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The Sackler family was once celebrated for its philanthropy. Now the owners of Purdue Pharma are vilified daily as egregious contributors to the U.S. opioid epidemic, which has shattered so many lives. It’s now time to look more closely at the contributions of another praised institution: free trade. Free-trade policies are routinely credited for spurring economic growth, but they have also helped determine when and where Americans die of opioid overdoses.

The companies and individuals that “addicted America” should be held liable — but their misdeeds don’t explain why some groups and regions have been devastated by the opioid crisis while others are nearly unscathed.


Since 2000, more than 60,000 U.S. factories have closed, as import competition and outsourcing eliminated more than 2 million well-paid manufacturing jobs. Although the narrative is that many of these shuttered factories are in the Midwest, the worst-hit region is Appalachia, which is also experiencing the worst drug crisis in American history.

The death rate from overdoses is now 65% higher in Appalachia than in the rest of the country. Economists Anne Case and Angus Deaton found that less-educated white males are dying from drugs, alcohol, and suicide at such high rates that the group’s life expectancy is now declining. They call these “deaths of despair.”

The trade crisis and the opioid crisis feed on each other. Economists have explained how free trade lowers wages and employment levels for less-educated manufacturing workers in the U.S. Relatively good jobs with high wages and benefits are disappearing, while factory closings damage the social fabric of their surrounding communities.


Free trade policies hit Appalachia, a region of 420 counties across 14 states, especially hard. The region accounts for only 8% of the United States population but suffered 16% of all trade-related job losses over the past 20 years.

Hickory, N.C., for example, was once the furniture capital of the world. A wave of cheap imports in the late 1990s and early 2000s wiped out 11,000 manufacturing jobs; the surrounding county now has one of the nation’s highest rates of opioid overdose deaths.

To examine the connection between trade policies and opioid deaths, we analyzed county-level data from both the Department of Labor and the Centers for Disease Control and Prevention. As we wrote in the journal SSM ‑ Population Health, for every 1,000 people who lost their jobs in a county there was a 2.7% rise in opioid-related overdose deaths. After fentanyl entered regional heroin supplies in 2013, the same 1,000 trade-related job losses led to an 11.3% spike in overdose deaths.

Statistics are complicated. We can’t say for sure that job losses are killing people. Yet it seems likely that there’s a relationship. Economists at Yale and the Federal Reserve Board showed a similar relationship between imports from China and overdose deaths. There is growing evidence that economic and social upheaval fundamentally fuel the opioid crisis.

President Trump’s attacks on free trade were a key part of the message behind his victory in 2016, and will also shape the 2020 presidential election. During the recent Democratic primary debates, most candidates attacked Trump’s trade war because they said it lacked a clear strategy. Most of them, however, supported the administration’s high tariffs.

Instead of this mixed message, Democrats should forcefully criticize the failures of both the Trump administration’s policies and the American approach to free trade. The administration’s tariffs do little for communities that were already devastated by trade-related job losses. And rather than increase welfare spending in these areas, the administration in 2018 cut by 7% the only federal program that provides benefits to workers who lose their jobs due to trade — Trade Adjustment Assistance.

The Trump administration recently announced $1.8 billion in federal funds for addiction prevention and treatment, but lacks a comprehensive plan to address the crisis and continues to fight against supervised injection sites that have been shown to reduce overdose deaths in Canada, Australia, and Europe.

Tariffs won’t fix the causes of economic despair in the parts of the country that have been ravaged by opioids. They may raise wages for some workers and prevent future layoffs, but they won’t fix broken communities or aid people suffering from opioid use disorder.

To make an immediate dent in the overdose crisis, we need to increase access to health insurance and evidence-based treatment programs. Naloxone rescue kits reverse overdoses, and teaching people how to use them can save lives. For people who have previously overdosed, treatment with methadone or buprenorphine decreases mortality by 50%.

At the very least, the U.S. government should provide such targeted health care programs in communities hurt by trade but ignored by Trump’s trade war.

Adam Dean, Ph.D., is an assistant professor in the Department of Political Science at George Washington University and author of “From Conflict to Coalition: Profit-Sharing Institutions and the Political Economy of Trade” (Cambridge University Press, 2016). Simeon Kimmel, M.D., is a research fellow and an infectious disease and addiction medicine physician at Boston Medical Center.

  • Has your group investigate the role of professional misconduct in opioid use.The industrial worker lose job due trade policy / technology. Them goes to disabled lawyer who send him to friendly pain doc.who proscribes opioid synthetic to relieve “back pain” and local drug detailers provide the incentive and Medicaid/ Medicare pays the bill.The worker gets on aveage of $1200 a month ,gets high and work of the books.The disability lawyer get the retro disability payment and the drug rep gets his bonu . We got here by not understanding consequence of wto(,china)and nafa (Mexico) .Moynihan was right” maximum feasible misunderstanding ” ken nysson msw

  • Tariffs, unlike social programs, have the inestimable benefit of saving US dollars by reducing the hemorrhage of American money to China, which has weaponized its new wealth to further damage the United States.

    The original idea was that a poverty-stricken China, teeming with starving desperadoes, was inimical to world stability, and that channeling wealth to China at the expense of American workers would lead to the growth of a middle class in China, devoted to commerce and trade, and desiring global peace.

    But instead of a nation of little shopkeepers peacefully running laundries and take-out restaurants, China finally found a way to deploy its largest resource — billions of people.

    China set up factories that used forced labor at minimal wages — and with no environmental safeguards — to strip manufacturing from Americans. It’s hard to buy any consumer item nowadays that is not manufactured in China.

    They used the tsunami of US money to build up their war machinery and military infrastructure, and to grab even more of the world’s trade.

    Very soon now, China will be the dominant economic and cultural leader in the world, and the US will be reduced to an irrelevancy — if not actual third world status.

  • How did legitimate pain patients who have been stable and well managed on opioid medication get blamed and persecuted from the “opioid crisis”? There are no drug addicts dying from properly prescribed medications where I live, somebody had to pay and it’s elderly pain patients and veterans who are suffering.

    • People die all the time from “legally” prescribed drugs. Maybe the patient takes them improperly—say with too much alcohol, and overdoses. Or maybe “polypharmacy” results—too many drugs intermixing in unexpected ways.

  • Yet you fail utterly to mention the Clinton backed NAFTA that set this ball rolling over people’s lives, you fail to even mention Obama not only laughing that the jobs were never coming back while his supporters cheered insanely for collapsing economies, you fail to assign any blame where it belongs–on the politicians who implemented these policies and instead attack the only one who has stood up for American jobs! Obama was on his way to signing the TPP that would have been the nail in all our coffins, and the medical ramifications would make the miserable mess of a medical care system we have today look like paradise. Yes, Trump isn’t perfect, no, he has not done enough for addiction to illegal street drugs sold by global illegal drug cartels and the criminal gang distribution networks that infest society. But he is the first president to come along who demanded that companies stop moving overseas and leaving these communities in despair, he actually traveled to those rust belt towns not to insult the people and tell them to learn to code but to vow to fight for them, and guess what, unemployment is at a record low not seen in decades, 3.5%! More jobs now than people to fill them, come on, yet you still find something to complain about? THIS is why you will lose in 2020 as well. You should have written about the newly disabled who have been forced out of the workforce because the DEA is bearing down on doctors instead of getting their backsides in the streets where the illegal drugs are, you should have written about people who have incurable degenerative diseases and injuries from literal back-breaking work but have had their routine standard medication forcefully taken from them and can no longer work or pay bills or take care of their families, and are facing homelessness and suicide, or turning to the streets for medical care. Those people are living in despair on a level that is impossible to comprehend because their jobs are still sitting there, they just cannot get out of bed to go work. And the solution is sitting on a shelf but they cannot have it. There is much to criticize in current policy, but this is not it.

    • Yes, you get it!
      I am one of those with incurable degenerative diseases now living in despair, thanks to the DEA’s stubborn dedication to bearing down on doctors instead of chasing down the counterfeit pill-makers with their fentanyl & pill presses and the actual drug dealers who sell their lethal garbage! (mexican oxy, heroin cut with fentanyl, etc..)
      Doctors and pain patients and prescriptions are not the problem….
      It’s the illegal drugs!

  • Why do we even bother, worry and even more significant discuss ,debate and or any other means as to the health care system or industry in The United States Of America .Only yesterday .Monday . October, 07. 2019 it was reported that we spend seven hundred sixty billion dollars of waste funds on Health care each year which is twenty five percent of the gross domestic product G.D.P Of The United State Of America Economy . and more than the entire military budget . Once again seven hundred sixty billion dollars wasted on health care each year . I have in my hands currently while i am writing this brief or comment The New York City Daily News . dated Sunday August . 06. 2019 . which states Montefiore?s Nurses Cry Packed .E.R. Is Like War Zone . additionally it states below Rip overcrowding they say endangers patients , staff .Article written by Rich Schumpird on page [4] .the next is Critical Condition . below Monterfiore Nurses .. Patients Suffer in dangerous and crowded emergency room pages 4-5 the next is Montefiore .E.R IS ONE HALL OF A MESS . below Patients linger on cots as staff speed by , now pol wants city to investigate fearing disaster looms . to quote , unquote the author Leonard Speene Of The New York City Daily News .dated .Tuesday , October , 16. 2018 . yes these are prime . truthful evidences of Crimes committed by Chain Hospitals such as this one . I Trevor .Merchant is a prime witness to these situations and conditions as my beloved .wonderful .glorious Mother was admitted to this same hospital for eleven [11] days . in The Month of November , 2016 even though my Mother had stated for more than one year before that she did not intend nor wish to be admitted to any more Hospitals . Unfortunately my brother being the proxy got her there . each and every evening i visited her during visiting hours saw and witnessed the chaotic .,deadly and dangerous conditions . My beloved Mother died five [5] days after she was sent home on Friday , November, 15 ., 2016 at 2. 45 p.m day light savings time. N.Y.C . Additionally i had to accompany this my same brother one early Sunday .evening about five [5 ] months ago to this same hospitals as he likes to go there . We arrived at about 3 50. p.m on this day of the Year 2019 He was admitted . after diagnosed in The Emergency Room . i departed this Hospital at about 7, 15 p.m that very Sunday Evening and my brother along with many .many others were all there in the emergency rooms areas clogged up . he my brother only got a bed or bed room called them what you may the Monday Evening at about 7 . 45 p.m yes am fully aware of these and more and things have only become worse and worse with the health care system . in the U.S. A . finally one more . theyy send patients home earlier than these patients should be discharge simply to create bed or bed rooms to other patients waiting for day and days . do i says more ? i thank you Trevor . Merchant . Tuesday . October., 08. 2019 at 4. 00 p.m . day light savings time . New York City .

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