Abandoned by Coal, Swallowed by Opioids? Gilbert E. Metcalf Qitong Wang NBER Working Paper No. 26551

Issued in December 2019, Revised in December 2019

NBER Program(s):Environment and Energy Economics, Health Economics

Opioid addiction and mortality skyrocketed over the past decade. A casual look at the geographic incidence of opioid mortality shows sharply higher mortality rates in the Appalachian region, especially in coal-mining areas. This has led observers to make a link that was characterized by one newspaper as “abandoned by coal, swallowed by opioids.” We test that theory using restricted death data and mine level coal production data. Specifically, we examine whether higher reliance on coal mining in a county’s economy leads to higher or lower opioid mortality. We find a positive relationship between the share of coal miners among total local labor force and county-level opioid mortality rates. This contradicts the “abandoned by coal, swallowed by opioids” story. Rather our results suggest that the higher rates of injury in underground coal mining (in particular) lead to greater amounts of opioid consumption and mortality. An implication is that the decline in coal mining in the United States may have a positive spillover in the form of reduced mortality from opioid use. You may purchase this paper on-line in .pdf format from SSRN.com ($5) for electronic delivery. Access to NBER Papers You are eligible for a free download if you are a subscriber, a corporate associate of the NBER, a journalist, an employee of the U.S. federal government with a ".GOV" domain name, or a resident of nearly any developing country or transition economy. If you usually get free papers at work/university but do not at home, you can either connect to your work VPN or proxy (if any) or elect to have a link to the paper emailed to your work email address below. The email address must be connected to a subscribing college, university, or other subscribing institution. Gmail and other free email addresses will not have access. E-mail:

Acknowledgments Machine-readable bibliographic record - MARC, RIS, BibTeX Document Object Identifier (DOI): 10.3386/w26551