Friday, January 3, 2020

As U.S. Auto Plants Closed, Opioid Overdose Deaths Rose

Opioid overdose deaths have jumped in parts of the country where automotive assembly plants closed, demonstrating a link between economic downturn and the opioid crisis, according to a study in JAMA Internal Medicine. Within five years of plant closure, opioid overdose deaths in the affected counties were 85% higher than expected compared with counties with no plant closures. 

“Our findings illustrate the importance of declining economic opportunity as an underlying factor associated with the opioid overdose crisis,” wrote Atheendar S. Venkataramani, M.D., Ph.D., of the University of Pennsylvania Perelman School of Medicine and colleagues. “In particular, our findings, combined with a growing body of research demonstrating adverse associations between trade-related industrial decline and drug overdose mortality, lend support to the view that the current opioid overdose crisis may be associated in part with the same structural changes to the U.S. economy that have been responsible for worsening overall mortality among less-educated adults since the 1980s.”

For their study, the researchers used data from industry trade publications, automotive company websites, and newspaper articles to build a database of all automotive assembly plants that were operational in 1999. Most of them were in the South and Midwest. The researchers also identified 112 counties that were within commuting distance of at least one automotive assembly plant. These counties were in the top fifth nationwide in the number of adults who worked in manufacturing. From there, the researchers tracked plant closures through 2016. 

Next, the researchers compared opioid overdose deaths that occurred among adults aged 18 to 65 years for the same timeframe. Although the number of opioid overdose deaths climbed across the board, they rose more sharply in counties affected by plant closures: Five years after a plant closed, there were 8.6 more opioid overdose deaths per 100,000 people in the affected counties compared with unaffected counties. The largest increases in opioid overdose deaths occurred in non-Hispanic white men aged 18 to 34 years, followed by non-Hispanic white men aged 35 to 65 years.

“Our findings should not be interpreted in such a way as to diminish the role of opioid supply, either from physician prescriptions or from illicitly made and supplied synthetic substances, in the U.S. opioid overdose crisis,” Venkataramani and colleagues wrote. “[S]uccessful approaches to address the opioid overdose crisis will likely involve complementary interventions to reduce the prescription and illicit opioid supply as well as interventions to diagnose and treat substance use disorders in regions of the country hardest hit by structural economic change.” 

For related information, see the book The American Opioid Epidemic: From Patient Care to Public Health by APA Publishing and the Psychiatric Services article “The Opioid Epidemic and Psychiatry: The Time for Action Is Now.”

(Image: iStock/Traimak_Ivan)

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