Socio-economic structural factors make residents of certain US counties more vulnerable to the opioid overdose crisis

The opioid overdose crisis has devastated communities across the US. Authors Confer et al. scrutinized the crisis using the framework of social disorganization theory, by considering the broader drivers and impacts of the crisis, beyond merely blaming overdose deaths on individual users. The authors identified factors related to overdose deaths by examining multiple county-level measures related to socioeconomic disadvantage, like unemployment, health insurance coverage, poverty, number of prescribed opioid pills, race, drug arrest rates, county rurality, and being located in Appalachia. To do this, they used panel data drawn from five major federal datasets. CDC data contained the number of opioid overdose deaths between the years 2006 and 2012. Two DEA datasets on prescribed opioid pills gave county-level details on pill volume distributed in the same time period, capturing potential drivers of overdoses at the local level. From the National Archive of Criminal Justice Data (NACJD), the authors retrieved data from the National Incident-Based Reporting System (NIBRS) Series, which included detailed county-level arrest data. And the Census Bureau’s American Community Survey provided county measures for demographic, economic, and social factors over a five-year period. The authors’ analyses found that higher rates of poverty, unemployment, location in Appalachia, and number of prescribed opioid pills were connected to increases in opioid overdose deaths over time in US counties. The number of prescribed opioid pills in a county from year to year was the strongest predictor of overdose deaths.