Deaths of despair going unanswered

September 26th, 2018

For the second year in a row, American life expectancy declined in 2016, according to a recent report on health and mortality from the Centers for Disease Control and Prevention. While deaths from cancer, heart disease, and diabetes decreased from 2015 to 2016, deaths from unintentional injuries, suicide, and chronic liver disease grew — especially among younger adults. 

Early death from alcohol and suicide, along with opioids and other drugs have 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 highlighted last year in Pain in the Nation, a report from the Trust for America’s Health (TAH) and the Well Being Trust (WBT). The CDC report confirms that this disturbing trend is continuing, and points to drug overdoses as an especially significant factor: 

“Increased death rates for unintentional drug overdoses in particular—a subset of unintentional injuries—contributed to the negative change in life expectancy observed in recent years,” the authors write.

The opioid crisis has drawn much more attention to the issue of drug overdoses. However, the drug overdose problem in America goes beyond opioids. University of Pittsburgh researchers Hawre Jalal, MD, and Donald S. Burke, MD, mapped overdoses of different drugs over the last 40 years, and found that what we think of as the “overdose epidemic” is not one trend, but several. Since 1980, overdose deaths have doubled every eight years, an exponential increase. But it’s not one drug causing this pattern; trends in overdose deaths for specific drugs have been distinct and unpredictable. This indicates that “the current epidemic of opioid overdoses is a manifestation of long-term ongoing processes,” Jalal and Burke write in STAT

The Pain in the Nation report identified 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 is also exacerbating the trend. Jalal and Burke concur, arguing that we need to address the factors that “pull” people toward drug abuse, like “widening economic disparities, loss of a sense of purpose, and dissolution of communities.”

The recent bipartisan bill is a promising first step toward addressing the overdose crisis, but likely not enough to turn the tide. The bill increases access to medication-assisted addiction therapy and inpatient care for substance abuse, provides funding for research on non-addictive painkillers, and blocks mail orders of synthetic opioids. While increasing access to treatment and curbing inappropriate prescribing of opioids are necessary and laudable, we also need to invest in solving these larger economic and social problems that are driving the larger trends of addiction and despair.