David M. Cutler, Edward Glaeser, 12 July 2021

Over 90,000 Americans died from opioids in the year ending November 2020, bringing the death total since 1999 to over 850,000. This column argues that rather than rising demand for opioids for relief from pain or despair, it is supply-side innovations in the legal and illegal drug markets that have been the main driver of the opioid epidemic. The opioid cycle is a cautionary tale about how technological innovation can go terribly awry, and calls for more collective scepticism about innovations that allegedly cleanse pleasure-inducing drugs of their addictive properties as well as stronger penalties for companies that mislead the public about the risks of their products.

Casey Mulligan, 28 January 2021

The spread of COVID-19 in the US has prompted extraordinary steps by individuals and institutions to limit infections. Some worry that ‘the cure is worse than the disease’ and these measures may lead to an increase in deaths of despair. Using data from the US, this column estimates how many non-COVID-19 excess deaths have occurred during the pandemic. Mortality in 2020 significantly exceeds the total of official COVID-19 deaths and a normal number of deaths from other causes. Certain characteristics suggest the excess are deaths of despair. Social isolation may be part of the mechanism that turns a pandemic into a wave of deaths of despair; further studies are needed to show if that is the case and how. 

Catherine Maclean, Justine Mallatt, Christopher J. Ruhm, Kosali Simon, 20 December 2020

Opioid misuse in the US is estimated to cost over $500 billion annually, with fatalities from opioid overdoses exceeding the American death count from the Vietnam War. This column examines the causes and consequences of the opioid crisis, based on a review of more than 100 economic studies. Policies such as prescription drug monitoring programmes, pill mill laws, prescribing limits, and doctor-shopping laws reduce opioid prescribing. However, their effects may be more limited in environments where many have already become addicted to opioids. 

Robert Kaestner, Engy Ziedan, 26 September 2019

Since 1999, the US has experienced a three-fold rise in opioid prescriptions, a four-fold rise in prescription opioid-related mortality, and a ten-fold rise in non-prescription opioid deaths. In response, many states have enacted laws to monitor opioid-prescribing behaviour. This column finds little evidence that such laws have had significant effects on wellbeing or mortality. Recognising the grave risks associated with prescription opioids, the column also considers their benefits: the reduction in pain and consequent salutary effects associated with responsibly used prescription opioids. 

David Bloom, Alyssa Lubet, 29 April 2019

As baby boomers get older, many high-income countries face challenges in the provision of pensions and healthcare. The column argues that the US has particularly acute problems arising from its ageing population, high healthcare costs, and high inequality in maternal mortality and other health indicators. It will take deep social policy and health system reforms to address these inequalities.

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