Causal or a symptom the bottom line is opioids are available around every corner it seems. The proliferation of pain management clinics has made obtaining pres

Causal or a symptom the bottom line is opioids are available around every corner it seems. The proliferation of pain management clinics has made obtaining prescriptions easy. The ACA has also helped as more people have insurance and the repaid expansion of Medicaid has resulted in dramatic increases in the number of opioids prescriptions written in numerous states. Additionally the economic downturn in 2007-2009 saw a huge increase in the number of people applying for disability rather than applying for unemployment. Although a large percentage of the applicants were denied many were awarded benefits and given the following this likely contributes as well: 1. Since 2004, the number of individuals receiving SSDI has increased 42% to just shy of 11M individuals. 2. In 2008 - 2010, the number of applications annually exceeded 2 million and hit 2.9 million in 2010. By 2013, the number of applications dropped to 2.3 million. On average, 45% of applications are approved and it can take as long as 600 days to get to an appeals hearing after an initial denial and reconsideration denial. By the time an application is awarded disability through a hearing the 27 month waiting period for Medicare has been met and the applicant has Medicare upon approval or shortly thereafter. In short, those waiting for disability that could not afford care Erie generally treated with narcotics. Opioids are certainly necessary for many people for the management of daily unrelenting pain but for others, they are a means of escape. Either way there is a "link to the job market" the question is are opioids the chicken or the egg?