Opioid Deaths Rise When Auto Plants Close, Study Shows

Being cynical, I fear that CEOs and Republican politicians are privately happy about the opioid epidemic. To meet the insatiable demands of Wall Street investors for maximum short-term gain, CEOs have made a priority of reducing labor costs. Wall Street applauds when a company announces a large layoff as the result of offshoring or a merger. While they wait for robots and AI sophisticated enough to fully replace workers, they discard expensive older workers in favor of cheap younger workers. They replace expensive full-time workers with cheaper temporary workers. Contrary to conservative propaganda, CEOs are not "job creators," but relentlessly destroy jobs to "unlock shareholder value." The discarded workers soon discover their experience is a disqualifying liability in finding new employment. If they can find new work (which too many older discarded workers can't), it pays much less than their former employment, and/or is precarious "gig economy" work with no benefits. It's best for those CEOs and their Wall Street customers if all those discarded workers would just quietly disappear. So it's great that they're killing themselves with opioids! That's certainly better than taxing corporate profits to help support the growing ranks of people they've consigned to destitution. Or worse, millions of angry, disaffected people voting for liberals who might seek to restrain their greed. Better dead than Blue! Of course, they'll never admit to any of that in public.

I worked as a college graduate trainee in the Wixom Assembley Plant in the mid 60's. Every pay day the local tavern would have a Brinks truck at the tavern so they could cash the auto workers checks. A line of cars with wives and children would line up outside the plant to collect there husbands checks. The absentee rate became so high after pay day that Ford divided up the pay days by name and paid one third each day so the plant could keep running. I am reading "The War on Normal People" by Andrew Yang in which he addresses this problem and many other social-economic problems, it is a well thought out and well worth the read.

Really! Another study to prove the logical?

Read this article and then consider how much the USA spends on unnecessary wars all across the globe to feed the military industrial complex. Its trillions of dollars. Human beings aren't even a line item in America's ever thirsty desire for crony capitalism. If you want to see America's greatest enemy in the world just go look in a mirror.

all these people just need to pull themselves up by the boot straps and get morals...correct?

NEWS FLASH: Putting people in very painful situations increases the likelihood they will become addicted to painkillers! It's that simple. The opiod crisis is serious, scary, growing, criminal, disgusting, immoral, and sad. But from an addiction perspective, it's not complicated.

The thing is, people need to WORK. You take their jobs and then what? Tell them to go back to school for retraining in a field that won't earn them a living wage for the rest of their working life? Or move to another city with better jobs? Aren't the folks that want to increase work requirements for food stamps and Medicaid always screaming about how work brings dignity? That's all well and good if you can FIND a job. If there's no work, you start to lose hope. And dignity isn't far behind. It's absolutely no wonder we've had this epidemic when factories have closed, retail is in the dumps, the farmers have surely gotten the shaft, and people can't work. This should have been obvious since about 2008.

An interesting side fact is that Americans are much less mobile now than in our history. That is to say, people don’t relocate for jobs like they used to. It would be interesting to know why. As an antidote, I support compulsory national service after high school; no exceptions. Military service would be one option among many. Model it on the Civilian Conservation Corps. Young adults would learn discipline, learn a trade, get out of their home towns, and learn to work on a common goal with people unlike themselves.

Although this fine study confirms our suspicions about the relationship between opioid misuse and poverty, unemployment and falling life expectations, the loss of health insurance to treat the emotional and physical illnesses is an un acknowledged factor. Even in states with Medicaid expansion, the move to COBRA or Medicaid after job termination is often rocky and poorly coordinated. Finding the documentation needed at such a time of turmoil is a game-changing challenge. For someone whose drug misuse has many roots, such an added obstacle can encourage the turn to street drugs, increasing the risk of death.

This is not surprising news, since it explains what I always wondered about, drug addiction in rust belt communities. Poverty + despair equal a poisonous cocktail that leads to drug abuse. Yet the whole thing is counter intuitive. Drug addition won't help any. It will only lead to even more poverty and even more despair.

Thank you for this article. Long overdue. We need to do more to boost our economy and create good paying jobs with benefits. Sadly Democrats abandoned the working class and it took Trump for them to “get it”.

I have been working in a safety net hospital for past three decades. There is 35% increase in out of hospital cardiac arrests in the past three years. It is mostly men and women between 50-60 years of age. We can blame many for this epidemic. But we still have not done enough to stop or contain it. Fentanyl and it is analogs remain the biggest problem. I lived through crack, cocaine, AIDS and now this may be the worst in untimely deaths.

This business about opioids killing people is misleading. Heroin addiction is killing them. They move from prescription pain killers (opioids) to heroin because it's cheaper. These folks are heroin addicts, plain and simple!

This is yet more evidence that the prosecutors and politicians have targeted the opioid medication pharmas because they have deep pockets. Like the tobacco litigation it plays well to the public that would like someone to blame. It wasn’t “doctor overprescribing” of opioid pain medication pushed by pharma that caused the problem. How is it that EVERY time statistics are cited as “proof”, it is the younger age groups that became addicted. I’ve got news for you: addiction started with alcohol and tobacco. If opioid pills were involved, it could have easily been heroin or fentanyl pills from China. At least half of deaths involving opioid are poly pharma.

Ah, free trade! What does Bill Clinton have to say about this? Win-win! How does opioid addiction associated with auto plant closings correlate with support for Trump?

You can blame the UAW for plant closings. 30 years of being uncompetitive because of inflated labor costs have made Detroit produce sub par vehicles. But hey, the workers got those raises they wanted....unions have wreaked havoc on this country’s manufacturing industry.

Excuses/ sadly it seems many commenters here find them necessary. I don't see any sympathy for the scourages that plagued cities in the 70s-80s and 90s: heroin, crack and opiods. Why? Perhaps a person's skin color has a lot to do with it. These people of color were told directly and indirectly 9if they weren't outright gnored) that nobody was interested in helping them. But because the current crop of opiod addicts are white, they suddenly need help? Like you tell others: man up. Maybe we'll get that sympathy rolling out to you, when the respect you all refuse to give current and past city dwellers is demonstrated. Until then, life goes on. Cruel, but no different , in fact a better offer than we city people got from you folks years ago. At least we haven't completely turned our backs on you.

So people who used to be middle class lost their jobs, their jobs may never return, they may or may not have done physical work that can cause pain. Take away the source of income and people lose hope? It doesn't take JAMA to prove this. Just look at any rural area where the main driver of income is lost and this is the result. THIS IS NOT ROCKET SCIENCE

Those companies are complicit in those deaths.

Destroying peoples livelihood increases the death rate. It always happens whether there are opioids or not. It takes what is needed to stay alive.

Did this study tell us anything we didn't already know? Couldn't we reach the same conclusion from studying the effects of decades-old job loss and economic decline in the black community? Or do we (still) believe the causes of crime and addiction among poor blacks to be caused by moral and character deficiencies? More than anything this study shows how the problems that confront black Americans aren't shared problems until they're experienced by whites. Even then, attention and resources will flow to where the "real" problem is said to exist.

Interesting. So now, MSM are ready to admit that addiction to substances is related to joblessness, hopelessness, etc.—not weakness of character, “absentee fathers”, and insufficient integrity and intelligence. Now, it’s a tragedy?

All the "free-traders" that pushed for NAFTA and other "free trade" agreements are responsible for these deaths.

Another triumph for social science, compiling reams of data to confirm what we already know. When people lose their job, they can't pay their bills, fight with their partner, experience a diminished sense of self-worth, and sometimes abuse drugs. What an astonishing, earth-shattering discovery! Looks like the 2020 Nobel Prize competition is over!

I think “Opioid Deaths” is an inaccurate terminology. “Opioid Suicide” is better.

I'm not surprised. If a person loses what they consider their identity, they fill the void with drugs and alcohol. Another awful reality of post-industrial America.

Not unlike WV and Ohio. Mining country. Poverty or the thought of poverty is the root cause. Why not call that out directly in your story? Journalism even at a fine source as the NYT is lacking in quality.

I'm pretty over the rust-belt.

I'm sure they will find a way to blame this on doctors and the health profession...

Legalize pot already!

Well, Florida was recognized for feeding the Opioid Crisis. We feed the "Oxi" generation. But, wait! Florida has now filled the gap with "Methamphetamine". It takes Law Enforcement 2 years to do investigation in the meantime there is a 1000 new addicts!

Out of one side of a politician’s mouth, you’ll hear them talk about investing and retraining and education. That sounds wonderful and would be wonderful EXCEPT companies like AT&T and Disney are replacing qualified Americans with foreign H1-b’s who have to be retrained by their American workers who are put on the streets. American workers are being undermined at every economic level by corporations while getting underserved and exorbitant tax cuts that have increased our deficit astronomically. No surprise opioid addiction is taking over cities across America and Trump was elected.

If there ever was a case of "correlation is not causality" this may be it. As others (vidre infra Baldwin) have noted, the key issue may not be the car plant but the place and people and lack of economic options for those involved. Stock investors jumped out of windows with the 1929 stock market crash--lives ruined by economic failure--but that did not mean open windows caused suicide.

While some aspect of this clearly has to do with a lost sense of purpose and a sense of hopelessness when factory closures lead to the loss of jobs and property values, we should also consider the role of lost income and how prescription opioids can come to replace that lost income. If a factory worker accustomed to making $10k/month or more loses that income and cannot replace that income with a new job, the temptation to sell all, or a portion of their prescribed opioid tabs may become too great. A patient who is prescribed say, 180 tabs per month of oxycontin tablets that can be sold for $40 each has just been given a source of revenue of as much as $7200 per month. It would make sense economically, even for a patient who is in pain, to make the case to their physician that their pain isn't well controlled, so that they will receive enough pills to both control their own pain and pay all of their bills. This isn't just theoretical. Those of us who practice medicine know that this has been happening on a grand scale, especially in places that have been economically hit hard in the past decade.

While this conclusion accords with my priors, I’m not sure this is really rock solid evidence. Counties where plants close are inherently different from ones where they don’t. So a comparison between the two begs the question what’s really causing what. As an example, poor local education might produce both outcomes even if there is no direct link from plant closure to opioid use. The best we can say is the opioid use appears to be correlated with measures of poor economic growth. Fair enough, but we probably knew that already.

Free community college education or vocational training for all. Let’s give all our young people a chance to take the first step toward a productive life.

As most have noted here this should not be a surprise to anyone. The pay and benefits of an auto worker are not out there unless you are in a specialized field with an advanced degree. Many of the auto workers are long term employees with deep roots in the community. When an auto plant closes thousands of people are out of work which overwhelms the community and the social support agencies. Additionally many people's lives are defined by their work, when that is gone so is their sense of self worth, hence drugs. This is one of the things that we as a nation are not good at addressing. The economy changes, that means a changing workforce, but what about those left behind? You are not going to get a 40 yrs old auto worker from Lordstown, OH with a high school education whose house is almost paid for, to move to San Diego, CA where there are lots of openings in the medical field, but also where the average rent for a 2 bedroom apartment is $2,385. Work in the medical fields would require a minimum of 2 years of training. How does she and her family survive? The barriers to entry in fields that are hiring are too high, hence drugs. We need a way to support not just the auto worker but also his/her family, until they can get their feet in the ground. Easy to say, but how to do this when 7,000 people have been laid off and the entire community has been knocked down?

Not sure that 16 to 65 is considered the prime working age. I hope this result holds true for ages 25 to 54.

Opioid-related deaths also extend to the faltering coal mining industry, as well. In Appalachia and middle-of-nowhere places like Carbon and Emery County in Utah where mines have reduced production or closed, opioid deaths are epidemic. These area are now bracing for another wave of epidemics according to the CDC: HIV and HCV (hepatitis) infections. https://www.cdc.gov/pwid/vulnerable-counties-data.html

The factories closed because manufacturing moved to low wage countries This development was widely praised by economists who attacked those opposed to it To cite "In Praise of Cheap Labor" by Paul Krugman " I guess I should have expected that this comment would generate letters along the lines of, “Well, if you lose your comfortable position as an American professor you can always find another job–as long as you are 12 years old and willing to work for 40 cents an hour.” Such moral outrage is common among the opponents of globalization–of the transfer of technology and capital from high-wage to low-wage countries and the resulting growth of labor-intensive Third World exports. "

Did workers compensation claims increase when plants close. If so, check prescription increase of opioids with those claims.

Is anyone really surprised by this information? All one has to do is take a look at a map of opioid deaths (and usage) in the US to see that the largest concentrations are in areas where there are no jobs and less hope. I keep saying when it comes to the opioid epidemic, we're fighting the wrong war. Despair, loss of hope equals a desire to escape one's current situation. Desire to escape equals drug use. It's a simple equation, and yet our politicians are blaming everyone except the people who created the problem; the companies who have outsourced US jobs to save money and pay fewer taxes at the expense of our industrial-based economy.

I am sure they rise whenever a huge local employer closes and puts whole communities out of work! This seems pretty obvious.

I can recall these same people making judgments about the inner city and refusing to see the crack epidemic as a loss of opportunities and a disease.Their insensitivity to others and now they find themselves in the same predicament.Their friends and neighbors vote Trump and blame other people for their lot in life.I wish them well though,may they find a 12 step program,achieve sobriety, gain a positive outlook on life and take responsibility for themselves.

We get the fruits of our education system and a focus on sports that prepare the majority of kids for working in a team, while giving them limited STEM abilities. Meanwhile, we are shipping our manufacturing jobs and we leave most people with no hope. Opioids crisis, or Trump's raise are not accidental. A lot of blue-collar workers feel useless and they are unprepared for the "better" jobs that usually require computer programming literacy, laboratory skills, etc. The technological revolution is affecting us as much as the Industrial Revolution affected our ancestors. The "laissez-faire" is heartless. We have to give our citizens back their dignity, not through governmental handouts, but by investing in them. Train the ones that can be trained for jobs change, invest in CO2 capturing technology, desalinization, update US infrastructure from bridges to high-speed trains and any other blue-collar jobs that can help both the environment and USA.

But as we know there has also been a steep rise in opioid abuse among teens, all of whom have not yet been working. Is their use impacted by their parents losing a job? If not, then what’s behind that?

One would have hoped for at least an iota of editorial input from the supposed Newspaper of Record. The root problem is a steep decline in economic opportunities for people dependent for local, remunerative (as opposed to slave-wage) employment on a single large manufacturing corporation - whether it be a maker of cars or anything else (Kodak in Rochester, NY comes to mind). Similar outcomes would result from the closing of a large hospital or military base.

Many many people suffer setbacks in their life- since when is it an excuse to abuse drugs or alcohol? Aren’t we all adults and responsible for ourselves??

Kudos for JAMA for engaging in socially relevant research. Their study a few months back on waste in the US healthcare system was path breaking. This piece is the type of research that needs to be done and popularized broadly. Health is impacted by employment, income, housing, education and more; not just your vital signs, genes, and other "hard" factors.

globalization! free trade! free markets! wait, maybe when businesses chase profits down to the last penny by paying workers as little as possible, it doesn't benefit the people whose jobs have vanished? can that be?

So why are we blaming the drug manufacturers, let alone the company that grew the poppies, if bored people get doctors to write prescriptions, and then take those drugs for no good reason?