Measuring the Longer Term Social Burdens of the Opioid Crisis on Local Communities

Outcomes Project ABSTRACT The opioid crisis is a public health emergency in the United States affecting not only the people who use drugs but also those who love them in their families/households and communities. While researchers and policymakers are often focused on the direct outcomes experienced by people who use drugs such as overdoses, misuse, and dependence, there is substantially less evidence quantifying the indirect, downstream consequences of the opioid crisis on households (e.g., grandparenting, child welfare) and communities (e.g., labor force participation, crime rates). The evolving and comprehensive impacts of the opioid crisis are a policy priority. In this project, we will study the downstream consequences of the opioid crisis. We will evaluate these outcomes given recent transitions of the opioid crisis first from prescription opioids to heroin, followed by the transition to illicitly manufactured fentanyl and the subsequent growth in polysubstance use. We will analyze outcomes related to family/household composition and intergenerational dynamics as well as community characteristics and labor market. We will examine communities defined by geography (state, county) and demographic characteristics (urban/rural status, education, marital status, and age). Moreover, we will examine why the opioid crisis has affected communities differently. We will examine how variation in the downstream consequences of the opioid crisis results from community resilience, differential drug-related criminal-legal enforcement, and/or differential public health policy responses. This involves compiling a database of community characteristics describing resilience factors (e.g., education, job opportunities, social connectedness) as well as measures of differential enforcement (e.g., drug-related crime/arrests) and policy responses (e.g., health spending, incarceration, legal system enforcement affecting illicit markets). This analysis will inform how resources can be efficiently targeted to meet the needs of communities most affected. After quantifying the evolving and variable relationship between the opioid crisis and its downstream consequences, we will develop a procedure to systematically and comprehensively quantify the costs of the opioid crisis. This procedure will focus on the indirect costs experienced by families/households and communities and will enable comparisons to the direct costs experienced by people who use drugs. We will assess costs for each wave of the opioid crisis and describe how the costs have changed over time. This analysis will generate a method and public metrics for the costs of the opioid crisis and how these costs vary across communities. This research will help the research community and policymakers understand the full scope of the costs of the opioid crisis, including which factors are most costly.