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Opioid use may be responsible for a fifth of the record number of prime working-age American men who have chosen to fully drop out of the work force and no longer seek a job. In a new paper delivered at the Brookings Institution today, Alan Krueger, a professor at Princeton, described a strong correlation between high opioid use and low labor force participation among men 25 to 54 years old.

Where the correlation is highest: Here is a chart of Krueger's county-by-county study, showing the strongest impact in Mississippi, which has 10 of the top 25 counties on the list. Six are in Arkansas; and four each are in Alabama and North Carolina.

Expand chart
Data: Brookings; Chart: Chris Canipe / Axios

The 10 counties with the highest correlation:

  1. Stone County, Miss.
  2. Marion County, Miss.
  3. Sebastian County, Ark.
  4. Boone County, Ark.
  5. Crawford County, Ark.
  6. Clarke County, Miss.
  7. Forrest County, Miss.
  8. Columbus County, N.C.
  9. Scotland County, N.C.
  10. Surry County, N.C.

The background: For decades, the U.S. labor force participation rate — the number of men aged 25 to 54 who are either working or trying to find work — stayed above 90%. Around 1970, the rate began falling, but never below 90% — until the 2008 financial crash. As of last month, it was at 88.4%.

But Krueger blames opioids, not the crash: The fault is with doctors who are exceptionally free with prescriptions, not pain reported by patients. "Despite the massive rise in opioid prescriptions in the 2000s, there is no evidence that the incidence of pain has declined," he said.

Some more of Krueger's findings:

  • 47% of these men take pain medication daily. About two-thirds said the medicine was prescription pain medication. "And these figures likely understate the actual proportion of men taking prescription pain medication given the stigma and legal risk associated with reporting taking narcotics," he said.
  • Look at this shocker: 40% of these men say pain prevents them from working full time on jobs for which they are qualified.
  • And this one: "Those who have difficulty dressing, running errands, walking or concentrating have a much lower participation rate than those who are blind or have difficulty seeing or hearing."
  • These men are sick: 43% say their health is fair or poor, compared with 12% of working men and 16% of unemployed men still in the work force.
  • Their most common ailments: walking, climbing stairs and concentrating, remembering and making decisions.

The bottom line: If policymakers want to reduce the malaise and alienation around the country, reduce opioid prescriptions: "The opioid crisis and depressed labor force participation are now intertwined in many parts of the U.S.," Krueger writes. "Addressing the opioid crisis could help support efforts to raise labor force participation and prevent it from falling further."

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