Man with a drink Along withalcoholism and suicide, opioids are part of the so-called deaths ofdespair phenomenon that has helped increase white Americanmortality rates since the turn of the century. (Photo: GettyImages)

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America's opioid crisis is a terrible tragedy in itself.Increasingly, though, the evidence suggests that it's behindanother malaise: the growing ranks of prime-aged males dropping out of the laborforce.

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The epidemic of opioid and opiate drug abuse contrasts sharplywith a broader improvement in Americans' health. Violent crime,domestic violence and teen pregnancy are all way down. Cancer survival rates are up, and HIV is on theway out. Air and water pollution have decreased.

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Related: Opioids now kill more people than carsdo

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The trouble started in the early 1990s, with a boom in theprescription of opioid painkillers like oxycodone and hydrocodone.Then worries about rising addiction rates led doctors to cutpatients off, which often sent them looking for street drugs likeheroin instead. By the time prescriptions peaked in2011, it was too late. A culture of addiction spread, supplynetworks developed, and powerful synthetic opioids like fentanyl became the top killers:

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The main cost is counted in lives. Opioids now kill moreAmericans than car accidents or guns. Along with alcoholism andsuicide (which may itself be partly driven by opioid addiction),opioids are part of the so-called deaths of despair phenomenon thathas helped increase white American mortality rates since the turnof the century. And the epidemic is quickly spreading toAfrican-Americans as well.

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That said, the crisis also has economic costs. There's of coursethe enormous expense of treating addicts. But opioids also burdenthe U.S. by taking workers out of the productive economy.

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Men's participation in the labor force has been declining formany years, but that trend seems to have accelerated since the turnof the century. Meanwhile, women's participation, which had beenrising for decades, plateaued in the late 1990s and has declinedsince 2009:

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Much of the decline is due to educated people taking earlyretirement, or to people staying in school longer as educationbecomes more important. But a sizeable chunk may be due to drugproblems, especially among men.

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In 2017, Princeton University economist Alan Krueger noted acorrelation between pain medication use and being out of the laborforce. In the early 2010s, he found, 43.5 percent of men aged 25-54who were out of the labor force reported using pain medication theprevious day. For those who were employed or actively looking forthe work, the number was only around 20 percent. Krueger also foundthat labor force participation had fallen more in counties whereopioids were prescribed more heavily, even after controlling for anumber of other local conditions.

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But as Krueger noted, causality is hard to determine. It mightbe that people started using drugs because they were disabled orhad no chance of finding a job, rather than the reverse. A newpaper from economists Dionissi Aliprantis, Kyle Fee, and MarkSchweitzer at the Federal Reserve Bank of Cleveland attempts todisentangle cause from effect.

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The researchers reason that if lack of a job causes opioid use,then areas hit harder by the Great Recession should have seenlarger increases. Using a common indicator of labor marketconditions, they didn't find a relationship. This suggests thatdrug use is driving people to drop out of the labor force, not viceversa.

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This paper isn't conclusive. First of all, the authors' measureof temporary changes in labor demand could have statisticalproblems that make it unreliable for this sort of measurement.Second, the effect of weak labor markets on drug use might belonger term — people who think they'll be unemployed only brieflymight not turn to drugs, while people who see no prospects mightstart using heroin or fentanyl. Although the authors try to controlfor long-term labor market conditions, there's always the chancethey've missed something.

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Nonetheless, evidence is piling up that the opioid epidemic iseroding the foundations of the U.S. economy by impairing the laborforce. It's a problem that policymakers need to addressurgently.

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Although President Donald Trump has declared the epidemic anational emergency, he hasn't done much to address it. For one, heshould stop trying to cut Medicaid benefits, which help addictsreceive needed treatment. Government health insurance should beexpanded, not shrunk. Legalizing marijuana at the federal levelwould help, too — legalization has been found to lower opioiduse.

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It will be a generation before the impact of the horrendousopioid epidemic fades from the national statistics. But with theright steps now, the U.S. might at least be able to end it morequickly.

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This column does not necessarily reflect the opinion of theeditorial board or Bloomberg LP and its owners.

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Noah Smith ([email protected])is aBloomberg Opinion columnist. He was an assistant professor offinance at Stony Brook University, and he blogs atNoahpinion. To contact the editor responsible for thisstory: Mark Whitehouse at [email protected]

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