Automotive Assembly Plant Closures And Opioid Overdoses

A recent study showed an association between automotive assembly plant closures and opioid overdose deaths in the U.S.

The study compared counties that had automotive assembly plant closures with ones where the plants remained open from 1999 to 2016.

Researchers examined opioid overdose death rates among adults ages 18 to 65 and selected 112 manufacturing counties mostly in the U.S. South and Midwest where the percentage of employed residents working in manufacturing were in the top 20 percent nationwide.

Twenty-nine of the 112 counties had closures between 1999 and 2016.

Researchers found that in those counties with closures, opioid overdose deaths increased every year for the first five years after closure.

After the first five years, they leveled off.

The study found that “five years after a plant closure, mortality rates had increased by 8.6 opioid overdose deaths per 100 000 individuals…in exposed counties compared with unexposed counties, an 85% increase relative to the mortality rate of 12 deaths per 100 000 observed in unexposed counties at the same time point.”

This means that compared to manufacturing counties with no closures, an automotive assembly plant closure meant that after five years, the opioid overdose mortality rate was 85% higher than it would have been if the plant remained open.

The study also found that this association largely affected white men.

Although the study only proved an association and not a causal relationship, meaning more research is needed, the findings are significant.

“The study is important because it shows that when economic opportunities collapse, it not only has consequences for people’s economic wellbeing but it might adversely affect their health too,” said Dr. Atheendar Venkataramani, assistant professor at the University of Pennsylvania Perelman School of Medicine, who was first author of the study.

“Economic opportunity matters for our health, and as the forces that are shifting economic opportunities for people are continuing to evolve, we have to think about how policies can both make people resilient — from a health sense — to the negative changes that might happen, and we also have to think about what types of policies on the economic side may actually give people opportunities, which may also bolster their health.”

In the U.S. each day more than 130 people die from opioid overdose, and 46 people per day die of prescription opioid overdose.

In the past 20 years, opioid overdose deaths have increased at such an alarming rate that in 2017, President Trump declared it a public health emergency.

The crisis started with the spread of misinformation about opioids by large pharmaceutical companies and lead to an increase in prescribing of opioids by healthcare providers.

Eighty percent of heroin users started off using prescription opioids.

These death rates are a major factor in the reducing American life expectancy, especially among middle-age white men.

Drug overdoses are the leading cause of injury-related death in the U.S., and opioids are the main driver of those drug overdose deaths.

In 2017, the states with the highest rates of death due to opioid overdose were West Virginia, Ohio, Pennsylvania, D.C., and Kentucky.

The Midwestern region saw an increase of 70 percent in opioid overdoses from 2016 to 2017.

Economic opportunity plays a large role in drug addiction and overdose, especially for blue collar workers.

Unemployment, poverty, disability, and instability at home are all factors that contribute to substance use disorder and death.

Investing in social infrastructure in communities that lack economic, social, and educational opportunities would have a positive effect.

Pill-mills and pharmaceutical companies did not flood these drugs into random communities, they chose economically vulnerable places in the U.S.

As one U.S. News article put it; “OxyContin and other strong opioids were heavily marketed in mining-dependent Appalachian communities long before they spread across the rest of the U.S. Of the 100 counties with the highest fatal drug overdose rates in the U.S., 80 of them are within the heart of Appalachia (West Virginia, Kentucky, Tennessee) or the former U.S. industrial belt (Ohio, Pennsylvania, Indiana).

What these places have in common is sustained devastation to their blue-collar industries, intergenerational poverty and little opportunity for upward mobility.”

Social and economic intervention is needed in these counties hard-hit by the opioid epidemic.

However, a first in America’s fight to end the opioid epidemic occurred in October of 2019 when four major pharmaceutical companies reached a $260 million settlement with Cuyahoga and Summit counties in Ohio to avoid what would have been the first federal opioid trial.

We are proud to report that Hunter Shkolnik, partner here at Napoli Shkolnik, was lead lawyer for Cuyahoga County in the settlement. In 2018, Shkolnik was appointed to the Plaintiff’s Executive Committee in the In Re: National Prescription Opiate Litigation (MDL 2804).

Shkolnik said the funds from the settlement will be put entirely toward treatment and other interventions to combat the opioid epidemic.

Walgreens was the only defendant who did not settle, and its trial has been postponed.

“[Walgreens] should have settled,” Shkolnik said.

“They’re going to find out that was a very bad mistake and I’m sure their fellow pharmacy chains, like CVS and Rite Aid, are very unhappy because they’re back in the courtroom here in Cuyahoga County with the bullseye on their backs.”

Across the U.S., the pharmaceutical industry still faces more than 2,600 other lawsuits over opioid overdose deaths.

Although this settlement was impactful, there is a long road ahead.