Drug and alcohol abuse and mental health issues in the US are contributing to an alarming surge in deaths among white middle-aged people, in a trend that has reversed decades of progress and is not being seen in other advanced economies.
Analysis from two Princeton economists, Anne Case and Angus Deaton, shows rising mortality among white men and women aged 45-54 since the late 1990s. The increase was caused not by factors such as heart disease or diabetes but by suicides and overdoses of prescription drugs and alcohol-related diseases.
If the white mortality rate in this age group had carried on declining at the rate recorded between 1979 to 1998, half a million deaths would have been avoided from 1999 to 2013. That compares with the number of lives lost in the Aids epidemic in the US.
Barack Obama has stepped up efforts to tackle opiate and prescription drug addiction as the US president enters his last year in office. Critics have said drug abuse is one of the few public health areas where the situation has deteriorated during his two terms in the White House.
Last month, Mr Obama visited West Virginia, the epicentre of the opiate epidemic, where twice as many people die from overdoses than the national average. “More Americans now die every year from drug overdoses than they do from motor vehicle crashes,” he said.
Despite the drug-related deaths of celebrities from Michael Jackson and Whitney Houston to actors such as Philip Seymour Hoffman, and the attention from television shows such as Breaking Bad, the problem remains stubborn. While the total number of overdose deaths is rising, the rise in heroin-related deaths is staggering, increasing almost threefold between 2010 and 2013.
Carl Sullivan, an addiction expert at West Virginia University, said the state faced a huge problem because patients who were once prescribed OxyContin, an addictive painkiller that is a form of oxycodone, had switched to heroin, which is cheaper and easier to obtain. He added that he treated only a handful of drug addicts during the whole of the 1990s, but had seen 21 patients just this week.
Mr Sullivan said part of the problem was a shortage of doctors and therapists to treat addicts, whom he estimated had a one in six chance of finding a doctor in West Virginia. Doctors with little training in treating addiction had worsened the problem by opening their own clinics, he said.
Although all education groups saw increases in mortality from suicide and poisonings, and an overall increase in external cause mortality, those with less education saw the most marked increases
Anne Case and Angus Deaton
The research by Ms Case and her husband Mr Deaton, who last month won the Nobel Memorial Prize in Economic Science, was reported in the Proceedings of the National Academy of Sciences.
Between 1978 and 1998, the mortality rate among US whites aged 45-54 fell 2 per cent a year on average, matching the averages among six other countries — France, Germany, the UK, Canada, Australia and Sweden.
However, while mortality rates in other rich countries continued to fall after 1998, the US saw a reversal, with gains of half a per cent a year, the academics found. The turnround was confined to white non-Hispanics, they said.
In parallel with the gains, the authors found increases in self-reported mental health problems, pain and inability to work, as well as clinically measured deteriorations in liver function.
The authors argued that while this “epidemic of pain, suicide and drug overdoses” preceded the financial crisis, it is possible that economic insecurity is playing a part in the problem. “Although all education groups saw increases in mortality from suicide and poisonings, and an overall increase in external cause mortality, those with less education saw the most marked increases,” the researchers said.
Jonathan Skinner, a Dartmouth economist who co-wrote a commentary on the analysis, said the findings were significant. “That this paper finds an increase in mortality among the middle aged is evidence that the combination of poor economic prospects, coupled with widespread use (and abuse) of opioids, has serious health consequences.”
According to a report from Trust for America’s Health and the Robert Wood Johnson Foundation, drug overdoses have become the leading cause of injury death in the US. In 2013, 44,000 people died from drug overdoses, doubling the number recorded in 1999. More than half of the deaths were from prescription drug overdoses as opposed to illegal narcotics.
44,000
People in the US who died from drug overdoses in 2013
Mr Obama, who talked in West Virginia about his addiction to nicotine and the fact that he “did stuff” with drugs as a young man, wants to improve access to treatment for addicts. He has tried to shift the debate so people view addiction as an illness that needs treatment rather than a crime that requires incarceration.
He also wants to improve training for doctors who prescribe opiates, and to double the number of physicians who can prescribe buprenorphine — a drug to combat opiate addiction — from 30,000 over the next three years.
The US Food and Drug Administration recently declared opioid abuse to be a national epidemic, claiming an average of 45 lives through overdose each day.
Four in every five heroin addicts say they first became addicted to opioid prescription painkillers, both of which are cleaved from the opium poppy. More than 2m people abuse opioid-based prescription painkillers such as OxyContin and Opana, a type of oxymorphone.
Some US doctors are now calling for curbs on prescriptions of opioids, pointing to statistics showing that opioid distribution on a measure known as “morphine milligram equivalent” soared from 25.3mme per person per year in 1980 to 550mme by 2012.
In Germany and the UK the comparable figures for 2012 were 195mme and 154mme per person, signalling a reluctance among doctors to hand out as many opioids, while in Japan, which takes a much stricter approach to opioid prescription, the number is lower still at 26mme.