Supply, Not Despair, Caused the Opioid Epidemic

Perhaps the most important question in deciding how to respond to the U.S. opioid epidemic is whether it's primarily caused by social and economic factors, as some allege, or simply by an increased availability of drugs. Some recent U.S. research, as well as European data, shows that the latter is more likely -- that people use dangerous drugs because they can rather than because they're victims of economic ills.

In an influential 2017 paper, Princeton University's Anne Case and Angus Deaton described drug overdose deaths -- but also deaths from suicide and alcohol -- as "deaths of despair," arguing they "come from a long-standing process of cumulative disadvantage for those with less than a college degree." Doctors' willingness to prescribe opioids for pain only "added fuel to the flames." This interpretation of America's drug problem as primarily a social one, associated with the decline of the white working class as a result of globalization, is intuitive, and media reports from states like West Virginia, with its well-known post-coal problems, reinforce it. Under the "deaths of despair" hypothesis, it's difficult to fix the opioid problem with direct policy responses: It's too deeply rooted for that.