
Opioids and the Labor Market (2018) - resalisbury
https://www.clevelandfed.org/newsroom-and-events/publications/working-papers/2018-working-papers/wp-1807-opioids-and-the-labor-market.aspx
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snowwrestler
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?

~~~
opportune
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

~~~
nradov
The counties with highest disability rates were at about 26% of the overall
population (not just adults) as of 2017. Washington Post has a good article
about the human impact.

[https://www.washingtonpost.com/sf/local/2017/03/30/disabled-...](https://www.washingtonpost.com/sf/local/2017/03/30/disabled-
or-just-desperate/)

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resalisbury
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."

~~~
ahmedalsudani
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.

~~~
mruts
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.

~~~
bsder
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.

~~~
xkcd-sucks
Hmm I've heard some people say that stimulants are good for awareness and
quickness, while opiates are good for simply making a large chunk of work seem
attainable and enjoyable. For example, "I can sit here writing this code
forever because it feels so nice to sit here and eat Dilaudid and write code".
Getting real utility out of it, though, seems to be up to self-awareness,
experience and luck.

~~~
mruts
I think that’s a good way to put it. When coked out, you get all these
grandoise plans and might start to rewrite the entire codebase. With heroin,
it’s more like you can just keep on chugging for a long-time.

This is in fact what makes heroin so dangerous. As long as you have the money,
you can keep on chugging, while feeing chill and relaxed at the same time.

The problem is when you run out.

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cubano
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
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.

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

~~~
pzone
Video games, social networking, and other forms of cheap digital
entertainment.

~~~
0x8BADF00D
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.

------
DannyB2
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_
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
Some people can benefit from the drug. But the opioid epidemic may make it
difficult or impossible to obtain. That's the point.

~~~
f-securus
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.

~~~
stallmanite
Can you point me to some studies showing that opiod abuse has gone down in
states that legalized recreational marijuana use? My doctor has tried to
convince me otherwise and I’d love to prove him wrong. Thanks in advance.

~~~
aphextim
[https://jamanetwork.com/journals/jamainternalmedicine/articl...](https://jamanetwork.com/journals/jamainternalmedicine/article-
abstract/2676999)

