Plant closings and opioids

Alarming statistics suggest a connection 


A new study by Dr. Atheendar Venkataramani, professor of medicine at the University of Pennsylvania has revealed that opioid deaths among individuals of prime working age are eighty-five percent higher in counties where factories have been closed.

The study, which is available online, specifically looked at auto plants.  Interviewed by Niraj Chokshi, writing in The New York Times, the authors elaborated; In Chokshi’s words, “…car plants…are often the economic mainstay of a community. The struggles of the auto industry have long been viewed as symbolic of a broader manufacturing decline, which has been felt keenly in parts of the country hit hardest by the opioid crisis.

The study reaches several conclusions:

Importance  Fading economic opportunity has been hypothesized to be an important factor associated with the US opioid overdose crisis. Automotive assembly plant closures are culturally significant events that substantially erode local economic opportunities….

…Main Outcomes and Measures  The primary outcome was the county-level age-adjusted opioid overdose mortality rate. Secondary outcomes included the overall drug overdose mortality rate and prescription vs illicit drug overdose mortality rates.

Results  During the study period, 29 manufacturing counties in 10 commuting zones were exposed to an automotive assembly plant closure, while 83 manufacturing counties in 20 commuting zones remained unexposed. Mean (SD) baseline opioid overdose rates per 100 000 were similar in exposed (0.9 [1.4]) and unexposed (1.0 [2.1]) counties. Automotive assembly plant closures were associated with statistically significant increases in opioid overdose mortality. Five years after a plant closure, mortality rates had increased by 8.6 opioid overdose deaths per 100 000 individuals (95% CI, 2.6-14.6; P = .006) in exposed counties compared with unexposed counties, an 85% increase relative to the mortality rate of 12 deaths per 100 000 observed in unexposed counties at the same time point. In analyses stratified by age, sex, and race/ethnicity, the largest increases in opioid overdose mortality were observed among non-Hispanic white men aged 18 to 34 years (20.1 deaths per 100 000; 95% CI, 8.8-31.3; P = .001) and aged 35 to 65 years (12.8 deaths per 100 000; 95% CI, 5.7-20.0; P = .001). We observed similar patterns of prescription vs illicit drug overdose mortality. Estimates for opioid overdose mortality in nonmanufacturing counties were not statistically significant.

Conclusions and Relevance  From 1999 to 2016, automotive assembly plant closures were associated with increases in opioid overdose mortality. These findings highlight the potential importance of eroding economic opportunity as a factor in the US opioid overdose crisis.

 

Experts in the New York Times article, along with the authors of the study themselves, caution that the opioid epidemic should not be attributed to economic factors; the overprescription of these drugs and their highly addictive nature are far more significant.  Andrea Taverna, senior adviser for opioids strategy at the Michigan Department of Health and Human Services,is quoted in the Times: “There are a lot of different vectors and a lot of different risk factors at play, and when a plant closes, that just raises the overall level of risk,”

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