Spark vs. Kindling: Assessing the Validity of Supply- vs. Demand-Side Explanations for Understanding Geographic Variation in U.S. Drug Mortality Rates

Shannon Monnat , Syracuse University

Drug mortality rates have increased over 300% since 2000, but there is widespread geographic variation in rates and rate increases. An emerging debate is whether geographic differences in drug mortality rates are driven by supply-side factors (i.e., opioid overprescribing) or demand-side factors (i.e., economic despair). The answer: it depends. I use county-level drug mortality rates for 2000-2016, opioid prescribing rates for 2006-2014, and economic distress in 2000. Both economic distress and opioid prescribing remain robust predictors of drug mortality rates in fully-adjusted models. However, the relationships between economic despair, prescribing, and drug mortality vary across the U.S. Prescribing rates were stronger predictors in metro counties than nonmetro counties, whereas economic distress was a stronger predictor in nonmetro than metro counties. Analyses of national trends in drug mortality must consider supply- and demand-side factors and allow for the reality that the explanatory value of these factors is inconsistent across the U.S.

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 Presented in Session 22. Deaths and Diseases of Despair