By Nancy Spannaus
Jan. 7, 2020—A new study published in the Journal of the American Medical Association (JAMA) on Dec. 30, has once again highlighted the relationship between the depressed state of American manufacturing and the ongoing epidemic of opioid deaths. Under the title “Association Between Automotive Assembly Plant Closures and Opioid Overdose Mortality in the United States: A Difference-in-Differences Analysis,” a team of five professors concluded that there is indeed a strong correlation.
This is not the first study of this kind. Back in November 2017, I published a piece by Angela Vullo, who had unearthed research done at Ohio State University on the same subject. Vullo reported on the presentation at the Farm Science Review on September 21 of that year in London, Ohio, entitled “Despair in Rural America,” where researchers Mark Partridge and Mike Betz had detailed the connection between economic collapse and increasing drug addiction in Ohio. She then took up the question of how to deal with the economic crisis – deindustrialization – which plays a decisive, though not the only role, in producing the opioid disaster. Ohio is a major center of drug death.
Despite a flurry of publicity around a special taskforce on the crisis in 2017 and President Trump’s declaration of a public health emergency, researchers such as Beth Macy (author of the 2018 book Dopesick) report no significant change in support for local communities from the Federal government. Ditto for the results from the Trump Administration’s promises to revive manufacturing, which is now in its fifth month of contraction after a short uptick.
Forget the hype about the stock market, the job figures, and the climate threat. Our deindustrialization policy is killing tens of thousands of people a year through the opioid crisis alone, many of them in the prime years of life, and we are doing absolutely nothing to stop it. This has led to a decline in life expectancy and a threat to our future as a nation. There are clear pathways toward recovery, demonstrated in the Hamiltonian tradition taken up by Franklin Roosevelt and John F. Kennedy. They require an immediate crash program, funded by Federal credit, for rebuilding our infrastructure, traveling to the Moon, and developing real clean energy—nuclear fusion power.
The New Study
The abstract for the JAMA study reports its results as follows:
During the study period, 29 manufacturing counties in 10 commuting zones were exposed to an automotive assembly plant closure, while 83 manufacturing counties in 20 commuting zones remained unexposed. Mean (SD) baseline opioid overdose rates per 100 000 were similar in exposed (0.9 [1.4]) and unexposed (1.0 [2.1]) counties. Automotive assembly plant closures were associated with statistically significant increases in opioid overdose mortality. Five years after a plant closure, mortality rates had increased by 8.6 opioid overdose deaths per 100 000 individuals (95% CI, 2.6-14.6; P = .006) in exposed counties compared with unexposed counties, an 85% increase relative to the mortality rate of 12 deaths per 100 000 observed in unexposed counties at the same time point. In analyses stratified by age, sex, and race/ethnicity, the largest increases in opioid overdose mortality were observed among non-Hispanic white men aged 18 to 34 years (20.1 deaths per 100 000; 95% CI, 8.8-31.3; P = .001) and aged 35 to 65 years (12.8 deaths per 100 000; 95% CI, 5.7-20.0; P = .001). We observed similar patterns of prescription vs illicit drug overdose mortality. Estimates for opioid overdose mortality in non-manufacturing counties were not statistically significant. (emphasis added)
While, of course, correlation does not prove causality, the evidence is damning. Losing a source of decent income and productive work is devastating to any community, and even where closure may be justified, the failure to build new industries to meet the nation’s crying infrastructure needs is criminally negligent. As in the period of the NASA buildup to put a man on the Moon, auto plants can be retooled to produce materials for high-speed rail and other crucial needs. At present, we are rapidly losing the workforce with skills like those of auto workers needed to carry out the kind of infrastructure mobilization we need.
The Opioid Crisis
Headlines about the CDC’s preliminary calculations on 2018 indicated that there had been a decline in deaths from opioid overdoses relative to 2017. The adjusted figure for 2017 was approximately 70,000 deaths, while the preliminary estimate for 2018 is approximately 68,000. A slight improvement, but certainly no cause for declaring victory.
In addition, a study from August of 2019 by the Rand Corporation points to the rising component of fentanyl overdoses within the data. The Rand study results, according to a report in Vox, point to the fact that the fentanyl increases are occurring primarily on the East Coast, in states with relatively small populations. The danger, it says, is that the use of fentanyl by addicts could begin to spread to the West (say, California and Texas) and be absolutely devastating in terms of the numbers affected.
The decrease in opioid deaths is being attributed to a decline in the use of prescription drugs – not illegal ones. However, if the underlying dynamic driving people to take such drugs is not reversed, one can only expect them to turn to illegal opioids, which are increasingly mixed with fentanyl, a drug more dangerous than heroin.
The drive for legalization of mind-destroying drugs – from marijuana on up – is seen by some as a “harm reduction” strategy for this crisis. I couldn’t disagree more. Are we really reconciled to a future like that conceived by Aldous Huxley in Brave New World, where he anticipated a society where order is kept by feeding people happy pills (soma)? Do we have so little faith in the ability of the human spirit to respond to the call to build a future for themselves and their posterity, that we wish to consign them to a drug haze? (Increases in car crashes involving people on marijuana in drug legalization meccas like Colorado should also raise the alarm.)
There is no mystery about what we need. This is a cultural, moral, social, and economic crisis and must be treated as such. Sam Quinones, author of Dreamland: The True Tale of America’s Opiate Epidemic, made this clear in his testimony before Congress in March of 2018, and went so far as to propose the kind of national mobilization required to deal with it. At the core of that mobilization would be the revival of manufacturing jobs, which would give hope to those now being drive into despair.
Congress wasn’t listening then, and it’s not listening now. Will you?