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“The real perfect storm fueling the opioid epidemic had been the collapse of work, followed by the rise in disability and its parallel, pernicious twin: the flood of painkillers pushed by rapacious pharma companies and regulators who approved one opioid pill after another. Declining workforce participation wasn't just a rural problem anymore; it was everywhere, albeit to a lesser degree in areas with physicians who prescribed fewer opioids and higher rates of college graduates. As Monnat put it: "When work no longer becomes an option for people, what you have at the base is a structural problem, where the American dream becomes a scam." She likened the epidemic's spread not to crabgrass but a wildfire: "If the economic collapse was the kindling in this epidemic, the opiates were the spark that lit the fire." And the helicopters were nowhere in sight.” — Beth Macy