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This paper quantifies the relationship between local opioid prescription rates and labor market outcomes in the United States between 2006 and 2016. To understand this relationship at the national level, we assemble a data set that allows us both to include rural areas and to estimate the relationship at a disaggregated level. We control for geographic variation in both short-term and long-term economic conditions. We demonstrate that the level of geographic information included in the estimation qualitatively alters the estimated results. We focus on measuring the impact of opioid prescriptions on labor markets, so we evaluate the robustness of our estimates to an alternative causal path, unobserved selection, and an instrumental variable from the literature. In our baseline specification, a 10 percent higher local prescription rate is associated with a lower prime-age labor force participation rate of 0.53 percentage …