Economists Gilbert E. Metcalf and Qitong Wang found evidence that coal employment correlated with the spread of opioids. The "deaths of despair" hypothesis says addiction was the result of layoffs. (Graphics from "Abandoned by Coal, Swallowed by Opioids?" by Gilbert E. Metcalf and Qitong Wang, National Bureau of Economic Research)

The assumption has long been that people turn to drugs when they lose their jobs.

 In coal mining areas in Appalachia, where the opioid epidemic began, the story line has been that as mining jobs disappear, opioid use increases. “Abandoned by coal, swallowed by opioid,” is how one newspaper described it

But that may not be the case at all. There is evidence that it was the presence of coal mining jobs that helped create the opioid epidemic, not their absence.

Coal mining, particularly underground coal mining, is unusually dangerous. Lots of miners are hurt on the job, and the strains of working underground produce all manner of injuries. 

Miners hurt on the job were prescribed opioids for their pain. That’s what spread the drug in coal regions, not unemployment, report Gilbert Metcalf of Tufts University and Qitong Wang of the University of Southern California. 

The two economists found that as active coal mining jobs decreased in counties, the overdose death rate also declined. The national shift away from coal to natural gas hasn’t set off a drug epidemic in coal counties because of economic despair, the two academics write. Instead, “we argue that the shift from coal to natural gas…has helped to blunt damages from the opioid epidemic.”

The mechanism at work here is pretty clear. Lots of miners are injured, especially in underground mines. Beginning in the 1990s, doctors increasingly prescribed medications to manage pain. More pain in coal counties led to more prescriptions. Opioid prescription rates in Appalachia are nearly double the rates in other regions.

Now, as mining jobs are disappearing in coal counties, overdose rates are declining.


Nothing like a presidential campaign to get a politician into a rural county!

Former New York City mayor and current-day Democratic candidate for president Michael Bloomberg was in Fairibault County, Minnesota, last week to “better understand rural America.” 

“I come from the city, but you’re the backbone of America,” Bloomberg told some Minnesota farmers.  “We eat and live based on what you do. I think it’s easy for us living in the big cities to not care about the rest of the world. (…) I think you’ve just got to understand that this country is bigger.”


Ever wonder why Democrats haven’t had a plan for rural America for, what?, decades?

According to a writer in Politico. Clara Hendrickson, a Brookings Institution researcher, it’s simple. Dems haven’t had a plan because they figured the world outside the huge metro areas didn’t matter, politically or economically.

Hendrickson wrote in Politico last fall:

There’s a reason why Democrats appear stranded on this issue: For years, the liberal-leaning economists that the party relies on to fuel its domestic agenda failed to reckon with the stark economic disparities between parts of the country. Many of them dismissed proposals to create economic opportunity outside the handful of “knowledge economy” hubs in the nation’s largest metropolitan areas as inefficient transfers to lagging places.

At the same time, Democrats’ long-standing hold on urban America meant the party came to represent the winners of the “knowledge economy” — the largest, richest metropolitan areas — and the party’s leadership hailed from states home to the nation’s most successful “superstar” cities. Many of the party’s political strategists encouraged a blindness to the economic and social problems confronting much of the country by urging candidates to spend their time and energy mobilizing their urban base rather than courting hard-to-reach and hard-to-get rural voters. Campaigning outside the country’s cities has not been a priority for Democratic candidates and their strategists, let alone having something to say to these communities.

This was certainly true with President Obama, as we’ve shown. President Obama didn’t visit rural America much while in office and he provided even less in policy aimed at rural places. 

The problem, according to Hendrickson, is that Democrats haven’t asked for much in rural policy. They’ve figured the answer is simple: People should get up and move to the cities. Nothing to it.

“Until recently, there has been a faith among economists and other policy wonks that ignoring place, and investing in people’s skills and encouraging mobility, would be enough to solve regional inequality problems,” Timothy Bartik, an economist at the W.E. Upjohn Institute for Employment Research, told Hendrickson.

Now candidates are trying to come up with programs, but there are few good examples out there. Hendrickson reports that Brookings economist Mark Muro “is currently developing a proposal along with Robert Atkinson from the Information Technology and Innovation Foundation and Jacob Whiton of Brookings urging the federal government to launch a set of major investments in select heartland metros aimed at accelerating their emergence as tech hubs, with benefits for nearby small-town and rural communities.”

Creative Commons License

Republish our articles for free, online or in print, under a Creative Commons license.