Labor unions and deaths of despair: Evidence from right-to-work laws.

This paper examines the relationship between union membership and deaths of despair. Using state-level variation in the timing of the adoption of right-to-work laws as a natural experiment, I show that right-to-work laws are associated with a decline in union membership and an increase in deaths of despair. Two-way fixed-effects (TWFE) difference-in-differences (DiD) estimates suggest that the adoption of a right-to-work law is associated with a 2.6 percentage point reduction in union membership and an increase in deaths of despair mortality of 13 additional persons per 100,000, implying there are approximately 7.5 additional deaths of despair for every 1,000 workers who lose union membership. An analysis of mechanisms suggests the increase in mortality is largely driven by increased opioid usage and a concomitant increase in overdose deaths. I support the TWFE results with estimates from two alternative estimators robust to concerns about treatment effect heterogeneity and variation in treatment timing. Estimates from the Callaway and Sant'Anna (2021) estimator and the Borusyak et al. (2024) estimator support the TWFE findings: right-to-work laws reduce union membership and increase deaths of despair.