The negative labor market effects of the opioid crisis have been substantially more severe in North Carolina than they have been nationwide. Between 1999 and 2015, the volume of prescription opioids per capita in North Carolina rose 677 percent, or about 14 percent annually. This rise in opioid use in North Carolina was associated with a 2.6 percentage point decline in the state’s labor force participation rate of prime-age workers, slowing annual real gross domestic product (GDP) growth by 1.0 percentage point.

Labor Force Participation

Table NC-1 contains the change in the prime-age labor force participation rate due to opioids between 1999 and 2015, and the resulting number of workers absent from the labor force as of 2015.

Table NC-1: Impact of Opioids on Prime-Age Labor Force Participation, 1999-2015

Gender	Prime-Age Labor Force Participation Rate, 1999-2015 (in percentage points)	Workers, 2015 (in thousands)*
Total	-2.6	-99.7
Men	-2.3	-41.4
Women	-2.9	-58.2
*Estimates for each gender may not add to total due to rounding.

The rise in opioid prescriptions from 1999 to 2015 led the labor force participation rate for both prime-age men and women to decline. Opioids lowered the participation rates of prime-age men and women by 2.3 percentage points and 2.9 percentage points, respectively. For perspective, opioids decreased nationwide labor force participation rates of prime-age men and women by 1.4 percentage points and 1.8 percentage points, respectively.

The decline in the prime-age male labor force participation rate in North Carolina means that in 2015 41,400 men were absent from the labor force due to opioids. The steeper decline in prime-age female labor force participation means that even more women were absent from the labor force. In 2015, opioids kept 58,200 women in North Carolina out of the labor force. Together, the growth in per capita prescription opioids from 1999 to 2015 caused the total prime-age labor force participation rate in North Carolina to decline by 2.6 percentage points. That translates to a loss of 99,700 workers as of 2015.

Work Hours

From 1999 to 2015, the rise in opioid dependency and resulting decline in prime-age labor force participation cumulatively cost North Carolina’s economy 1.3 billion work hours. Table NC-2 contains the cumulative loss of work hours associated with North Carolina’s decline in labor force participation.

Table NC-2: Impact of Opioids on Work Hours, 1999-2015

Gender	Work Hours, Cumulative 1999-2015 (in millions)
Total	-1,293
Men	-548
Women	-745

As the number of individuals absent from the labor force due to opioids grew, North Carolina’s economy lost an increasing number of work hours. Between 1999 and 2015, North Carolina cumulatively lost a total of 1.3 billion work hours. Since opioid dependency led more women out of the labor force than men, the majority—58 percent—of the lost work hours was attributed to North Carolina’s decline in female labor force participation. Specifically, the state’s economy lost 745 million work hours due to absent female workers, and lost 548 million work hours due to absent male workers.

Real Economic Growth

The 1.3 billion lost work hours slowed economic growth in North Carolina. Table NC-3 contains the cumulative reduction in real economic output due to the opioid crisis and the associated decline in the annual real GDP growth rate.

Table NC-3: Impact of Opioids on Real Economic Growth, 1999-2015 (in 2009 dollars)

Gender	Real Output, Cumulative 1999-2015 (in billions)*	Annual Real GDP Growth Rate, 1999-2015 (in percentage points)
Total	-$75.5	-1.0
Men	-$32.0	-0.4
Women	-$43.6	-0.6
*Estimates for each gender may not add to total due to rounding.

From 1999 to 2015, the opioid-induced decline in North Carolina’s labor force participation was a substantial cost to the state’s economy. From 1999 to 2015, North Carolina’s economy cumulatively lost $75.5 billion in real economic output, which translates to the state’s annual real GDP growth rate slowing by 1.0 percentage point. To put this loss in perspective, from 1999 to 2015, North Carolina’s real GDP grew 1.8 percent annually. Had opioids not drawn 99,700 prime-age workers out of the labor force, the state’s economy would have grown 2.8 percent each year, or about 60 percent faster.

Since more women left the labor force due to opioids than men, the decline in female labor force participation resulted in a larger portion of the economic cost. The decline in female labor translated to a cumulative loss of $43.6 billion in real output between 1999 and 2015, slowing North Carolina’s real GDP growth rate by 0.6 percentage points. The decline in male workers cost the economy $32.0 billion, which reduced the state’s real GDP growth rate by 0.4 percentage points.