Social Capital May Play a Role in Drug Overdose Deaths


The study supports growing literature that social isolation contributes to drug use, and strong communities offer resilience against drug epidemics and have less overdose mortality.

michael zoorob, department of government, harvard university

A recent study has found evidence that social capital plays a statistically significant role in the number of drug overdose deaths in a community.

The study suggests overdose deaths may be affected by social capital and that social and environmental variables may play a part in determining risk of drug overdoses. Social capital seems to have a prophylactic effect, protecting communities, and that data on county-level social capital may attenuate overdose death rates, and be used to predict a community's risk in relation to drug overdoses.

Doctoral student Michael J. Zoorob, Department of Government at Harvard University, and Jason L. Salemi, PhD, department of Family and Community Medicine at the Baylor College of Medicine, in Houston, Texas, conducted an ecologic temporal trends study on the county-level utilizing data from the Centers for Disease Control and Prevention (CDC) on estimated of overdose deaths from 1999-2014. County-level comparisons of social capital obtained from an earlier study, led by Anil Rupasingha, PhD, a research economist currently working with the USDA, used data from the US Census and other sources to determine county-level social capital through an examination of group membership within those counties.

Zoorob and Salemi determined that people living in counties with higher social capital, produced via involvement in social and community networks, were 83% less likely (p < 0.01) to fall into the high-overdose category and 75% less likely to fall in the moderate-overdose category.

Both Zoorob and Rupasingha's studies define social capital as a sense of community worth and belonging contingent upon connections between individuals via social networks, and hypothesize that the reciprocity, trust and community mindedness created by such social networks creates habits of information sharing and cooperation are telling markers of community fragility — an environmental confounder many researchers have linked to the opioid epidemic.

In the investigation of the relationship between drug overdose mortality and social capital, Zoorob and Salemi produced a county-level analytic dataset comprising, age-adjusted drug overdose mortality, social capital, availability of drug abuse treatment centers, prescription drug claims prescribed by health care providers, population demographics, urbanicity, and socioeconomic status.

Zoorob and Salemi investigated 3,104 US counties and county equivalents (parishes and boroughs) between 1999—2014. Zoorob observed a crude inverse association between social capital and mortality due to drug overdose, finding that nearly 55% (20.0% +34.9%) of low mortality counties were in the highest 2 quintiles of social capital, and that these counties were 8.3% less likely to have high mortality related to drug overdoses.

Zoorob and Salemi suggest several mechanisms by which social capital may ameliorate overdose mortality including social capital's ability to prevent the initial onset of drug-taking.

In an interview with MD Magazine, Zoorob stated study findings may shed light on where, and even to some degree why, overdose epidemics are likely to occur.

"Our study suggests that overdose epidemics are more likely to occur in places experiencing erosion of community structures like voluntary associations, religious institutions and unions,” Zoorob said. “Our findings are consistent with the theory that overdose epidemics occur in part because people are more likely to start using drugs or relapse when they lack social support."

Zoorob believes that the data from the study supports growing literature providing evidence that social isolation contributes to drug use, and strong communities offer resilience against drug epidemics. The authors also noted the pattern holds up throughout the country — places with stronger communities have less overdose mortality.

Zoorob told MD Magazine he hopes clinicians recognize the importance of social isolation as a risk factor for drug use and overdose and a potential barrier to recovery. It’s hoped the research motivates policymakers to examine how to build and rebuild social capital and that future scholarly work attempts to trace the underpinnings of regional divergences in the extent and depth of drug overdose.

The article "Bowling alone, dying together: The role of social capital in mitigating the drug overdose epidemic in the United States" appears in the April 2017 issue of Drug and Alcohol Dependency.

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