The Economic Cost and Spatial Diffusion of the Opioid Crisis, 2009–18

Alex Brill, Scott Ganz and Burke O’Brien | AEI Economic Perspectives


Recent data show a small decline in opioid-related mortality following a decade during which opioid-related mortality more than doubled to nearly 53,000 in 2018. However, the aggregate statistics mask important spatial and temporal trends in the data. This report estimates nationwide, regional, and county-level economic costs associated with the opioid crisis. The data show that, despite recent nationwide per capita opioid-related cost declines, the impact of the crisis continues to be felt across large swaths of the Northeast, Midwest, and South. We also find that opioid-related mortality tends to diffuse among nearby counties, with the local diffusion rate from illegal opioids—which are the primary cause in the current wave of the crisis—exceeding the rate from prescription opioids, which were the primary cause in earlier waves. The combination of lower aggregate mortality and faster diffusion among nearby counties points to a changed spatial distribution of economic costs as the opioid crisis evolves.

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