Inequalities in Opioid Prescribing and Mortality in California: A Test of Fundamental Cause Theory

A critical problem facing the health of the U.S. is the opioid epidemic which has been unfairly addressed due to racism and the divide of color. Prescription opioid use has seemingly affected different demographics at different periods and rates, with growing racial disparities. Much evidence suggests a discrepancy in the government and public response to this drug epidemic in comparison to the criminalization of the drug epidemic of the 1980s, having to do with the race/ethnicity of a person using drugs, with communities of color facing incarceration and Whites facing recovery services. A strong theoretical tradition in medical sociology says that health outcomes are built on social factors, specifically racialized social systems that reinforce white privilege through social relations and practices. Data from the State of California (CA), over much of the period of the epidemic (2008-2018), was used to test whether this happened for opioid prescriptions and deaths in CA counties(n=58). To investigate some of the dynamics of this growing problem, I formulate and empirically test hypotheses derived from fundamental cause theory (FCT) as a contributing explanation for opioid prescription and overdose (OD) death trends in California. This theory proposes that disparities by socioeconomic status (SES) and race-ethnicity persist or are reproduced because access to treatments and interventions are unequally distributed, flowing more freely to those with greater access to flexible resources of knowledge, money, and power, prestige, and beneficial social connections. Multiple regression was run to investigate the extent to which counties that were predominately populated by Whites, had greater access to opioid prescriptions over time. An investigation of OD death trends in CA counties overtime was also investigated. Results were consistent with FCT, involving resources that determined the extent to which whites were able to avoid multiple disease outcomes involving the opioid epidemic