Has Wider Availability of Prescription Drugs for Pain Relief Affected SSDI and SSI Enrollment?

This paper examines two recent trends. A large and growing share of people receive disability insurance for pain-related conditions. About 40% of older adults have chronic pain, and musculoskeletal conditions (including back and neck pain, arthritis, and related maladies) are the most common conditions leading people to enroll in Social Security Disability Insurance (SSDI; SSA 2015). We ask whether this is related to the rapid rise in the availability of opioid analgesics to treat chronic pain. Between 2001 and 2010, shipments of pain relievers increased by a factor of nearly four. The impact of the increased supply of opioids on enrollment in disability programs is unclear. On the one hand, greater availability of pain medications may increase the ability of people with musculoskeletal ailments to remain active and working. On the other hand, opioid pain relievers may not provide the long-term pain relief that was hoped for given a lack of evidence to support efficacy of opioid analgesics to treat chronic non-cancer pain (Reinecke et al., 2015). We use two types of analysis, both relying on cross-state differences in the availability of opioid medications over time. The first analysis is aggregate: we examine the relationship between state-level changes in the availability of opioid medications from 2001 to 2015 and state-level disability insurance applications. We complement this with micro data from the Health and Retirement Study over the same time period. In these data, we examine how people who report pain are treated in different states over time, and how this is related to subsequent disability enrollment.