December 30, 2019
The economic decline of the U.S. automotive manufacturing and assembly industry can be geographically linked to a rise in deaths caused by opioid overdoses, according to a new research from the University of Pennsylvania and Massachusetts General Hospital.
Building on previous knowledge about the relationship between opioid abuse and declining labor force participation, the study examined plant closures in the United States over a 17-year period from 1999-2016.
Researchers looked at 112 manufacturing counties near major automotive plants, noting their dates of closure and opioid-related deaths within their commuting zones.
Of the counties in the study, 29 experienced a plant closure during the period in question. Among adults between 16 and 65 years old, opioid overdose mortality rates were 85% higher in these counties than in those where plants remained open.
"Major economic events, such as plant closures, can affect a person's view of how their life might be in the future. These changes can have a profound effect on a person's mental well-being, and could consequently influence the risk of substance use," said lead author Atheendar Venkataramani, an assistant professor of Medical Ethics and Health Policy at Penn. "Our findings confirm the general intuition that declining economic opportunity may have played a significant role in driving the opioid crisis."
The group most heavily impacted by plant closures was non-Hispanic, white men between 18-34 years old, followed by non-Hispanic, white men between 35-65 years old. Increased opioid overdose mortality rates also were observed among younger, non-Hispanic, white women.
The authors of the study acknowledged that the increase in opioid overdose deaths occurred during a period in which opioid prescription rates skyrocketed. With greater awareness of the risks and tougher prescribing guidelines, those numbers have decreased steadily since 2010.
One of the study's goals was to look more deeply at factors in the crisis that help explain why people have taken advantage of the access to prescriptions.
"Our results are most relevant for the worsening population health trends in the industrial Midwest and South, regions that have experienced some of the largest increases in opioid overdose deaths and in which the automotive production and other manufacturing industries have long been economically and culturally significant," Venkataramani said.
The study, published Monday in JAMA Internal Medicine, urges changes in policy that can immediately address contributors to the opioid crisis.
"Until we can achieve structural change to address the fundamental drivers of the crisis, there are some health care system and health policy changes that can be implemented immediately," said senior author and co-study lead Alexander Tsai, an associate professor of psychiatry at the Massachusetts General Hospital and Harvard Medical School. "There is an urgent need to rapidly lower the threshold for accessing evidence-based treatment for substance use disorders, for example, at the level of state Medicaid policy and private payor utilization management."