Working Paper: NBER ID: w26264
Authors: Resul Cesur; Joseph J. Sabia; W. David Bradford
Abstract: Grim national statistics about the U.S. opioid crisis are increasingly well known to the American public. Far less well known is that U.S. war veterans are at ground zero of the epidemic, facing an overdose rate twice that of civilians. Post-9/11 deployments to Afghanistan and Iraq have exposed servicemembers to injury-related chronic pain, psychological trauma, and cheap opium supplies, each of which may fuel opioid addiction. This study is the first to estimate the causal impact of combat deployments in the Global War on Terrorism on opioid abuse. We exploit a natural experiment in overseas deployment assignments and find that combat service substantially increased the risk of prescription painkiller abuse and illicit heroin use among active duty servicemen. War-related physical injuries, death-related battlefield trauma, and Post-Traumatic Stress Disorder emerge as primary mechanisms. The magnitudes of our estimates imply lower-bound combat exposure-induced health care costs of $1.04 billion per year for prescription painkiller abuse and $470 million per year for heroin use.
Keywords: Opioid Crisis; Veterans; Combat Deployments; Opioid Abuse
JEL Codes: H56; I1; I12
Edges that are evidenced by causal inference methods are in orange, and the rest are in light blue.
| Cause | Effect |
|---|---|
| combat zone deployment assignments (H56) | prescription painkiller use (I11) |
| exposure to enemy firefight (Y50) | prescription painkiller abuse (I12) |
| combat assignment (H56) | nonmedical use of prescription painkillers (K42) |
| combat exposure (Y60) | prior month illicit heroin use (I12) |
| combat service (H56) | opioid abuse (I12) |
| combat-related physical injuries and psychological trauma (H56) | opioid abuse (I12) |