Drug overdose deaths: It's not just economics
Let me start this highly unscientific post with a caveat, I think it’s quote likely that economic distress plays some role in the recent rise in drug overdose deaths. Here I’ll try to caution people that the role might be less that you would think, as casual empiricism suggests that many well performing states have high rates of drug overdoses, and vice versa. If you look at the data on state fatality rates from drug overdoses for 2015, you do see some of the expected pattern. Booming North Dakota had by far the lowest rate, and depressed West Virginia had by far the highest rate. But after that things seem less predictable.
There are several ways of thinking about economic distress. One is inequality. Utah is the most equal state, then Alaska, Wyoming and New Hampshire. In terms of median family income, Maryland is the richest state, then New Hampshire. So the Granite State is in a sweet spot, both very rich and relatively equal. But its drug deaths exceed the national average. The three states at the top of the gini table (i.e. most equal) also have above average median incomes. So they can be viewed as economic success stories. Utah even has a religion with wholesome values. And yet all three have above average drug overdose death rates, with Utah coming in a particularly bad 47th place (where 1st is lowest rate and 51st is highest.)
In contrast, the 5 states with the lowest rate of drug deaths are all in the northern plains area. (Note that the 4 most equal states and the 5 lowest drug deaths states are mostly white, but their drug death rates are vastly different.) Interestingly after the 5 plains states you have Virginia, followed by four very unequal states, with lots of poverty; Texas, New York, Mississippi and Georgia rounding out the top 10 for fewest drug deaths. Why do those 4 unequal states have relatively low drug death rates? (Mississippi is also quite poor.) I would have expected exactly the opposite; I would have expected their death rates to be far higher than the four best states for inequality, where economic distress is far less severe. If you prefer unemployment, New Hampshire has a 3.1% rate and Utah has a 3.5% rate.
Again, this is very unscientific, but I suspect that the correlation at the state level between economic distress and drug overdoses is much weaker than you might expect, even if at the individual level it is somewhat stronger. If America could have an income composition like New Hampshire or Utah, most people on the left, and many on the right would consider it a dream come true. Rich and equal. The bottom 20% in New Hampshire may have the highest living standard that the bottom 20% have experienced almost anywhere in the world, at any time in human history. And yet if we are somehow miraculously able to make the US just like New Hampshire, is this what awaits us?
New Hampshire saw at least 385 drug deaths in 2015, according to the latest tally from the Office of the Chief Medical Examiner — but the actual total could be even higher, as some 45 cases are still pending toxicology.
Toward the end of last year, state officials began warning that the state could end up surpassing 400 drug deaths total for 2015. Even if the current figure remains the same, however, that would still make 2015 the deadliest in recent years when it comes to drug overdose fatalities.
Of the cases processed so far, nearly two-thirds of the drug deaths last year involved fentanyl, either alone or mixed with other drugs.
Again, at the individual level economic distress probably matters a lot. But I suspect that tackling those economic issues at the macro level isn’t going to make all that much of a difference for the drug overdose problem. Even Bernie Sanders couldn’t make America as equal as Utah, nor could Jeb! make us as rich as New Hampshire.