🌎 Resumen en español · traducción automática
La epidemia de opioides desencadenada por OxyContin, introducido por Purdue Pharma en 1995 y especialmente comercializado en comunidades de Apalacia, ha causado más de 700,000 muertes por sobredosis desde 1999 y continúa revelando nuevos daños. Investigadores de la Universidad de Toronto y Notre Dame descubrieron que las comunidades más afectadas por la epidemia experimentaron menor crecimiento poblacional debido a la migración de adultos con educación universitaria hacia otras regiones. Este éxodo agrava los problemas económicos locales al erosionar las bases tributarias y dificultar la provisión de servicios públicos, especialmente en el este de Kentucky donde ya existían crisis por el declive de la industria del carbón.
Traducción y resumen generados por IA a partir del artículo en inglés. Puede contener errores; consulte el texto original.
Purdue Pharma introduced the painkiller OxyContin in late 1995 – and we are still learning of the harm it has caused.
Purdue marketed Oxy in communities with high percentages of people with chronic pain from cancer. The company particularly targeted Appalachian communities. Oxy proved especially addictive and easy to both obtain and abuse.
When restrictions were placed on Oxy, people turned to heroin and then fentanyl. It was an epidemic of abuse. Since 1999, more than 700,000 people have died of opioid overdoses.
The Oxy-fueled opioid epidemic has been the subject of books, articles and any number of lawsuits. But we are still learning about the ill effects of this man-made disaster.
In a new paper, researchers have documented another pernicious effect of Purdue’s painkiller: outmigration. Researchers from the University of Toronto and Notre Dame have found that “communities more exposed to the (opioid) epidemic experienced lower population growth, driven primarily by increased out-migration among college-educated adults.”
The paper by Carolina Arteaga and Stephen Claassen at the University of Toronto and Victoria Barone at Notre Dame helps explain a growing divergence among communities in the United States. Between 2010 and 2020, for example, the nation as a whole had strong population growth, but during this period half of U.S. counties lost population.
(You can find a copy of the paper, Demographic Divergence: The Legacy of the Opioid Epidemic, here.)
The local effects of this decline are well known. “Population losses erode local tax bases, strain the provision of public goods, and generate fiscal pressures that are difficult to reverse, particularly in areas with fixed infrastructure and aging populations,” the authors note.
This describes much of Eastern Kentucky, as The Lantern has documented.
Most of the population decline in the mountains is due to both the demise of the coal industry and the lackluster development policies of federal and state governments. (An economy based on prisons and data centers? Really?)
What these researchers have found is a new cause of the collapse. People were also pushed out by the opioid epidemic. And not only did places lose people, they lost their most educated citizens.
The researchers compared commuting zones, groups of counties tied together economically. They determined which zones had high rates of cancer mortality in 1996, the year Purdue began marketing OxyContin as pain treatment for cancer patients. Records show that Purdue concentrated its sales efforts in these communities – and these are the areas where the opioid epidemic started.
From 1996 to 2019, commuting zones with high cancer rates showed increased outmigration, the researchers found. The people who left were largely those who had more than a high school education. Residents with only a high school diploma also moved out of these areas, but at half the rate of their neighbors with more education.
“Our findings reveal that the epidemic triggered profound demographic adjustments that ultimately reduced population growth in the communities most affected,” the authors wrote, “and that will continue to shape their social and economic trajectories.”
Quality of life
Where did these people go? On average, they moved to areas that had lower cancer mortality rates – and thus away from the growing opioid epidemic.
The authors believe the better-educated migrants experienced a “negative amenity shock.” The opioid epidemic affected “local quality of life.” Crime increased. Neighborhood conditions worsened. Emergency calls surged as “emergency naloxone administrations became commonplace in public spaces.” Homelessness became more common.
People left for places with a better way of life.
Meanwhile, fertility rates increased in the counties where the opioid epidemic took hold. “Working in the opposite direction,” they wrote, “the opioid epidemic induced substantial increases in fertility, concentrated among non-college educated mothers, which by the end of our period (2020) partially offset these population declines.”
From the 1950s through the 1970s communities in the United States converged economically. Differences in wages and growth from place to place diminished. People with college degrees were “remarkably evenly distributed” among America’s cities, according to Harvard University economist Edward Glaeser.
Since then, the country has splintered. Educated people clustered in some places and not others. Regional incomes diverged. In Appalachia, mining jobs disappeared, spurring an epic demographic collapse. And now we know that the heavy foot of the opioid epidemic accelerated regional inequality.
In 2005, less than ten years after Purdue began selling OxyContin, people in Harlan produced a play about the painkiller they knew was destroying their community. In “Higher Ground,” there was a “drug zombie dance” that had a doctor writing pain pill prescriptions for people asking for a “cure to take my pain away.”
Close to 80,000 people lived in Harlan in the 1940s. Today there are fewer than 25,000.
Welch, West Virginia, was a “little San Francisco” in the ‘40s, local historian Jean Battlo told me. Guy Lombardo played there and so did Glenn Miller. The audiences were filled with people from all over the world. Since then, McDowell County has lost nearly 80 percent of its population.
We blamed coal, correctly. And, falsely, some blamed the people who lived there. Now we know that these places suffered from powers and processes we are only beginning to understand.
