Three Essays on Political Responses to Opioid Use in the United States
Date of Award
Doctor of Philosophy (PhD)
In the first two decades of the 21st century, opioid use in the United States has grown to unprecedented levels. Approximately half of the U.S. adult population has been prescribed an opioid based pain reliever, 1.7 million people have an opioid use disorder, and nearly 50,000 people die of opioid related overdoses each year. Public attitudes and drug policy have transformed in the wake of this staggering loss of life. These changes are often attributed to the racial, socioeconomic, and geographic profile of those most affected by the overdose and addiction epidemic, as well as the perceived culpability of physicians, pharmaceutical executives, and regulators. I introduce this dissertation by briefly framing contemporary trends in historical context, then present three essays on aspects of the political response to increased opioid use in the United States. The first of these essays characterizes mass perceptions of who uses opioids illegally, including heroin and prescription opioids not taken as directed by a doctor. I compare perceptions regarding who uses opioids illegally to perceptions of who uses cocaine and methamphetamine. I find that perceptions of who uses various drugs do differ in ways that mirror media coverage and observed demographic patterns of drug use. People who use opioids, however, are not generally seen to be uniquely White, wealthy, or likely to be living in rural areas. This group is similarly not viewed in a distinctly positive light. Survey respondents vastly overestimate the rate at which people who use opioids (as well as people who use other drugs) commit theft and assault. In the second essay, I estimate the effect of perceptions regarding who uses illegal opioids on patterns of blame for opioid addiction and drug policy preferences. In an original survey experiment, I offer informational corrections regarding the proportion of people who use illegal opioids who are White, engaged in violent crime, or were prescribed opioids prior to illegal use. Results indicate that the information regarding racial composition of this group can affect perceptions of exposure to prescription opioids, and vice versa. These perceptions appear to shape some patterns of blame, but I only detect an effect of information regarding violent crime on punitiveness of drug policy preferences. Finally, I move from the realm of public opinion to an essay on local policy development in response to increased opioid use. Many U.S. localities face high vulnerability to infectious disease outbreak among people who inject drugs. I analyze political, economic and epidemiological conditions in the 440 counties most vulnerable to HIV (human immunodeficiency virus) and HCV (hepatitis C virus) outbreaks, as identified by the Centers for Disease Control and Prevention in 2015. Examining policymaking in counties with similar vulnerability that were or were not targeted for CDC outreach, no effect of the risk signal on policy response is distinguishable from zero. However, I find that political and economic conditions are predictive of local efforts to reduce the risk of outbreak.
Orr, Lilla, "Three Essays on Political Responses to Opioid Use in the United States" (2021). Yale Graduate School of Arts and Sciences Dissertations. 149.