James V Koch
Background: The age-adjusted death rate from drug overdoses in the United States per 100,000 individuals rose from 6.8 in 2010 to 17.1 in 2018. The most common explanation offered is the â€œdeaths of despairâ€ hypothesis. We identify additional factors that have contributed to the rise in drug overdose deaths in cities and counties. Methods: We utilize a period fixed effects model with a multi-variate panel data set for 94 independent cities and counties in Virginia for the period 2008 through 2017. Results: The drug overdose mortality rate is: (a) an increasing function (prob. <.05) of the percentages of the population that smoke, are obese, are White, are incarcerated, are receiving SNAP payments, have earned a high diploma, and are employed in mining, as well as the average minutes workers must travel to their jobs and the number of prescriptions written; and, (b) a decreasing function (prob. < .05) of median household income, population density, and the degree of market concentration of pharmacies filling drug prescriptions. We provide estimates of the percent change in the drug overdose death rate one can expect in response to changes in each of these factors - information highly useful to decision-makers. Conclusions: Although the â€œdeaths of despairâ€ hypothesis has a degree of empirical validity, multidisciplinary analysis reveals that oft-neglected factors, including commuting time, local pharmacy market structures, prescription practices, and prevalence of SNAP payments, also have a major impact on drug overdose death rates. The factors influencing drug overdose mortality are much more complex than the deaths of despair hypothesis suggests.