Boston College, Chestnut Hill, MA, USA.
University of North Texas, Fort Worth, TX, USA.
J Health Soc Behav. 2020 Sep;61(3):275-289. doi: 10.1177/0022146520939514. Epub 2020 Jul 16.
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.
从需求方的角度来看，药物过量流行是经济变化的结果，这些变化使没有大学学历的工人阶级落后。相比之下，供应方的观点认为，这种流行病主要是由于合法和非法毒品环境的变化造成的，而第三种截然不同的观点则认为，收入不平等很可能是这种流行病的一个关键驱动因素。为了评估这些相互竞争的观点，我们使用了两级随机截距模型和 2006 年至 2017 年美国各州的数据。与需求方的方法相反，我们发现教育程度与与药物相关的死亡率无关。支持供应方的方法，我们提供的证据表明，阿片类药物处方率与与药物相关的死亡率呈正相关。我们还发现，收入不平等是这种流行病的一个关键驱动因素，特别是缺乏资源流向收入最低的 20%的人群。最后我们认为，考虑收入不平等是将需求方和供应方观点联系起来的一个重要途径。
