Home Emergency Management News America’s Opioid Crisis: A Nation Hooked
America’s Opioid Crisis: A Nation Hooked

America’s Opioid Crisis: A Nation Hooked

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In a speech last month, President Trump declared America’s opioid crisis a national public health emergency, telling observers that “nobody has seen anything like” it. He’s right: The opioid epidemic is being called the worst public health crisis in American history, with its lethal consequences exacting a toll on users, families, and law enforcement nationwide. Though the affected span all ages, it’s Boomers (and early-wave Xers) who are pushing up overdose rates the most—a divergence from typical demographic patterns and a reflection of a risk-taking ethos that has followed these generations into maturity.

In 2015, more than 52,000 Americans died of drug overdoses. Nearly two-thirds were linked to opioids such as OxyContin, Vicodin, heroin, and fentanyl. This figure has quadrupled since 1999 and is now the highest on record, exceeding the death toll of past heroin epidemics, the crack epidemic of the 1980s, and the peak of the AIDS epidemic in the 1990s. Drug overdoses now kill more Americans than car accidents or guns. And the numbers keep rising: A preliminary analysis by The New York Times estimates that there were 59,000 to 65,000 such deaths in 2016. It’s even possible these figures are too low, because many deaths that result from opioid-induced conditions—such as pneumonia—aren’t being counted as overdoses.

America’s opioid epidemic has taken center stage, with President Trump recently declaring it a public health emergency.

The crisis is so significant that it has contributed to worsening population mortality. U.S. life expectancy fell in 2015 and has seen almost no gain since 2013. To be sure, there were other reasons behind the drop, including increased mortality for leading causes of death like heart disease. But CDC researchers cite a jump in unintentional injury deaths, namely drug and alcohol overdoses, as another major contributor.

As the number of fatalities has shot up, the public face of addiction has shifted. In contrast to past drug epidemics, opioids are killing white Americans at double to triple the rates of their black and Hispanic peers. The problem is most acute in rural areas, but transcends socioeconomic class and income level. What’s more, it’s the middle-aged who’ve been hardest hit. Though overdose death rates have risen for every age group, late-wave Boomers (ages 55 to 64) have seen the most dramatic percentage-point spike since 1999. The highest death rate (30.0), meanwhile, belongs to early-wave Xers (ages 45 to 54).

The geography of the crisis has changed over time as well. In 1999, overdose deaths were largely concentrated in Western states like New Mexico and California. By 2015, they had spread across a more diverse range of states, and the epicenter of the crisis had shifted eastward to the Rust Belt, rural Appalachia, and New England. Many victims come from overwhelmingly white areas in states like Ohio, Rhode Island, West Virginia, Kentucky, and New Hampshire. Leading the nation in per-capita overdose deaths is Ohio’s Montgomery County, which is on track for 800 fatalities this year and where the coroner’s office routinely runs out of room for bodies.

Many commentators link the opioid epidemic to economic difficulties. Princeton economist Anne Case, for example, suggests that struggling Americans are self-medicating “to soothe the beast” brought on by stress and poor health. Research by another Princeton economist, Alan Krueger, found that 44% of prime working-age male labor-force dropouts—roughly 7 million men—take pain medication on a daily basis, and in two-thirds of cases, they take prescription drugs. These men report lower levels of emotional well-being than their employed counterparts. But this theory is incomplete. Ours is not the only nation experiencing economic trauma—yet no other country is afflicted by an opioid epidemic. We consume an astonishing 80% of the world’s supply and 99% of the hydrocodone supply.

A better explanation points to something uniquely American: the U.S. medical-industrial complex, which has facilitated the massive proliferation of prescription painkillers.

In the 1990s, doctors faced pressure to treat pain more seriously as “the fifth vital sign.” They turned to opioids, which pharmaceutical companies were pushing hard (and as recent lawsuits allege, in the name of profit) as a safe solution. The U.S. health care system equates quality of care with the ability of doctors and hospitals to deliver what patients ask for, incentivizing providers to pull out the prescription pad. In 2012, doctors wrote 259 million opioid prescriptions—enough to give a pill bottle to every adult in the country. Twelve states had more prescriptions than people. The Centers for Medicare and Medicaid Services even links reimbursements to patient surveys that ask whether “your doctors did everything they could to help with your pain.”

Generational and cultural drivers are also at play. Back in the 1960s and ‘70s, there was a sizable drug abuse epidemic and most of it was driven by Boomer youth. Today, these same Boomers—having spent a lifetime dabbling in mind-altering substances—are a major driver of today’s epidemic.  Research shows that Americans are more likely than Europeans to believe that “life is perfectible” (in other words, that pain is avoidable), making it all the more likely that a Boomer might seek out substances to deal with the pains of aging.

Experts are conflicted on the appropriate next step. Some say lawsuits against Big Pharma are the answer—yet even as the number of opioid prescriptions has fallen each year since 2012 (since the medical profession is at last waking up to the danger), the death rate from street drugs like heroin and fentanyl is rising faster than ever. Others maintain that the most useful tool against overdoses is the antidote naloxone, which dozens of states now offer without a prescription and law enforcement officials routinely carry.

In the meantime, the opioid crisis will continue to leave its mark on Americans of every age: babies born addicted, kids inundating foster care, addicts overdosing in public places, and grandparents who find themselves gaining custody of young children. Addiction is unique in that its effects often ripple outwards and linger for generations, leaving communities grasping to find a way out of an epidemic that shows no signs of letting up.

 

This article was written by Neil Howe from Forbes and was legally licensed through the NewsCred publisher network. Please direct all licensing questions to legal@newscred.com.



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