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Opioids and the Labor Market (2018) (clevelandfed.org)
130 points by resalisbury 10 days ago | hide | past | web | favorite | 63 comments

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.


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?

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

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.



The problem is not the marginal value of labour, is that the value those people create is close to 0. Even working for free, some people will just create negative value.

The only solution is for the able to pay others to not work, through welfare. The improvements in technology should more than make up for this loss.

There's no incentive alignment between those who own the tech (the source of productivity increase), and those who would need the welfare (who would presumably be consuming some of said productivity increase).

The owners of the tech is highly likely to prefer to capture fully the output (by lowering taxes for example).

I think there should be a way to align incentives - education paid for by owners of the tech, but also a contractual obligation to work for X years for their sponsors.

I think the incentive is basic empathy. Just because our fellow humans are economically worthless, does not mean they are lesser people.

If the point is that those people produce no value, they shouldn't work at all. They could just dig and fill ditches, but that doesn't produce value. Amazon also leeches from the public goods, but that is somehow socially acceptable.

Ah, yes, indentured servitude, a brilliant suggestion for uplifting a population out of poverty!

I've had employees that I would have been happy to pay to stay home.

The NYC school system has the "rubber room", where unflushable employees are warehoused.

One of the reasons I support UBI is because it's cheaper than welfare for keeping certain people out of the way.

And what if someone's unable to work?

> Humans are rational creatures

I think this claim needs to be backed up too. There is a lot of evidence indicating that we're incredibly irrational.


> I suspect that the biggest cause of disability is simply obesity. Government has a role to clean up the food supply and agricultural system, not to give handouts to millions of people affected by its dysfunction.

While I somewhat agree with your sentiment, and I'm not a big fan of the fact that these obese people are weighing down (no pun intended) our health care system, there really isn't a good solution that I can think of that doesn't limit these fat people's ability to make decisions about what they eat and how physically active they are day to day. I'd rather have a bunch of fatties making terrible health decisions and causing more stress on our healthcare system than having some Government representative telling people what they can or cannot do in the name of protecting them and keeping them healthy...

Forbidden meta comment:

While I disagree with you, I disagree with the amount of down-voting you're receiving even more.

It's unfortunate that reasonably stated views that disagree with the basic frequency of the given echo chamber are so discouraged.

> family, community, religion or charity

If these are not enough?

People still got by in the past before govt welfare existed. What happened today?

They didn't, actually. Severe poverty was widespread on a scale we don't really see today. Not having SS, especially, lead to extreme destitution being common among the elderly.

They did not "get by" they died or where incarcerated on workhouses.

Many of the BBC who do you think you are series have terrible stories of peoples ancestors in workhouses.

I mean, many of them died. Or ended up in the workhouse.

> community

Um, welfare, disability, social security, medicare, ... and all of the other "health and human services" related governmental programs are literally our entire country coming together as a community, to "provide for them".

God, you're so close. /r/selfawarewolves is calling you.

> Make the difficulty of getting employed and earning an income as easy as possible, and the jobs and work will follow.

Why should they? Demand elasticity is empirically very low for minimum wage workers. Lowering minimum wage a small amount does not create jobs, just as raising it a small amount does not eliminate them.

See: the inverted funnel plot of Doucouliagos and Stanley



Is "green text" a pejorative on HN?

New account names (<2 weeks old) are colored green.

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.



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."

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.

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.

Thanks for sharing, I didn't know it was used in those circles/circumstances.

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.

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.

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.

The problem with stimulants is that you get cracked out really easily and it is very hard to maintain. Physically it takes a toll: you can’t sleep, your muscles’ feel sore, you mind races.

Heroin, provided you have the money, is much more sustainable. You can feel fine, day after day, on heroin (provided you don’t run out).

Moreover, it’s hard for people to notice. If you snorted some coke everyday, people might think you were overly enthusiastic and eventually, people would notice your disjointed and cracked out thoughts. Things like: “we need to replace all of our code because it was garbage!! Fuck that shit!! Lets get it done!! Lets fuck our competition up boyz!”

With heroin it’s more like: I can get this done, and more, I’m just going to work through it. Ans it’s okay, because I feel great while I’m doing it.

Cocaine is not an opioid

You are quite correct. I should have said "drug" of choice.

Man, that sounds like a real dark time. Glad to hear you left that job--hope you're doing better now. Thank you for sharing your story!

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.

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!

> If we just made all drugs illegal, I think we would eliminate this "gateway" effect.

Did you mean to write the opposite of this?

Yes sorry: legal

~75% of addictions start with people using them _without_ a prescription.


I appreciate the data. I'm not much of a conspiracy theorist, but I could see the US government having an extremely strong motive to fudge this data.

But almost all of that %75 comes from hand outs from someone the user knows and 6.48B indicates that person has a prescription for said pills.

>> 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.

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.

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.

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"

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.

I'd be more inclined to think that the two trends share a cause, rather than cause one another.

Well that's exactly what "correlation does not equal causation" means

True, correlation does not equal causation. However a .44 correlation should not be ignored.

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.

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.

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

Video games caused a 1.5 - 3.0% decrease in labor hours.


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

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.

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.

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.

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

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.

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.

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.

Wait, are you using Brave New World as a positive example?

Just a counterpoint. I currently have a home and have lived in a home for years and years. I don't understand the homelessness crisis, it doesn't seem like an appealing lifestyle.

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