Grim national statistics about the U.S. opioid crisis are increasingly
well known to the American public. Far less well known is that U.S. war
veterans are at ground zero of the epidemic, facing an overdose rate
twice that of civilians. Post-9/11 deployments to Afghanistan and Iraq
have exposed servicemembers to injury-related chronic pain,
psychological trauma, and cheap opium supplies, each of which may fuel
opioid addiction. This study is the first to estimate the causal impact
of combat deployments in the Global War on Terrorism on opioid abuse.
We exploit a natural experiment in overseas deployment assignments and
find that combat service substantially increased the risk of
prescription painkiller abuse and illicit heroin use among active duty
servicemen. War-related physical injuries, death-related battlefield
trauma, and Post-Traumatic Stress Disorder emerge as primary mechanisms.
The magnitudes of our estimates imply lower-bound combat
exposure-induced health care costs of $1.04 billion per year for
prescription painkiller abuse and $470 million per year for heroin use.
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