
Opioid use could account for 20% of decline in men’s labor force participation - randomname2
https://www.brookings.edu/bpea-articles/where-have-all-the-workers-gone-an-inquiry-into-the-decline-of-the-u-s-labor-force-participation-rate/
======
tim333
Related
[https://news.ycombinator.com/item?id=15192829](https://news.ycombinator.com/item?id=15192829)
(256 comments)

~~~
mirimir
Yes, and "Opioid Use Could Explain 20% of the Drop in American Men from Labor
Force" would be a much more accurate title for this item.

> The increase in opioid prescriptions from 1999 to 2015 could account for
> about 20 percent of the observed decline in men’s labor force participation
> (LFP) during that same period.

------
payne92
An important point of clarity: according to the article, 2/3rds of those men
taking opiods (and not in the labor force) are taking _prescription_ pain
medicine.

That seems consistent, since severe pain generally prevents or limits work.

~~~
ComputerGuru
Presumably you meant with a prescription? Prescription medication is a term
for drugs that can/would be prescribed, regardless how they were obtained.

------
lefstathiou
Just finished a thought provoking book on my flight this afternoon titled
Man's Search for Meaning which may shed light on potential underlying causes
of this crisis. Interesting that decades ago psychologists observed broad
differences in the psychological "health" of men living in the US versus
Europe for example that potentially left them more susceptible to
physiologically degenerative ailments like depression, suicide and drug
addiction. I think that one of the defining challenges of our life time will
be to figure out a way to broadly replace in society the sense of purpose and
meaning one derives from religion and spirituality in an increasingly
secularized world.

~~~
ehnto
I have wondered if one of the benefits of being a European is having a rich
heritage. Coming from a very new country that really has a limited cultural
identity it can be hard to grasp onto anything patriotic that feels
legitimate. Couple that with less importance on family values and an
increasingly isolated and individualist society it's also hard to come across
anything feeling much like a community.

Not being able to anchor your contributions to anything meaningful past "a
business" it can be easy to feel like it doesn't really matter that much.

To poke at the digital world, most of what we create on our computers is
ephemeral, transient and bound for quick obsolescence. With no roots in the
real world, with no past to be a part of and no community to belong to, our
efforts existing briefly at best, perhaps it is no wonder everything is
underscored by a lonely existential dread.

~~~
rebuilder
Huh, you think patriotism is more legitimate in Europe? Subjectively speaking,
I have to say I think it's the opposite, because patriotism and nationalism
almost destroyed Europe in the first half of the 20th century, and that still
shows in how people think here, IMO.

~~~
ehnto
Revisiting this comment, it's really not to do with patriotism at all and more
about individual existentialism. I seem to have connected to a story arc I
didn't realise existed by using the word patriotism.

I feel like having more history lends a bit more material to feel a connection
to the past, and like you are part of a continuum, which can lend legitimacy
to your current existence. You aren't just a fleshy blob meandering through a
brief existence, you are part of a long and storied past of fleshy blobs and
your existence is a chance to contribute to that story.

------
apatters
This title is not in line with HN guidelines: "Please use the original title,
unless it is misleading or linkbait."

I would like to ask the OP to refrain from posting provocative titles which
don't comply with the guidelines. I get that the issue is serious but all that
title did was alarm me and waste my time.

~~~
mirimir
Yes! And it's based on a misreading of the article.

------
alkonaut
How much is this due to people really needing these prescriptions, and then
aren't informed or helped quit, and how much is this due to plain
overprescription?

It should be pretty easy to compare with any comparable country to see what
the difference in opioid prescription is.

~~~
DanBC
The US prescribes far more opioids than any other country.

[http://www.painpolicy.wisc.edu/opioid-consumption-
data](http://www.painpolicy.wisc.edu/opioid-consumption-data)

Here we see the comparison with the AMRO zone (the Americas) which shows the
US and Canada prescribe a lot more opioids than any other country in the
Americas.

And here we compare AMRO to EURO:
[http://imgur.com/a/bb4wD](http://imgur.com/a/bb4wD)

[https://www.washingtonpost.com/news/wonk/wp/2017/03/15/ameri...](https://www.washingtonpost.com/news/wonk/wp/2017/03/15/americans-
use-far-more-opioids-than-anyone-else-in-the-world/?utm_term=.b5705cca9112)

> And what it finds about the United States is jaw-dropping: Even when the
> list is restricted to the top 25 heaviest consuming countries, the United
> States outpaces them all in opioid use.

> For example, Americans are prescribed about six times as many opioids per
> capita as are citizens of Portugal and France, even though those countries
> offer far easier access to health care. The largest disparity noted in the
> U.N. report concerns hydrocodone: Americans consume more than 99 percent of
> the world’s supply of this opioid.

~~~
alkonaut
Interesting. What is driving this? Obviously the finger has been pointed
towards medical companies bribing doctors to prescribe their meds, but that
doesn't explain the use opioids in particular (other than if you are very
cynical and believe that pharmaceutical companies want addicted customers -
which might be partly true but hopefully not the whole truth).

The question becomes - what are doctors elsewhere doing?

\- Prescribing physiotherapy for e.g back pains, rather than meds?

Or

\- prescribing other kinds of pain medication?

Or something else?

There is also a question of how many of these people had non-prescription
addictions and simply switched to prescription drugs because it's convenient
and doctors can be persuaded to prescribe.

Here in Europe I know many people (most?) who have been prescribed pain
medication at some point, but no one who has had potent opioids outside of
hospital. Typical pain med prescriptions are for higher-than-usual doses of
non prescription drugs like paracetamol/ibuprofen and only in rare cases
weaker synthetic opioids like tramadol.

Hydrocodone and similar opioids are typically only used for terminal cancer
patients and are banned from general prescription. Methadone is used for
treatment of heroin addiction though.

~~~
DanBC
Some time ago the VA noticed a lot of people had long term untreated pain.
They ran a campaign "pain: the 5th vital sign". That campaign asked doctors to
ask patients if they were in pain, and asked doctors to treat pain. It also
said opioids are weakly addictive when used to treat pain.

It turns out that opioids, when used to treat long term pain, are more
addictive than they thought. And also if you ask people about pain you end up
treating a heck of a lot more people.

People in long term pain do need treatment, but that should normally be
opioids as a last resort, and carefully controlled in a pain management
clinic.

Here's the VA document:
[https://www.va.gov/PAINMANAGEMENT/docs/Pain_As_the_5th_Vital...](https://www.va.gov/PAINMANAGEMENT/docs/Pain_As_the_5th_Vital_Sign_Toolkit.pdf)

Here's a rebuttal which started the reduction in prescriibing opioids for long
term pain:
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1924634/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1924634/)

------
spodek
> _Prime age men who are out of the labor force, however, report less
> happiness and more sadness during their days than do unemployed men,
> although they evaluate their lives in general more highly than unemployed
> men. Prime age and older women who are out of the labor force report
> emotional well-being and life evaluations in general that are about on par
> with employed women the same age_

Tens of millions of men are suffering in a way that women aren't. It seems
when something affects the sexes differently society treats it as gender issue
and seeks to help women specifically.

There appear to be specific gender issues here hurting men more. I'd
hypothesize unequal expectations. Is this an issue to look at from a gendered
perspective?

------
snovv_crash
The Opium Wars brought China to its knees, from which it is only now
recovering. I'm surprised that the leaders of the US aren't more worried about
this.

~~~
mac01021
Only now? Can you elaborate?

~~~
anovikov
Probably he meant that China went from being a top #1 economy in the world by
a huge margin when the opioid epidemic began there, and it has just recently
became #1 again, so far by a small margin. That sounds about right. They lost
ca. 200 years.

Of course explaining that by opioids alone would be balancing between a huge
oversimplification and a plain lie, but at least opioids have been the biggest
single factor.

~~~
Banthum
Just because they fell in the rankings doesn't mean they actually lost
anything.

E.g. Another way for a country to lose the #1 economy spot is for it to simply
stay the same while other nations (e.g. Europe in this case) make huge
advances.

Being fair, a few other things happened in there too. I don't think that
during the communists' Cultural Revolution the country was primarily being
held back by opiod abuse.

~~~
anovikov
In a way it was. Majority of population were just off the drugs, and most kids
who became 'red guards' \- they were born in China's darkest days - had
prenatal drug problem so they were kinda mentally impaired which caused most
or all that shit.

If such a relatively innocent thing as inhaling lead vapours from suddenly
omnipresent cars in 1960s and 1970s could cause a 1980s-1990s crime wave in
the U.S., it is easy to see what putting whole nation on opioids could do with
the next generation.

------
narrator
I think the thing that annoys me about modern medical trends such as the
enormous rise in obesity, Alzheimer's, autism and chronic pain and ensuing
opiod abuse is the shoulder shrugging by the medical establishment as to the
cause. Any meaningful change for the worse in medical statistics over time
seems to be uninteresting to most of the medical community and is almost
always ascribed to "better reporting" or moral failings of the patient.

------
DanielBMarkham
This title is whack. Here's the quote from the article:

 _"...In earlier research presented at the Boston Fed in 2016, Krueger found
that nearly half of prime age men who are not in the labor force take pain
medication on a daily basis, and that two-thirds of those men—or about 2
million—take prescription pain medication on a daily basis..."_

I take a baby aspirin every morning, so I would qualify as somebody taking
pain medication daily.

I believe the opiod problem in the U.S. is an extremely serious thing,
therefore we need to be very careful about what kinds of information we stick
in our heads regarding it.

There's a ton of correlation here, things like "Over the last 15 years, LFP
fell more in counties where more opioids were prescribed"

Well, okay. If more people are being injured and are in pain, they would get
medication, right? And therefore there would be less people in the workforce.
Because people are on pain meds doesn't mean that's keeping them from work. It
might mean that things that keep you from work significantly involve pain.

I have no intention of trashing the article. It's worth reading. I would
simply advise caution in jumping to conclusions.

My opinion is that mankind is finally creating the perfect world (relatively
speaking compared to all of history): plenty of food and shelter. The internet
and gaming means you'll never be bored. Throw in a little pharmacological
assistance for any pain, boredom, ennui, depression, or loneliness you're
feeling, and what more could you want?

But that's rampant speculation, which I readily admit. I worry about articles
that encourage reader speculation without explicitly calling it out.

~~~
misja111
I found that earlier research article:
[https://www.bostonfed.org/-/media/Documents/economic/conf/gr...](https://www.bostonfed.org/-/media/Documents/economic/conf/great-
recovery-2016/Alan-B-Krueger.pdf)

------
StudentStuff
Why do we continue to demonize those that use prescription pain meds? In doing
so, we force them out of mainstream society, hurting our economy and
communities in the process.

~~~
sametmax
It's a mater of scale. This number of magnitude can only mean 2 things:

\- a lot of those people do not need to take those products. Then we have an
substance abuse problem.

\- a lot of those people DO need to take them. Then we have a public health
problem.

In both cases, ouch.

~~~
mcbits
Substance abuse isn't inherently immoral or ungodlike or whatever. In some
cases it can cause harm. Causing harm is a problem at individual and societal
levels. Public policy should aim to reduce harm, but our drug policies almost
all aim to inflict multiple forms of devastating harm to scare or crush
addicts into sobriety. Worse, it doesn't even solve the faux "problem" of
substance abuse.

~~~
sametmax
You confuse "abuse" and "consumption". "abuse" assumes there is harm.

~~~
mcbits
Abuse is any use that is unacceptable to those making the determination. With
illegal and prescription drugs, that's usually any recreational use at all.

Substitute "recreational use" for "abuse" if it makes you feel better about
the semantics. Then we can dissect the finer points of "recreational". An LEO
told me his use of wine wasn't recreational because he only used it socially,
not for the effects, whereas recreational drug users are always using it for
the effects.

