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Authors:Rajeev Darolia, Colleen Heflin Pages: 7 - 14 Abstract: The ANNALS of the American Academy of Political and Social Science, Volume 703, Issue 1, Page 7-14, September 2022. We provide a brief orientation to the articles that comprise this volume, which is an effort to understand the consequences of the opioid epidemic in a variety of societal and community domains. These domains include child welfare, living arrangements, education, food insecurity, housing, and public budgets, and they are often paid scant attention compared to research that focuses on the direct effects of opioid use. We give an overview of the articles that comprise this volume and discuss the ways in which they contribute new empirical insights on the consequences of the opioid crisis in the U.S. and Canada. We conclude with thoughts on the challenges inherent in this work, insights about how this volume of research might help us understand the broader reach of the epidemic, and how it helps in the development of prosocial public policies. Citation: The ANNALS of the American Academy of Political and Social Science PubDate: 2023-03-20T12:01:34Z DOI: 10.1177/00027162231157569 Issue No:Vol. 703, No. 1 (2023)
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Authors:Johanna Catherine Maclean, Justine Mallatt, Christopher J. Ruhm, Kosali Simon Pages: 15 - 49 Abstract: The ANNALS of the American Academy of Political and Social Science, Volume 703, Issue 1, Page 15-49, September 2022. We review quasi-experimental studies that examine the relationship of opioids to health, healthcare, and crime in the U.S. Our findings align with the general perception that the opioid crisis has negatively impacted health and increased healthcare costs; we find limited evidence that appropriate opioid use enhances work capacity or carries other benefits. Extant studies suggest that opioids also increase crime, although the link is not as strong as has been observed in previous drug epidemics. This finding is consistent with the fact that opioids are pharmacologically different than stimulant substances like cocaine that have dominated earlier drug epidemic periods. We argue that the healthcare system has a potentially important role to play in combatting the opioid crisis, largely through the provision of treatments that address underlying addiction, and through the development of strategies to effectively curtail access to the drugs. Citation: The ANNALS of the American Academy of Political and Social Science PubDate: 2023-03-20T12:01:37Z DOI: 10.1177/00027162221149285 Issue No:Vol. 703, No. 1 (2023)
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Authors:Shannon M. Monnat Pages: 50 - 78 Abstract: The ANNALS of the American Academy of Political and Social Science, Volume 703, Issue 1, Page 50-78, September 2022. The U.S. drug overdose crisis has been described as a national disaster that has affected all communities. But overdose rates are higher among some subpopulations and in some places than they are in others. This article describes demographic (sex, racial/ethnic, age) and geographic variation in fatal drug overdose rates in the United States from 1999 to 2020. Across most of that timespan, rates were highest among young and middle-age (25–54 years) White and American Indian males and middle-age and older (45+ years) Black males. Rates have been consistently high in Appalachia, but the crisis has spread to several other regions in recent years, and rates are high across the urban-rural continuum. Opioids have been the main contributor, but overdoses involving cocaine and psychostimulants have also increased dramatically in recent years, demonstrating that our problem is bigger than opioids. Evidence suggests that supply-side interventions are unlikely to be effective in reducing overdoses. I argue that the U.S. should invest in policies that address the upstream structural drivers of the crisis. Citation: The ANNALS of the American Academy of Political and Social Science PubDate: 2023-03-20T12:01:37Z DOI: 10.1177/00027162231154348 Issue No:Vol. 703, No. 1 (2023)
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Authors:Lindsey Rose Bullinger, Vivian Wang, Kenneth A. Feder Pages: 79 - 105 Abstract: The ANNALS of the American Academy of Political and Social Science, Volume 703, Issue 1, Page 79-105, September 2022. Children exposed to parental opioid use disorder are at an elevated risk of maltreatment. We study whether parents’ access to medication-assisted opioid treatment programs (OTPs) affects the well-being of their children. An administrative decision to lift a moratorium on access to these programs in Indiana created the opportunity for this study. We show that after a county opened an OTP, methadone dispensing increased and emergency department visits related to opioid overdose decreased there, offering evidence of the success of these programs. We also show that the opening of these OTPs did not have significant effects on reports of child maltreatment, but that out-of-home foster care placements were reduced by 22 percent. Our findings are consistent with past research showing that child welfare cases involving parental substance use tend to be complex and tend to have longer times to parent/child reunification than child welfare cases in which substance use is not present. We argue that expanding access to opioid treatment programs may help reduce foster care placements. Citation: The ANNALS of the American Academy of Political and Social Science PubDate: 2023-03-20T12:01:38Z DOI: 10.1177/00027162221142644 Issue No:Vol. 703, No. 1 (2023)
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Authors:Jessica Pac, Christine Durrance, Lawrence Berger, Deborah B. Ehrenthal Pages: 106 - 138 Abstract: The ANNALS of the American Academy of Political and Social Science, Volume 703, Issue 1, Page 106-138, September 2022. We estimate the causal effects of infants’ exposure to opioids in utero on their health at birth and on the likelihood that their parents will be the subjects of subsequent reports to child protective services. We use administrative data on 259,723 infants born to 176,224 mothers enrolled in Medicaid between 2010 and 2019. Results suggest that an infant experiencing withdrawal symptoms after birth or needing admission to intensive care is strongly associated with prenatal opioid exposure, and that this effect is concentrated among those whose mothers used illicit opioids or were undergoing medication-assisted opioid treatments in their first and third trimesters. Prenatal opioid exposure is also associated with referrals of parents to child protective services and with being born preterm, low birthweight, or small for gestational age. We find smaller effects among infants exposed to prescription opioids, but these effects are not trivial, supporting current recommendations to balance the potential for infant adverse effects with the benefits of pain management during pregnancy. Citation: The ANNALS of the American Academy of Political and Social Science PubDate: 2023-03-20T12:01:37Z DOI: 10.1177/00027162231154338 Issue No:Vol. 703, No. 1 (2023)
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Authors:Alexander Chapman Pages: 139 - 161 Abstract: The ANNALS of the American Academy of Political and Social Science, Volume 703, Issue 1, Page 139-161, September 2022. Rising opioid mortality coincides with reported rises in child maltreatment since the early 2000s. I consider mechanisms that link the opioid epidemic and child maltreatment, focusing on social disorganization, the geographic and temporal patterns of opioid mortality, and community-level substance use and child maltreatment. I combine data from the ACS, CDC WONDER, and NCANDS in county-level analyses. I show a positive association between adult opioid mortality and child maltreatment that varies over time, and the results suggest a stronger association between opioid mortality and child maltreatment in high-poverty counties. Counties with high levels of residential mobility show negative associations between opioid mortality and child maltreatment when mortality levels are low. These findings bolster arguments that child maltreatment can be decreased by reducing poverty and opioid mortality and by increasing opportunities for residential mobility. Citation: The ANNALS of the American Academy of Political and Social Science PubDate: 2023-03-20T12:01:36Z DOI: 10.1177/00027162221144172 Issue No:Vol. 703, No. 1 (2023)
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Authors:Mónica L. Caudillo, Andrés Villarreal, Philip N. Cohen Pages: 162 - 187 Abstract: The ANNALS of the American Academy of Political and Social Science, Volume 703, Issue 1, Page 162-187, September 2022. Although the detrimental effects of the opioid epidemic on individuals’ health and well-being have been well documented, we know little about how it has affected the family contexts in which children live. We assess how the opioid epidemic, as measured by a rise in the opioid overdose death rate, has affected the rates at which children live in different family arrangements: two married parents, two cohabiting parents, single mother, single father, or another configuration. Our local fixed-effects models show that higher local overdose death rates are associated with fewer children living with two married parents and with an increase in children living in family structures that tend to be less stable, such as those led by cohabiting parents or a single parent. These changes in family arrangements have potential long-term implications for the well-being of future generations. Citation: The ANNALS of the American Academy of Political and Social Science PubDate: 2023-03-20T12:01:38Z DOI: 10.1177/00027162221142648 Issue No:Vol. 703, No. 1 (2023)
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Authors:Rajeev Darolia, Sam Owens, John Tyler Pages: 188 - 233 Abstract: The ANNALS of the American Academy of Political and Social Science, Volume 703, Issue 1, Page 188-233, September 2022. We propose a simple model of how opioids in a community can impact the educational outcomes of children based on both the extent of exposure to opioids in the community and on the child’s vulnerability to any given level of exposure. We then use national data to document where and how the opioid crisis has intersected with students’ performance on standardized test scores in the U.S., focusing particularly on rural communities. Finally, we estimate the extent to which variation in one measure of the opioid crisis, drug-related mortality, is related to variation in test scores. We find strong relationships between the two, as well as evidence that the relationship is particularly salient for third-grade students in rural communities. Citation: The ANNALS of the American Academy of Political and Social Science PubDate: 2023-03-20T12:01:36Z DOI: 10.1177/00027162231151523 Issue No:Vol. 703, No. 1 (2023)
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Authors:Jessica Drescher, Lily Steyer, Carrie Townley-Flores, Keith Humphreys Pages: 234 - 261 Abstract: The ANNALS of the American Academy of Political and Social Science, Volume 703, Issue 1, Page 234-261, September 2022. The potential spillover effects of the United States’ opioid epidemic on children’s educational outcomes have received surprisingly little attention from researchers. Accordingly, this study leverages national datasets of county-level opioid prescription rates and public school students’ third- to eighth-grade academic achievement to provide the first analysis of associations between community opioid prevalence and children’s learning rates. We find that students in counties with higher community opioid presence learn more slowly than peers in counties with low community opioid presence, both in aggregate and across different racial, ethnic, and socioeconomic groups of students. Moreover, within states we observe a small significant negative association between community opioid presence and student learning rates. This association is similar in rural and nonrural communities. These findings underscore the urgency of conceptualizing the opioid epidemic as a community-level crisis, with potentially long-lasting implications for children’s future educational attainment and life outcomes. Citation: The ANNALS of the American Academy of Political and Social Science PubDate: 2023-03-20T12:01:36Z DOI: 10.1177/00027162231151524 Issue No:Vol. 703, No. 1 (2023)
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Authors:Colleen Heflin, Xiaohan Sun Pages: 262 - 284 Abstract: The ANNALS of the American Academy of Political and Social Science, Volume 703, Issue 1, Page 262-284, September 2022. The opioid epidemic has increased adult mortality, disrupted families, and changed labor supply—all factors that are independently associated with poverty and food insecurity. We explore the relationship between the opioid crisis and food insecurity at the state level, first by examining the relationship of drug-related mortalities to food insecurity, and then by exploiting cross-state variations in OxyContin misuse prior to reformulation of the drug to investigate whether food insecurity increased as individuals with opioid use disorder transitioned from prescription to street drugs such as heroin. Results provide further evidence of the presence and size of the social consequences of the opioid crises and the negative consequences associated with drug reformulation for food security. Citation: The ANNALS of the American Academy of Political and Social Science PubDate: 2023-03-20T12:01:37Z DOI: 10.1177/00027162221149287 Issue No:Vol. 703, No. 1 (2023)
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Authors:Andrew Sullivan, Changwe Park Pages: 285 - 302 Abstract: The ANNALS of the American Academy of Political and Social Science, Volume 703, Issue 1, Page 285-302, September 2022. The federal government awarded $115 million to local entities between 2015 and 2018 for medication-assisted treatment (MAT) programs to treat opioid use disorder. These programs integrate the use of medications with counseling and behavioral therapies to reduce withdrawal symptoms and other adverse, individual-level effects of opioid misuse. Mounting evidence shows the benefits of MAT interventions among individuals, but little is known of whether these programs have prosocial, community-level effects. We examine the effect of MAT programs on one such community-level outcome: homelessness. Our event study design shows that MAT grants did not have a discernable relationship to homelessness at the community level; and we argue that while MAT may be an effective approach to treating opioid use disorder among individuals, more must be done to scale up its effects of these programs on community-level outcomes like homelessness. Citation: The ANNALS of the American Academy of Political and Social Science PubDate: 2023-03-20T12:01:35Z DOI: 10.1177/00027162231156291 Issue No:Vol. 703, No. 1 (2023)
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Authors:Alexander Cheung, Joseph Marchand, Patricia Mark Pages: 303 - 323 Abstract: The ANNALS of the American Academy of Political and Social Science, Volume 703, Issue 1, Page 303-323, September 2022. Opioids were declared a public health emergency in British Columbia, Canada, in 2016, and from that year through 2021, 29,894 Canadians lost their lives to opioid overdoses. More than two-thirds of those victims were employed in the five years prior to their deaths, and this study aims to quantify their lost productivity to the Canadian economy. We apply two human capital model variants in our analysis, projecting forward the future economic output of individuals who died from opioids, from their deaths to what would have been their eventual retirements, based on the industries in which they were employed. The total estimated productivity loss to Canada is at least $8.8 billion, with the equivalent “value of statistical life” calculations an order of magnitude higher; these are based on estimates of the amount of money that individuals would pay to avoid death. Our results challenge the notion that the opioid crisis predominantly affects unproductive members of society. Citation: The ANNALS of the American Academy of Political and Social Science PubDate: 2023-03-20T12:01:35Z DOI: 10.1177/00027162231155040 Issue No:Vol. 703, No. 1 (2023)
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Authors:Robert Bifulco, Iuliia Shybalkina Pages: 324 - 349 Abstract: The ANNALS of the American Academy of Political and Social Science, Volume 703, Issue 1, Page 324-349, September 2022. Adverse effects of the opioid crisis on individuals influence the need for state and local government expenditures and erode their tax bases. Systematic estimates of the magnitude of such fiscal impacts are lacking. We estimate the magnitude of the effect of the opioid crisis on state and local expenditures and discuss approaches that might be taken to evaluate the impact of the crisis on revenues. We find that the fiscal impacts of the opioid crisis on state and local governments are modest for the U.S. as a whole but are likely to be greater in states with particularly high rates of opioid-use disorders. Our analysis aims to encourage and guide more in-depth studies in the future. Such studies can inform intergovernmental aid policies designed to offset the fiscal impacts of opioid misuse and can also contribute to assessing damages in opioid lawsuits. Citation: The ANNALS of the American Academy of Political and Social Science PubDate: 2023-03-20T12:01:35Z DOI: 10.1177/00027162221137171 Issue No:Vol. 703, No. 1 (2023)
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