The demand-side perspective argues that the drug overdose epidemic is a consequence of changes in the economy that leave behind working-class people who lack a college education. In contrast, the supply-side perspective maintains that the epidemic is primarily due to changes in the licit and illicit drug environment, whereas a third, distinct perspective argues that income inequality is likely a key driver of the epidemic. To evaluate these competing perspectives, we use a two-level random intercept model and U.S. state-level data from 2006 to 2017. Contrary to the demand-side approach, we find that educational attainment is not associated with drug-related mortality. In support of the supply-side approach, we provide evidence indicating that opioid prescription rates are positively associated with drug-related mortality. We also find that income inequality is a key driver of the epidemic, particularly the lack of resources going to the bottom 20% of earners. We conclude by arguing that considerations of income inequality are an important way to link the arguments made by the demand-side and the supply-side perspectives.

需求方的观点认为，药物过量流行是经济变化的结果，留下了缺乏大学教育的工人阶级。相比之下，供应方的观点认为流行主要是由于合法和非法药物环境的变化，而第三种不同的观点认为收入不平等可能是流行的关键驱动因素。为了评估这些相互竞争的观点，我们使用了 2006 年至 2017 年的两级随机截距模型和美国州级数据。与需求方方法相反，我们发现教育程度与毒品相关死亡率无关。为支持供应方方法，我们提供的证据表明阿片类药物处方率与药物相关死亡率呈正相关。我们还发现收入不平等是这一流行病的主要驱动因素，尤其是收入最低的 20% 的人缺乏资源。我们得出结论认为，考虑收入不平等是将需求方和供应方观点联系起来的重要方式。