There’s a larger problem behind the opioid crisis…

The opioid crisis has been ubiquitous in health news this year, and for good reason – 7.7 million Americans have a drug use disorder and about 64,000 people died from overdoses last year. However, opioid deaths are not the only preventable death causing public health experts to worry.

A crisis of despair

Early death from alcohol and suicide, along with opioids and other drugs has risen at alarming rates. These “deaths of despair” were first documented by Princeton economists Anne Case and Angus Deaton in their landmark 2015 paper and subsequent report on trends in mortality and morbidity. Case and Deaton found that mid-life mortality among middle-aged white Americans with a high school degree or less increased by 0.5% a year in the 21st century.

Now, a new report, “Pain in the Nation,” from the Trust for America’s Health (TAH) and the Well Being Trust (WBT), builds on Case and Deaton’s work, clarifying the prevalence, causes, and possible ways to prevent these deaths. The project features an interactive map that tracks the changes in deaths from drugs, alcohol, and suicide since 1999 in each state, as well as projected deaths up to 2025 from these causes.

From 2006-2015, more than a million Americans died from drugs, alcohol, and suicide – and this problem is only going to get worse. TAH/WBT estimate that even in the best case scenario, 1.5 million more people will die from a drug overdose, suicide, or alcohol by 2025. If people keep dying at the rate they did in 2016, there would be 2 million excess deaths by 2025, which is double the rate of deaths from 2006-2015. 

The number of deaths is so high it has led to a decline in life expectancy in the US, for the first time since 1993 at the peak of the AIDS epidemic. Americans in general are in poor health compared to their counterparts in other wealthy countries. A recent report from The Commonwealth Fund found that American seniors are sicker than elderly people in the rest of the developed world, despite having insurance coverage through Medicare. This may be because by the time Americans reach the age where they are eligible for Medicare, the damage of economic inequality, poor lifestyle behaviors, and low access to health care has already been done.

The roots of despair

Both Case and Deaton and TAH/WBT identify deep-seated reasons for rising rates of drug and alcohol abuse and suicide such as lack of economic opportunity, instability or trauma in childhood, and prolonged stress. The lack of access to basic health care, behavioral health services, and substance abuse treatment and prevention has also exacerbated the trend.

In their report, TAH and WBT identify several strategies to address deaths of despair. A key part of their plan is prevention through early interventions in childhood, supporting stable homes and communities, providing access to preventive health care, and expanding behavioral health services. Their message is clear – we have to invest in preventing as well as managing pain in the U.S. 

Unfortunately, the White House’s plan for reducing opioid deaths aims primarily to limit the supply of opioids and contains little in the way of prevention. In The New York Times, public health researcher and blogger Austin Frakt writes, “Among the report’s 56 recommendations, only two aim to prevent people from seeking out opioids for no medical purpose,” he writes, “And neither approach has particularly strong science behind it.”

While limiting the supply of opioids is important, this problem goes far beyond availability of drugs, and beyond opioids themselves. It’s a crisis of an economy and education system that has left too much of middle America behind.