Working Paper: NBER ID: w26551
Authors: Gilbert E. Metcalf; Qitong Wang
Abstract: Opioid addiction and mortality skyrocketed over the past decade. A casual look at the geographic incidence of opioid mortality shows sharply higher mortality rates in the Appalachian region, especially in coal-mining areas. This has led observers to make a link that was characterized by one newspaper as “abandoned by coal, swallowed by opioids.” We test that theory using restricted death data and mine level coal production data. Specifically, we examine whether higher reliance on coal mining in a county’s economy leads to higher or lower opioid mortality. We find a positive relationship between the share of coal miners among total local labor force and county-level opioid mortality rates. This contradicts the “abandoned by coal, swallowed by opioids” story. Rather our results suggest that the higher rates of injury in underground coal mining (in particular) lead to greater amounts of opioid consumption and mortality. An implication is that the decline in coal mining in the United States may have a positive spillover in the form of reduced mortality from opioid use.
Keywords: Opioid Mortality; Coal Mining; Public Health
JEL Codes: I1; Q32; Q35
Edges that are evidenced by causal inference methods are in orange, and the rest are in light blue.
| Cause | Effect |
|---|---|
| Coal mining activity (L71) | Opioid mortality rates (I12) |
| Share of coal miners (L71) | Opioid mortality rates (I12) |
| Coal mining activity (L71) | Workplace injuries (J28) |
| Workplace injuries (J28) | Opioid prescriptions and availability (I11) |
| Opioid prescriptions and availability (I11) | Opioid mortality rates (I12) |
| Decline in coal mining (L71) | Opioid mortality rates (I12) |
| Coal mining activity (L71) | Opioid mortality rates (younger populations) (I12) |