Work

Right-to-work laws, union decline, and the opioid crisis

Year: 2026

Type: article

Abstract: A large literature links de-unionization to determinants of health, but direct evidence on objective health outcomes remains scarce. Exploiting the staggered implementation of right-to-work (RTW) laws across four US states, we quantify the role of union presence in opioid misuse. We combine the synthetic control method with staggered differences-in-differences to estimate time-varying effects. RTW adoption is followed by a persistent decline in unionization within 4 to 6 years, and this decline is associated with sizable increases in both nonfatal and fatal opioid overdoses, with no comparable changes for non-opioid drugs. Effects are concentrated among working-age men and align with channels tied to workplace conditions, including higher occupational risk, lower wages, longer hours, and elevated work stress. Taken together, the evidence indicates that the decline in unionization meaningfully contributes to the opioid crisis in affected states.

Source: Journal of Population Economics

DOI: 10.1007/s00148-026-01168-w

Authors: Kelly Chen, Yingying Dong, Samia Islam

Institutions: Boise State University, University of California, Irvine

Language: English

Topic: Opioid Use Disorder Treatment

Subfield: Public Health, Environmental and Occupational Health

Field: Medicine

Domain: Health Sciences

SDGs: Good health and well-being, Decent work and economic growth, Peace, justice, and strong institutions

Open Access status: hybrid

Estimated APC paid: $3,190