What Is Driving the Drug Overdose Epidemic in the United States?

Ryan P. Thombs, Dennis L. Thombs, Andrew K. Jorgenson, Taylor Harris Braswell

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


The demand-side perspective argues that the drug overdose epidemic is a consequence of changes in the economy that leave behind working-class people who lack a college education. In contrast, the supply-side perspective maintains that the epidemic is primarily due to changes in the licit and illicit drug environment, whereas a third, distinct perspective argues that income inequality is likely a key driver of the epidemic. To evaluate these competing perspectives, we use a two-level random intercept model and U.S. state-level data from 2006 to 2017. Contrary to the demand-side approach, we find that educational attainment is not associated with drug-related mortality. In support of the supply-side approach, we provide evidence indicating that opioid prescription rates are positively associated with drug-related mortality. We also find that income inequality is a key driver of the epidemic, particularly the lack of resources going to the bottom 20% of earners. We conclude by arguing that considerations of income inequality are an important way to link the arguments made by the demand-side and the supply-side perspectives.

Original languageEnglish
Pages (from-to)275-289
Number of pages15
JournalJournal of Health and Social Behavior
Issue number3
StatePublished - 1 Sep 2020


  • deaths of despair
  • drug overdose epidemic
  • income inequality
  • mortality
  • population health


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