While I continue to think that the Affordable Care Act had meaningful effects on opioid overdoses, these impacts are dwarfed by the overall increases in rates nationally since 2000 and by how concentrated by race these increases have been, at least through 2015 (the New York Times article on 2016 rates suggested that there may have been a significant crossover among urban blacks last year). For example, 25-54 year old black women have increased overdose rates by around 25% overall since 2000, with a lot of variation by age cohort and state, while 25-54 year old white women have increased overdose rates by over 200%:
This is also visible in who participates in drug treatment programs for opiate abuse, which is both much more white and much more female than it used to be:
You can put out a million ideas about potential causes for this emerging racial disparity and increasing presence of women among addicts. Sam Quinones in his book Dreamland mentions that the Mexican farm boys-turned-drug runners he profiled and who came on the scene in the 2000s wanted to avoid black-dominated cities because they were afraid to compete with existing, violent gangs. I have also heard that the “pain revolution” that led to mass prescription of addictive opiates was more muted in black cities because doctors were more afraid of addiction among their patients.
One other hypothesis I’d like to see explored more widely is whether widespread antidepressant use has put a section of the population at greater risk of becoming addicted and of overdosing. The timing and demographics of widespread antidepressant use line up pretty well with who later was at increasing risk of overdosing on opiates.
For example, as discussed in a CDC brief put out this month, over one in five non-Hispanic white women were currently taking antidepressants in 2011 through 2014.
Of those taking antidepressants, most have been taking them for years:
And older people are more likely than younger to be taking antidepressants.
This has been a large increase since 1999, which was itself a large increase since the late 1980s:
There are obviously all kinds of reasons we should worry about such a large fraction of the population taking antidepressants for year after year, but making users more psychologically pre-disposed toward addiction and pharmacologically more disposed towards overdose seems like a not-unlikely effect, especially given how much stress these drugs put on the liver.
It also seems to me that the increases in alcohol-related deaths and suicides- that is, all the “deaths of despair,” not just drug overdoses that Angus Deaton and Anne Case observed increasingly among white women since 1999 could be made more common by widespread use of drugs that compromise the liver.