20 ms·

Opioids and the Labor Market (2018)

130 points by resalisbury 8y ago

resalisbury 8y ago
The standard "correlation does not equal causation" rebuttal here might be "how do you know that ppl who are unemployed aren't just more likely to take more opioids?" The authors have attempted to address such a rebuttal thusly: "We also present evidence on reverse causality, finding that a short-term unemployment shock did not increase the share of people abusing prescription opioids."
- microcolonel 8y ago
  I'd be more inclined to think that the two trends share a cause, rather than cause one another.
  - williamdclt 8y ago
    Well that's exactly what "correlation does not equal causation" means
- ahmedalsudani 8y ago
  That's a weak way to address it. You don't start using opioids right after losing your job. There's a period when you're trying to find another job and keep yourself productive. Looking at short-term shocks is obviously flawed.
  - ngngngng 8y ago
    I was under the impression that MOST opioid addictions are caused by an opioid prescription. This would have nothing to do with your current job status.
    - sandworm101 8y ago
      >> caused by an opioid prescription. This would have nothing to do with your current job status. This is still the USA. Healthcare is attached to employment. I think it safe to say that those without jobs aren't visiting the doctor, getting prescriptions, at the same rate as those with employer-provided care.
    - mruts 8y ago
      I think people over estimate that possibility. I (and many people I know) got addicted because the same guy who deals one drug, deals other drugs. In my case I was buying cocaine to party and have sex and it turned out my drug dealer had heroin and offered me some one time for free. Because drugs are illegal, they are lumped to together, one guy who sells one might/probably sell the other. This is also why people call weed a "gateway" drug, because the dealer might have some MDMA or coke on them as well. If we just made all drugs illegal, I think we would eliminate this "gateway" effect. The can see evidence of this grouping effect in the mafia. They sell untaxed cigarettes, stolen goods, drugs, etc. What is the commonality between all of these things? The fact they are illegal of course!
      - reidjs 8y ago
        > If we just made all drugs illegal, I think we would eliminate this "gateway" effect. Did you mean to write the opposite of this?
        mruts 8y ago
        Yes sorry: legal
    - bobcostas55 8y ago
      ~75% of addictions start with people using them _without_ a prescription. https://www.samhsa.gov/data/sites/default/files/NSDUH-DetTabs2014/NSDUH-DetTabs2014.htm#tab6-47b https://www.samhsa.gov/data/sites/default/files/NSDUH-DetTab...
      - 8y ago
  - mruts 8y ago
    In my personal case, using opiates, specifically, heroin, was the only thing that let me keep my job (well, until I quit my job to get off of that shit). Working 12 hour day, 6-7 days a week in a brutal and miserable work environment (finance), the only thing I could do to survive was heroin. I would get like 4-5 hours a night and just felt like shit and really depressed everyday. Consequently, I started doing heroin for that extra "pep" (it's a common misnomer that heroin makes you fall asleep, it actually wakes you up). With heroin, I could work non-stop, sometimes for even 24 hours at a time while feeling sort of okay, provided I had a steady supply of heroin. I do however think that heroin/opiates use decreases the ability to rejoin the workforce. I fortunately was making a great salary so I could afford an expensive heroin habit ($200-$300 a day). But your average blue-collar worker probably isn't making as much money, and therefore, there state is much more unstable. Oscillating between getting high, going into withdrawals, running out of money, etc etc. When you are in this state, it is very hard to plan for the future (the only thing you are thinking about is how to not go into horrible pain in 3-4 hours) and, therefore, get a job.
    - zanmat0 8y ago
      Thanks for sharing, I didn't know it was used in those circles/circumstances.
      - exolymph 8y ago
        Eye-opening threads on the same topic, from a while back: https://news.ycombinator.com/item?id=16465762 https://news.ycombinator.com/item?id=16465762 https://news.ycombinator.com/item?id=14776864 https://news.ycombinator.com/item?id=14776864
    - bsder 8y ago
      I always presumed that cocaine was the "drug" (edit: originally used "opioid") of choice for finance. Heroin always seemed as for the "hardcore" or "musician" crowd.
      - opportune 8y ago
- KorematsuFred 8y ago
  Another issue here is that people who are out of employer provided insurance might be ending up consuming painkillers instead of actually getting proper health treatment.
- causalarrow 8y ago
  The US granted China permanent normal trade relations in 2000. Between 2000 and 2015, US imports from China more than quadrupled, increasing the decline of manufacturing jobs. According to Autor, Dorn & Hanson (2016): "Adjustment in local labor markets is remarkably slow, with wages and labor-force participation rates remaining depressed and unemployment rates remaining elevated for at least a full decade after the China trade shock commences"
  - DigiMortal 8y ago
    They took er jobs and gave us fentanyl
- peteradio 8y ago
  I'm skeptical of that rebuttal. Are they selecting only those who had a short term unemployment for that group? Perhaps that group is exactly the group who wouldn't be in despair since they were easily able to find new work. Did they normalize that group demographics/industry type to that of those in the original study group? How do they know they aren't selecting all tech workers based on the quick rebound for instance.
- ryanmarsh 8y ago
  True, correlation does not equal causation. However a .44 correlation should not be ignored.
- gabbygab 8y ago
  That seems a bit deceptive by the researchers. I don't think anyone is saying "short term unemployment" leads to opioids. I think most people assume long term unemployment or lack of long term opportunities lead to hopelessness and drug use. Certainly there is a difference between I got laid off from Company A and it took be 3 months to land a job at Company B and the only major employer in my area shut down and I have no real prospects. I may be mistaken, but isn't "lack of participation in the labor force" equivalent to long term unemployment rather than short term unemployment? Isn't the question whether there is a causative relation between "long term unemployment" and "opioid use"? Short-term unemployment has no bearing on the issue.
golemiprague 8y ago
What amazes me is the lack of empathy the ruling classes have to those people, especially under the Obama administration when this epidemic started and nobody was trying to do anything or help in any way. Is it because it is a predominantly white phenomenon and therefore they all considered to be privileged who deserve no empathy?
hlnas 8y ago
dude weed lmao
bredren 8y ago
I don't have data, but I also believe video games are a major factor.
- pzone 8y ago
  Video games, social networking, and other forms of cheap digital entertainment.
  - 0x8BADF00D 8y ago
    It will be interesting when mixed reality experiences become the norm, rather than an outlier. Digital opioids exist, and affect the brain in much the same way. It will only be a matter of time before VR experiences provide the same level of drug induced euphoria.
- nradov 8y ago
  Video games caused a 1.5 - 3.0% decrease in labor hours. https://www.nber.org/papers/w23552 https://www.nber.org/papers/w23552
DannyB2 8y ago
Just a counterpoint. I have taken prescription hydrocodone, for occasional use, for over ten years. I have been careful not to develop a tolerance. (because I want it to work when I need it.) It improves my quality of life. It's just a tool. A useful tool, like JSON, and unlike XML. Use it when needed, and don't use it when not needed. There are times I would have gone home from work, but sometimes even 1/2 tablet can make a huge difference. Maybe this is related and maybe not: I also do not drink alcohol and have never seen any reason why it would be appealing.
- caconym_ 8y ago
  Good for you. Also, the opioid epidemic is a real thing. I'm not sure what the point of this counterpoint is supposed to be.
  - DannyB2 8y ago
    Some people can benefit from the drug. But the opioid epidemic may make it difficult or impossible to obtain. That's the point.
    - LockNess0 8y ago
      The possible point should be that we just mature as a society and accept that drugs are a part of human life - and that altering brain chemistry can be very useful. Then we might develop drugs which are safe to use and non-addictive, and provide real productivity gains. Brave New World as an example. If all drugs are developed or sold under a veil of criminality, that will never happen. We need to expose them to market forces, litigation, consumer testing and regulation.
      - barbecue_sauce 8y ago
        Wait, are you using Brave New World as a positive example?
    - f-securus 8y ago
      Many of those same people can benefit from marijuana. Yet, it is still illegal nationally (in the States). Studies have shown opioid abuse has gone down in states that legalized recreational marijuana use. The opioid epidemic isn't making opioids more difficult or impossible to obtain. It is the backwards thinking war on drugs that wants to punish those who self medicate. Then they keep punishing people for arbitrary reasons. Recidivism rate in this country is far too high due to the prison/jail system's goal. It isn't to improve behavior, it is to make money. Who benefits from locking up a non-violent offender? The public foots the bill. Police officers have increased paperwork/workload which takes them away from far serious crimes. The offender doesn't receive help and has to jump through arbitrary hoops and walk a very fine line (compared to non-offenders) just to avoid re-incarceration. We don't actively work to improve people who are struggling. The jail system in the US primarily keeps people down.
snowwrestler 8y ago
If you haven't seen it, this interesting report from NPR draws connections between changes in welfare programs that saw their rolls diminish, with a commensurate increase in the rolls of disability programs. http://apps.npr.org/unfit-for-work/ http://apps.npr.org/unfit-for-work/ This was published in 2013 and it has stuck with me since then. I feel like we can now draw the line further, into the opioid epidemic today. It seems like we kicked people off welfare and their only option was disability, where they had legal access to opioids and an incentive to get and take them--to manage pain, yes, but also to embody their disabled status. Did we cause our own crisis through bad policy choices?
- c0nducktr 8y ago
  The book Dreamland[1] touches on this as well. There was this interview[2] (which I probably heard about on HN) with the author a couple years ago which was really interesting. [1]https://www.goodreads.com/book/show/22529381-dreamland https://www.goodreads.com/book/show/22529381-dreamland [2]http://www.econtalk.org/sam-quinones-on-heroin-the-opioid-epidemic-and-dreamland/ http://www.econtalk.org/sam-quinones-on-heroin-the-opioid-ep...
- opportune 8y ago
  I can attest that disability is a way of life in certain parts of the country. $15k/year may not sound like a lot, and it objectively isn't, but a household of 2 adults and 0-2 kids pulling $30k/year in some parts of the country can actually get by pretty well. If you can get an extra $10-20k/year in free opiates that's either a great way to feed an addiction or to make money on the side. There are counties where almost half of the adult population is on some kind of disability and those also happen to be the counties hurt hardest by the opiate epidemic, and known for "pain clinics". But, I think there is a third part of the cycle that the article you linked mentions. Nobody grows up wanting to survive off disability and being an opiate addict - while the pain clinic/disability combo might enable people entering this state, the reason people give in to this is that they have poor life prospects. Going on disability is basically giving up. We need to figure out how to provide better job and educational prospects in the areas / for the kind of people who are incentivized to go on disability so that they actually have much better options. The average West Virginian isn't intrinsically less able than the average resident of Utah
deleted 8y ago
[deleted]
cubano 8y ago
So how does this study capture individuals like, say, myself who apparently industry has deemed "unemployable" due to past legal (all-substance related) "transgressions" but is desperate to work in the industry where he has a 25 year history? I deal daily, now that I am mid-50's, with deep bone-on-bone pain due to a badly torn ACL in high school, and have found that light-dose opioid treatment keeps my QOL at a reasonable level and let's me live a pretty normal life. Getting access to these medications is now basically impossible without a huge financial and emotional investment thru "normal" channels. Have any of you ever felt the shame one feels when a 26yo pharmacist looks at you with semi-disguised disgust because you asked him to fill a opioid prescription? Or even worse, tell you that they are "out" of the medication and suggests you go to the other side of town to fill it? And let's not mention the incredible hassle and expense of trying to get said prescription nowadays...you can't even mention the word opiate during your examination without risking being kicked out of the office or something of the like. Does taking 30mg of a crappy synthetic opioid twice a day to relieve me of chronic pain really make me an unhireable junkie piece of shit? YES! shouts back society on a daily basis. Because that is where we are nowadays...BTW, I work my ass off while on medication because it allows me to concentrate on my software and not on the never ending aching throb in my knee. I've tried Tramadol and many other pain relief concoctions to various degrees of success, but I just don't understand why I have to live with the trade off when what works for me works so much better then anything else. So I choose to buy my opiates on the street...the natural type thank-you-very-much, and my life is much more pleasant, besides the fact no one will hire me due to my past, then it would otherwise be.
zhengiszen 8y ago
The talk about opioids always seems to forget the origin of the crisis : the war against Afghanistan taliban's successful curbing of opium cultivation and trafficking. The big pharma and industrial interests and their political servants are not challenged about it till today.

130 points by resalisbury 8y ago

The standard "correlation does not equal causation" rebuttal here might be "how do you know that ppl who are unemployed aren't just more likely to take more opioids?" The authors have attempted to address such a rebuttal thusly: "We also present evidence on reverse causality, finding that a short-term unemployment shock did not increase the share of people abusing prescription opioids."

microcolonel 8y ago
I'd be more inclined to think that the two trends share a cause, rather than cause one another.
- williamdclt 8y ago
  Well that's exactly what "correlation does not equal causation" means
ahmedalsudani 8y ago
That's a weak way to address it. You don't start using opioids right after losing your job. There's a period when you're trying to find another job and keep yourself productive. Looking at short-term shocks is obviously flawed.
- ngngngng 8y ago
  I was under the impression that MOST opioid addictions are caused by an opioid prescription. This would have nothing to do with your current job status.
  - sandworm101 8y ago
    >> caused by an opioid prescription. This would have nothing to do with your current job status. This is still the USA. Healthcare is attached to employment. I think it safe to say that those without jobs aren't visiting the doctor, getting prescriptions, at the same rate as those with employer-provided care.
  - mruts 8y ago
    I think people over estimate that possibility. I (and many people I know) got addicted because the same guy who deals one drug, deals other drugs. In my case I was buying cocaine to party and have sex and it turned out my drug dealer had heroin and offered me some one time for free. Because drugs are illegal, they are lumped to together, one guy who sells one might/probably sell the other. This is also why people call weed a "gateway" drug, because the dealer might have some MDMA or coke on them as well. If we just made all drugs illegal, I think we would eliminate this "gateway" effect. The can see evidence of this grouping effect in the mafia. They sell untaxed cigarettes, stolen goods, drugs, etc. What is the commonality between all of these things? The fact they are illegal of course!
    - reidjs 8y ago
      > If we just made all drugs illegal, I think we would eliminate this "gateway" effect. Did you mean to write the opposite of this?
      - mruts 8y ago
        Yes sorry: legal
  - bobcostas55 8y ago
    ~75% of addictions start with people using them _without_ a prescription. https://www.samhsa.gov/data/sites/default/files/NSDUH-DetTabs2014/NSDUH-DetTabs2014.htm#tab6-47b https://www.samhsa.gov/data/sites/default/files/NSDUH-DetTab...
    - 8y ago
- mruts 8y ago
  In my personal case, using opiates, specifically, heroin, was the only thing that let me keep my job (well, until I quit my job to get off of that shit). Working 12 hour day, 6-7 days a week in a brutal and miserable work environment (finance), the only thing I could do to survive was heroin. I would get like 4-5 hours a night and just felt like shit and really depressed everyday. Consequently, I started doing heroin for that extra "pep" (it's a common misnomer that heroin makes you fall asleep, it actually wakes you up). With heroin, I could work non-stop, sometimes for even 24 hours at a time while feeling sort of okay, provided I had a steady supply of heroin. I do however think that heroin/opiates use decreases the ability to rejoin the workforce. I fortunately was making a great salary so I could afford an expensive heroin habit ($200-$300 a day). But your average blue-collar worker probably isn't making as much money, and therefore, there state is much more unstable. Oscillating between getting high, going into withdrawals, running out of money, etc etc. When you are in this state, it is very hard to plan for the future (the only thing you are thinking about is how to not go into horrible pain in 3-4 hours) and, therefore, get a job.
  - zanmat0 8y ago
    Thanks for sharing, I didn't know it was used in those circles/circumstances.
    - exolymph 8y ago
      Eye-opening threads on the same topic, from a while back: https://news.ycombinator.com/item?id=16465762 https://news.ycombinator.com/item?id=16465762 https://news.ycombinator.com/item?id=14776864 https://news.ycombinator.com/item?id=14776864
  - bsder 8y ago
    I always presumed that cocaine was the "drug" (edit: originally used "opioid") of choice for finance. Heroin always seemed as for the "hardcore" or "musician" crowd.
    - opportune 8y ago
KorematsuFred 8y ago
Another issue here is that people who are out of employer provided insurance might be ending up consuming painkillers instead of actually getting proper health treatment.
causalarrow 8y ago
The US granted China permanent normal trade relations in 2000. Between 2000 and 2015, US imports from China more than quadrupled, increasing the decline of manufacturing jobs. According to Autor, Dorn & Hanson (2016): "Adjustment in local labor markets is remarkably slow, with wages and labor-force participation rates remaining depressed and unemployment rates remaining elevated for at least a full decade after the China trade shock commences"
- DigiMortal 8y ago
  They took er jobs and gave us fentanyl
peteradio 8y ago
I'm skeptical of that rebuttal. Are they selecting only those who had a short term unemployment for that group? Perhaps that group is exactly the group who wouldn't be in despair since they were easily able to find new work. Did they normalize that group demographics/industry type to that of those in the original study group? How do they know they aren't selecting all tech workers based on the quick rebound for instance.
ryanmarsh 8y ago
True, correlation does not equal causation. However a .44 correlation should not be ignored.
gabbygab 8y ago
That seems a bit deceptive by the researchers. I don't think anyone is saying "short term unemployment" leads to opioids. I think most people assume long term unemployment or lack of long term opportunities lead to hopelessness and drug use. Certainly there is a difference between I got laid off from Company A and it took be 3 months to land a job at Company B and the only major employer in my area shut down and I have no real prospects. I may be mistaken, but isn't "lack of participation in the labor force" equivalent to long term unemployment rather than short term unemployment? Isn't the question whether there is a causative relation between "long term unemployment" and "opioid use"? Short-term unemployment has no bearing on the issue.

golemiprague 8y ago

What amazes me is the lack of empathy the ruling classes have to those people, especially under the Obama administration when this epidemic started and nobody was trying to do anything or help in any way. Is it because it is a predominantly white phenomenon and therefore they all considered to be privileged who deserve no empathy?

hlnas 8y ago

dude weed lmao

bredren 8y ago

I don't have data, but I also believe video games are a major factor.

pzone 8y ago
Video games, social networking, and other forms of cheap digital entertainment.
- 0x8BADF00D 8y ago
  It will be interesting when mixed reality experiences become the norm, rather than an outlier. Digital opioids exist, and affect the brain in much the same way. It will only be a matter of time before VR experiences provide the same level of drug induced euphoria.
nradov 8y ago
Video games caused a 1.5 - 3.0% decrease in labor hours. https://www.nber.org/papers/w23552 https://www.nber.org/papers/w23552

DannyB2 8y ago

Just a counterpoint. I have taken prescription hydrocodone, for occasional use, for over ten years. I have been careful not to develop a tolerance. (because I want it to work when I need it.) It improves my quality of life. It's just a tool. A useful tool, like JSON, and unlike XML. Use it when needed, and don't use it when not needed. There are times I would have gone home from work, but sometimes even 1/2 tablet can make a huge difference. Maybe this is related and maybe not: I also do not drink alcohol and have never seen any reason why it would be appealing.

caconym_ 8y ago
Good for you. Also, the opioid epidemic is a real thing. I'm not sure what the point of this counterpoint is supposed to be.
- DannyB2 8y ago
  Some people can benefit from the drug. But the opioid epidemic may make it difficult or impossible to obtain. That's the point.
  - LockNess0 8y ago
    The possible point should be that we just mature as a society and accept that drugs are a part of human life - and that altering brain chemistry can be very useful. Then we might develop drugs which are safe to use and non-addictive, and provide real productivity gains. Brave New World as an example. If all drugs are developed or sold under a veil of criminality, that will never happen. We need to expose them to market forces, litigation, consumer testing and regulation.
    - barbecue_sauce 8y ago
      Wait, are you using Brave New World as a positive example?
  - f-securus 8y ago
    Many of those same people can benefit from marijuana. Yet, it is still illegal nationally (in the States). Studies have shown opioid abuse has gone down in states that legalized recreational marijuana use. The opioid epidemic isn't making opioids more difficult or impossible to obtain. It is the backwards thinking war on drugs that wants to punish those who self medicate. Then they keep punishing people for arbitrary reasons. Recidivism rate in this country is far too high due to the prison/jail system's goal. It isn't to improve behavior, it is to make money. Who benefits from locking up a non-violent offender? The public foots the bill. Police officers have increased paperwork/workload which takes them away from far serious crimes. The offender doesn't receive help and has to jump through arbitrary hoops and walk a very fine line (compared to non-offenders) just to avoid re-incarceration. We don't actively work to improve people who are struggling. The jail system in the US primarily keeps people down.

snowwrestler 8y ago

If you haven't seen it, this interesting report from NPR draws connections between changes in welfare programs that saw their rolls diminish, with a commensurate increase in the rolls of disability programs. http://apps.npr.org/unfit-for-work/ http://apps.npr.org/unfit-for-work/ This was published in 2013 and it has stuck with me since then. I feel like we can now draw the line further, into the opioid epidemic today. It seems like we kicked people off welfare and their only option was disability, where they had legal access to opioids and an incentive to get and take them--to manage pain, yes, but also to embody their disabled status. Did we cause our own crisis through bad policy choices?

c0nducktr 8y ago
The book Dreamland[1] touches on this as well. There was this interview[2] (which I probably heard about on HN) with the author a couple years ago which was really interesting. [1]https://www.goodreads.com/book/show/22529381-dreamland https://www.goodreads.com/book/show/22529381-dreamland [2]http://www.econtalk.org/sam-quinones-on-heroin-the-opioid-epidemic-and-dreamland/ http://www.econtalk.org/sam-quinones-on-heroin-the-opioid-ep...
opportune 8y ago
I can attest that disability is a way of life in certain parts of the country. $15k/year may not sound like a lot, and it objectively isn't, but a household of 2 adults and 0-2 kids pulling $30k/year in some parts of the country can actually get by pretty well. If you can get an extra $10-20k/year in free opiates that's either a great way to feed an addiction or to make money on the side. There are counties where almost half of the adult population is on some kind of disability and those also happen to be the counties hurt hardest by the opiate epidemic, and known for "pain clinics". But, I think there is a third part of the cycle that the article you linked mentions. Nobody grows up wanting to survive off disability and being an opiate addict - while the pain clinic/disability combo might enable people entering this state, the reason people give in to this is that they have poor life prospects. Going on disability is basically giving up. We need to figure out how to provide better job and educational prospects in the areas / for the kind of people who are incentivized to go on disability so that they actually have much better options. The average West Virginian isn't intrinsically less able than the average resident of Utah

deleted 8y ago

[deleted]

cubano 8y ago

So how does this study capture individuals like, say, myself who apparently industry has deemed "unemployable" due to past legal (all-substance related) "transgressions" but is desperate to work in the industry where he has a 25 year history? I deal daily, now that I am mid-50's, with deep bone-on-bone pain due to a badly torn ACL in high school, and have found that light-dose opioid treatment keeps my QOL at a reasonable level and let's me live a pretty normal life. Getting access to these medications is now basically impossible without a huge financial and emotional investment thru "normal" channels. Have any of you ever felt the shame one feels when a 26yo pharmacist looks at you with semi-disguised disgust because you asked him to fill a opioid prescription? Or even worse, tell you that they are "out" of the medication and suggests you go to the other side of town to fill it? And let's not mention the incredible hassle and expense of trying to get said prescription nowadays...you can't even mention the word opiate during your examination without risking being kicked out of the office or something of the like. Does taking 30mg of a crappy synthetic opioid twice a day to relieve me of chronic pain really make me an unhireable junkie piece of shit? YES! shouts back society on a daily basis. Because that is where we are nowadays...BTW, I work my ass off while on medication because it allows me to concentrate on my software and not on the never ending aching throb in my knee. I've tried Tramadol and many other pain relief concoctions to various degrees of success, but I just don't understand why I have to live with the trade off when what works for me works so much better then anything else. So I choose to buy my opiates on the street...the natural type thank-you-very-much, and my life is much more pleasant, besides the fact no one will hire me due to my past, then it would otherwise be.

zhengiszen 8y ago

The talk about opioids always seems to forget the origin of the crisis : the war against Afghanistan taliban's successful curbing of opium cultivation and trafficking. The big pharma and industrial interests and their political servants are not challenged about it till today.