of our trade policies, investing in our infrastructure, preparing for artificial intelligence, incentivizing start-ups, and rediscovering our spirit of making things all seem like reasonable solutions.

While it’s heartening to see a few Senators recently take a stand for civility, we also need to get some things done. Civility won’t repair this despair, but public policies can. If we want to stem the opioid epidemic over the long-haul, we must rebuild the economic future of these distressed communities.