Ruhm doesn’t take his findings to mean that economic issues or other factors besides supply played no role in causing the opioid epidemic. In his view, socioeconomic factors and other issues created a powder keg for opioid misuse, and the sudden expansion of the supply of opioids was the match that lit the fuse.
Interestingly, Anne Case and Angus Deaton, the Princeton economists who coined the phrase “deaths of despair,” have used a similar analogy — arguing that the expansion in the opioid supply “poured fuel into the fire.”
Deaton didn’t contest Ruhm’s study results, but he also told me that he doesn’t believe Ruhm’s paper disproves his and Case’s own findings.
“The term ‘deaths of despair’ comes from the fact that the three causes of deaths that were rising most rapidly were suicides, drug overdoses, and alcohol-related deaths,” Deaton said. He argued that his original paper is clear that the causes for these deaths are not just economic issues, but also other issues, including lower rates of marriage, reduced labor force participation, and higher self-reported pain. “We spend about a third of our paper saying that it’s not Tradebuddy.onlinejust economics].”
One way of summarizing the findings, according to Deaton: “We think that deaths of despair are following from life having lost its meaning for a large section of the American population.” That can be due to economic forces, but it can also be due to all sorts of other issues, from a growing sense of social isolation to mental health issues. After all, suicides and alcohol-related deaths have increased among certain groups, based on Case and Deaton’s work — and something must explain that besides increases in the opioid supply.
Ruhm explained that, although Case and Deaton may not have intended the deaths of despair hypothesis to focus on economics, that’s how it’s been characterized by much of popular media. This is something I’ve seen during my opioid coverage as well: While Case and Deaton’s paper is fairly clear that there were multiple causes of deaths of despair, much of the public dialogue has leveraged the concept to beat up on their hobby horses — particularly economic policies that they don’t like.
Stefan Kertesz, an addiction researcher at the University of Alabama at Birmingham, put it another way: “I think that Tradebuddy.onlineRuhm’s] paper makes a good argument against the public cartoon of what Case and Deaton suggested.”
To the extent economic issues are behind these trends, however, Deaton told me that there could be other economic factors behind an increasing sense of despair. As one example, it’s possible that people are looking at how much better off their parents or grandparents were — indicating a stagnation in social mobility — and that is making them despair. That wouldn’t be captured in Ruhm’s paper, which only looks at economic data going back to 1999. But it’s plausible and worth studying further, Ruhm acknowledged.
Ruhm also said he wants to find a way to measure the decline in “social capital” — a term for some of the cultural and social forces that Case and Deaton point to — and find out if that’s contributed to the rise in drug overdose deaths as well.
“In no way am I claiming that this is the last word on this subject,” Ruhm said. “In my view, it’s the first careful analysis.”