"Evidence presented here suggests that much of the regional variation in opioid prescription rates across the U.S. is due to differences in medical practices, rather than varying health conditions that generate pain. Furthermore, labor force participation is lower and fell more in the 2000s in areas of the U.S. that have a higher volume of opioid medication prescribed per capita than in other areas. Although some obvious suspects can be ruled out — for example, areas with high opioid prescription rates do not appear to be only masking historical manufacturing strongholds that subsequently fell on hard times — it is unclear whether other factors underlying low labor force participation could have caused the high prescription rates of opioids in certain counties. Regardless of the direction of causality, the opioid crisis and depressed labor force participation are now intertwined in many parts of the U.S."