Pain from working in the mines, not layoffs, led to opioid addiction, researchers say.

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 storyline 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.

This piece was originally published by the Daily Yonder.