The question of "how did we arrive at a place where 60,000 people a year die from drug overdose," in other words, is at least partly a question of "how far would we go to avoid pain?"
But if you're an economist, answering that question is surprisingly difficult. You can't simply flat-out ask people how much they'd pay to avoid pain. Most people aren't used to thinking of their suffering in dollar terms. People who haven't experienced severe or chronic pain are likely to underestimate the value of being pain-free. There's often a gap between what people say on questions like these, and what they actually do.
So for this paper, the researchers used a technique that's been used to study the implicit "cost" of a number of different ailments, like migraines, cancer and arthritis. They analyzed data from over 22,000 Americans over the age of 50 who had taken part in the Health and Retirement Study, a federally-funded survey of older Americans, between 2008 and 2014.
That survey asked respondents three key questions. First, how satisfied they were with their life overall. Second, how much money they made in the past year. And third and most crucially: "Are you often troubled with pain?"
Triangulating a dollar value for pain from these three variables requires some statistical jiu-jitsu. To heavily oversimplify it, you can use the three numbers to estimate how much money it would take for a person currently suffering pain to rise to the same level of overall life satisfaction as somebody not experiencing pain. Conversely, for a person not experiencing pain you can estimate how much money you'd have to take away for them to have the same life satisfaction as a pain-sufferer.
As the study's authors put it, you get an implicit answer to this question without having to actually pose it to people: "Consider your overall satisfaction with life being often troubled by pain, what would you be willing to pay to be just as happy but without pain?"
The answer: between $56 and $145. A day. Which works out to between $20,000 and $53,000 a year. Recall that the median household income is about $56,000, and the trade-off becomes stark: Some people would theoretically be willing to give up their entire livelihoods to be pain-free.
These results control for a number of other factors that could presumably influence this trade-off, like marital status, age, race, and various health conditions. The authors nonetheless found that two considerations have a lot of influence on the numbers: pain severity (the more pain you're in, the more you'd pay to make it stop) and overall income (if you have more money to burn, you'd pay more to get rid of pain).
Still, the overall well-being cost of pain is staggering, particularly when you stack it against the cost of products designed to make pain go away: prescription opiates. At current prices, according to drug price aggregator GoodRX, you can purchase a 120-pill supply of Oxycodone for about $20 (without insurance). That works out to a generous day's supply of four pills for a total of 68 cents. Insurance coverage would drive the price down to practically zero. All you need is a doctor's prescription.
Imagine you're a rational pain-sufferer, willing to pay upwards of $100 a day to ease your suffering. Along comes a product that offers the promise of doing that for less than 1/100th of that price. What are you going to do?
This new study has limitations, of course. It focused exclusively on older Americans — the math might be different for young folks. The pain price estimates are just that — estimates, based on survey data that may be subject to its own forms of error.
But it nevertheless underscores the huge gap between what people appear to be willing to pay to get rid of pain and the actual price dealing with pain via opiate painkillers.