‘Deaths of despair’ is the most commonly cited explanation for the 151% increase in drug-overdose deaths that occurred in the USA between 2010 and 2018. We use panel data describing 84 Virginia cities and counties to assess the validity of the deaths of despair hypothesis and alternate explanations that focus on disability rates, travel time to work, urban vs. rural location, educational attainment, racial and ethnic characteristics, the influence of other health conditions such as obesity, and supply-side factors that include pill availability and pharmacy market shares. We find deaths of despair to be only a partial explanation for the upsurge in drug-overdose deaths and conclude that a much broader view of the causes of drug-overdose deaths is merited
