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Comment by snowwrestler | Hacker News Reader

If you haven't seen it, this interesting report from NPR draws connections between changes in welfare programs that saw their rolls diminish, with a commensurate increase in the rolls of disability programs.

http://apps.npr.org/unfit-for-work/

This was published in 2013 and it has stuck with me since then. I feel like we can now draw the line further, into the opioid epidemic today.

It seems like we kicked people off welfare and their only option was disability, where they had legal access to opioids and an incentive to get and take them--to manage pain, yes, but also to embody their disabled status.

Did we cause our own crisis through bad policy choices?

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I can attest that disability is a way of life in certain parts of the country. $15k/year may not sound like a lot, and it objectively isn't, but a household of 2 adults and 0-2 kids pulling $30k/year in some parts of the country can actually get by pretty well. If you can get an extra $10-20k/year in free opiates that's either a great way to feed an addiction or to make money on the side. There are counties where almost half of the adult population is on some kind of disability and those also happen to be the counties hurt hardest by the opiate epidemic, and known for "pain clinics".

But, I think there is a third part of the cycle that the article you linked mentions. Nobody grows up wanting to survive off disability and being an opiate addict - while the pain clinic/disability combo might enable people entering this state, the reason people give in to this is that they have poor life prospects. Going on disability is basically giving up. We need to figure out how to provide better job and educational prospects in the areas / for the kind of people who are incentivized to go on disability so that they actually have much better options. The average West Virginian isn't intrinsically less able than the average resident of Utah

The counties with highest disability rates were at about 26% of the overall population (not just adults) as of 2017. Washington Post has a good article about the human impact.

https://www.washingtonpost.com/sf/local/2017/03/30/disabled-...

The book Dreamland[1] touches on this as well. There was this interview[2] (which I probably heard about on HN) with the author a couple years ago which was really interesting.

[1]https://www.goodreads.com/book/show/22529381-dreamland

[2]http://www.econtalk.org/sam-quinones-on-heroin-the-opioid-ep...

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