A few months back, The Economist had an article on the drug problem in Scotland. This statistic caught my eye:
Scots in the poorest areas are 16 times more likely to die a drug-related death than those in the richest places.
The difference between the overdose death rates for the rich and poor is too large to be attributed to mere coincidence. This discrepancy cries out for some sort of explanation.
One possibility is that a lack of money makes people depressed, and depressed people are more likely to abuse drugs in order to ease the pain of poverty. Another possibility is that both poverty and drug abuse are caused by a third factor. How could we distinguish between these alternative theories?
The same article in the Economist has a graph which shows some equally startling differences in drug overdoes rates across countries:
There seems to be little or no correlation between the wealth of nations and the rate of drug abuse. Scotland’s per capita GDP is right at the average of the European Union, the US is far richer than the European average, while Portugal is much poorer than average. And yet it is Portugal that has the lowest level of drug overdose deaths.
So how can we reconcile the fact that drug abuse within a country like Scotland is highly correlated with income, while at the international level one sees little evidence of poverty causing drug abuse? One possibility is that both drug abuse and poverty are caused by a third factor.
Suppose that both poverty and drug use are correlated with some aspect of personality. Also assume that all countries have a mix of personalities, some more susceptible to drug use than others. And finally, assume that international difference in per capita income are not caused by difference in national personalities. I’m not suggesting that any of these assumptions are completely true, rather I’m claiming that they allow us to understand why drug use with a country might strongly correlate with poverty, but not across countries.
If we assume that in both poor and rich countries a fairly stable percentage of the population has a personality that makes them susceptible to drug abuse, then we would not necessarily expect more drug abuse in poor countries than in rich countries. If we also assume that the same aspect of personality that leads to drug abuse also leads to poverty (say a lack of self control), then we can explain both the within country correlation and the lack of international correlation.
Case closed? Not quite. This doesn’t explain why there is such a large difference in drug overdose deaths between different countries (and even between different regions, as we see in the UK.) Something else is going on, but poverty alone doesn’t seem to be an explanation.
One possibility is that some countries have legal systems that are more tolerant of drug use. But that also doesn’t seem to fit the data, as both Switzerland and Portugal rely more on a softer “harm reduction” approach, whereas the US and Scotland have much stricter enforcement of laws against drug use. Indeed, it may be the case that strict enforcement of drug laws actually increases overdose deaths, by creating an underground market where drug quality is highly unreliable.
Instead, I suspect that drug use is correlated with two factors—personality and regional culture. Regions of the world where people lack community support systems may have higher rates of drug abuse, and people with certain personality types within any given area are more likely to abuse drugs. The worst situation of all would be people who lack self control and live in relative isolation in countries without strong support systems for individuals struggling with life.
In the US, the two states with the lowest rates of drug overdose deaths are Nebraska and South Dakota. Both states have many small rural towns with a strong sense of community. North Dakota used to be quite similar in a cultural sense, but the fracking boom in the Bakken region has brought in many younger workers who are isolated from their family and community. North Dakota still has a fairly low drug overdose rate, but it’s now significantly worse than its two neighbors to the south. And yet no one would argue that the oil boom has made North Dakota poorer—indeed just the opposite is true.
To conclude, poverty probably does not directly cause drug overdose deaths. But within any given region, the factors that cause poverty likely do correlate with the factors that cause drug abuse.
READER COMMENTS
Peter
May 24 2024 at 3:42pm
You are missing two more obvious, and true in my observation among friends and my time working at a homeless shelter:
(1) Rich people have more reputable dealers, i.e. my wealthy friends who do methamphetamine get less adulterated drugs from their high class dealers than my homeless friends who get it off the street even though the price per gram is identical, often even slightly more for the adulterated stuff because of a street risk premium. Cleaner drugs means less chance of death hence less reported deaths among the wealthy users.
(2) A $3000 a month heroin habit, which is a pretty normal usage floor for someone abusing heroin, as opposed to recreationally, given they go though about a $100 a day, will for purposes of statistics make you appear to be in poverty if you aren’t wealthy. I.e. someone making $30K a month isn’t in poverty on that habit where as the identical person making $3K month is. It’s not that poverty caused the drug use nor the drug use caused the poverty, it’s simply a matter of total income and buckets of money. Our former guy has the free income to also pay rent and buy a Tesla, the latter doesn’t but either way they both spending the same on heroin. It’s about priorities.
Matthias
May 24 2024 at 8:03pm
Good! I was about to write something similar, though purely from speculation, not from experience working at a shelter.
Btw, depending on.how you measure poverty your second reasons might not cause ‘poverty’. Ie if you measure poverty by income, spending all your money on drugs doesn’t necessarily cause your income to fall (assuming you can keep your job).
But if your income is pretty low, it causes all your other consumption to fall.
Peter
May 24 2024 at 8:39pm
To your latter point, official poverty doesn’t track off book income, i.e. whether they hold a legal job or not, our homeless guy is making $3K a month regardless to pay for that habit, dealers don’t generally do charity.
Nobody seeing an organized crimelord driving his Porsche around town is living in poverty even in their reported monthly income is zero. My cleaning lady on the books makes $23K a year but nobody would say she is living in poverty as both her kids go to prestigious private schools, she drives a current year high end Mercedes which she changes annually, and she and her kids take four three weeks vacations a year all over the world and has for a decade, they recently just got back from Norway for example but yeah $23K, food stamps, must be in “poverty”.
I believe when people talk poverty, generally speaking, they measure it by perceived monthly expendable income and lifestyle, i.e. a homeless guy spending 3K a month in heroin while sleeping in a shelter rather than $3K a month in rent is perceived to be in drug induced poverty whereas the other person isn’t even if both have identical income, both are on food stamps, and rent is just as discretionary as heroin given money is fungible.
Scott Sumner
May 24 2024 at 11:27pm
Good point about how the rich benefit from “reputable dealers”.
Richard W Fulmer
May 24 2024 at 5:49pm
We’re missing some data. What is the number of regular drug users per million people in each area in question? Presumably, there is a strong correlation between drug use and drug overdoses. If the correlation is perfect, then fewer Portuguese use drugs than do Scots. Simple.
If, however, some regions have high drug use but relatively few overdoses while other areas have low drug use and relatively high overdoses, then there are other factors at play.
steve
May 25 2024 at 11:50am
Which drugs they are using matters a lot. Fentanyl is common here and IIRC parts of eastern Europe but not the west. Lot easier to have accidental OD of fentanyl and harder to treat.
Steve
Richard W Fulmer
May 25 2024 at 2:11pm
Great point. So, yet another variable.
Kevin Erdmann
May 25 2024 at 5:45pm
I’m increasingly coming to see how important orthogonal factors are in fueling public confusion or obstinance on issues. In housing, 2 common issues that your discussion reminded me of:
1) supply-side constraints create a permanently rising cost trend. There are always short term cycles around that trend, so the trend is always most noticeable during upcycles. This leads to pluralistic majorities who think the problem is that it is too cyclical, and the worse the supply problem is, the more convinced they are that the cycles are the problem.
2) Homelessness is obviously caused by a lack of housing. But even homeless advocates will be convinced that housing has nothing to do with it. “I work with these people! They’re all mental cases and drug addicts! You can’t solve their problems with your easy ivory tower solutions.”
Peter
May 26 2024 at 3:58pm
On (2) while true in an absolute sense, in a practical sense the problem isn’t a lack of housing as many shelters are actually under capacity on average throughout the year, but ACCEPTABLE housing.
Shelter’s won’t accept the vast majority of homeless who try use their services, many shelters have restrictions which make them untenable (no pets, clean and sober, no co-ed couples, curfews, no phone recharging, no secure storage, etc), and often the shelter is worse than the street as they are plagued with crime (theft is rampant as is sex and physical abuse by employees), bedbug and mold infestations, and holier-than-thou condescending staff that make every minute hell.
Why go to a shelter where you have to get rid of the only thing that brings you joy in life, your dog, only to be robbed in your sleep, woken up in the morning covered in bedbug bites, and then lectured for breakfast about how inferior you are by some upper middle class princess only to be kicked out for the TB you caught while there.
There is a case right now before the Supreme Court about can you criminalize being homeless as long as the municipality claims they have excess capacity to house them but what the Judges in their orals were high unsympathetic to was human dignity and the fact municipalities intentionally make shelters nobody wants to use simply as a way to pro forma skirt the law and run them out of town given the catch 22. If the Court is going to rule in favor of the municipalities then it needs to be qualified with ACCEPTABLE housing as defined by the homeless population themselves, i.e. all barriers to entry which prevent them from using it need to be removed.
Jose Pablo
May 26 2024 at 7:48pm
Caplan makes a similar argument in a recent post.
https://www.betonit.ai/p/poverty_and_behhtml?utm_source=post-email-title&publication_id=820634&post_id=128197701&utm_campaign=email-post-title&isFreemail=true&r=1gbsup&triedRedirect=true&utm_medium=email
The argument is that it is difficult to blame drug abuse on poverty since poverty is a good reason to avoid drug abuse (some of the reasons pointed out in previous comments).
Very likely poverty and drug abuse are caused by a third factor. The numbers you mention just show that this “third factor” has significant “local” and international variations.
[As a “byproduct” of Bryan’s post: it is a pity that we still don’t have “Poverty. Who to blame”, although “The Case Against Education” was published 5 years ago]
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