The role of alcohol, drugs, and despair in falling U.S. life expectancy
January 16, 2020 By Mark Gold, MD
After 2014, U.S. life expectancy fell for 3 straight years. This striking trend is not associated with other wealthy countries in the world and has given rise to a cottage industry of speculation on causes, with varied social, cultural, and political actors making use of the findings for preferred narratives. Some of this speculation arose after Princeton economists Anne Case and Angus Deaton coined the term “deaths of despair,” an easily misunderstood phrase. Case and Deaton used the term to refer to fatal drug overdoses, alcohol-related diseases, and suicides. “We think of all these deaths as suicides, by a very broad definition,” these economists have written,“and we attribute them to a broad deterioration in the lives of Americans without a college degree who entered adulthood after 1970.”
What did this study find about U.S. life expectancy?
This study found that U.S. life expectancy, between 1959 and 2016, rose to 78.9 years from 69.9 years. But, following 2014, life expectancy began declining. “A major contributor,” this study’s authors write, “has been an increase in mortality from specific causes (eg, drug overdoses, suicides, organ system diseases) among young and middle-aged adults of all racial groups, with an onset as early as the 1990s and with the largest relative increases occurring in the Ohio Valley and New England.”
This study also finds that:
- Mortality increases are concentrated among Americans at “midlife”, or those between 25-64 years of age. The all-cause mortality rate rose by 6% between 2010-2017 for Americans between these ages.
- Rising mortality between 2010-2017 led to 33,307 excess deaths.
- More than 32 percent of these deaths happened in Kentucky, Indiana, Ohio, and West Virginia–or the Ohio Valley states. The upper New England states also had some of the largest mortality increases, though they account for a lower share of the overall total.
- These rising mortality figures are found among all racial groups in the U.S.
These trends do not reflect significant changes in violent crime. The U.S. is much less violent than it used to be, and although it still has higher violent crime rates than other rich countries, things have gotten much better in the last 30 years. Other medical conditions, such as infectious diseases and cancers, were also not behind these changes, as outcomes for certain medical problems actually improved.
What’s going on?
It’s a tough question. The authors write, “The largest relative increases in midlife mortality occurred among adults with less education and in rural areas or other settings with evidence of economic distress or diminished social capital.” But these observations aren’t necessarily explanatory factors in our life expectancy decline. This review considers different explanations and evidence in their favor. Isn’t it really just our drug epidemics – the rising death toll from heroin in the sixties and seventies, cocaine in the eighties, and then the three-stage opioid epidemic of prescriptions, heroin, and synthetics? Well, the authors say, this is a significant part of the story, but far from complete. Suicides and alcohol-related liver diseases have also contributed substantially and the timing is off because our life expectancy divergence started in the eighties, “and involved multiple diseases and nondrug injuries.” They also point to 2 studies suggesting that only 15 percent of our life expectancy divergence can be explained by fatal overdoses.
What about smoking? Americans smoke less than we used to, but smoking more decades ago could still kill more people today. And Americans are often more obese than their peer country counterparts, so could that account for the differences? This review points to research on other countries, like Australia, that resemble the U.S. in smoking and obesity but haven’t followed our marked life expectancy divergence. Health care? The U.S. famously spends more to cover fewer people than its peers, and Americans also face higher costs of care, but the authors note that this wouldn’t account for why we have more deaths from some diseases and not others, and from suicides or obesity-related deaths “which originate outside the clinic.” Might the problem be “deaths of despair” after all, then, or a large increase in psychological distress? There’s “inconclusive evidence” that depression and anxiety, which can also harm physical health, rose over the relevant time period, and, the authors say, it’s also hard to figure out the link between conditions like depression and all the rising specific causes of death.
The authors say these various possible causes “are not independent and collectively shape mortality patterns.” They call for the accumulation of more rigorous evidence, gathered from machine learning, migration research, and cohort studies, and interdisciplinary research, given how many different areas may contribute, and attempts to answer comparative questions about why some states and regions have worse life expectancy than others, and why other rich countries do better. These are sensibly modest conclusions but gravely important – they affect our view of the most important challenge we face.
Many death certificates tell a different story. Around 75,000 people died in the U.S. in 2017 from liver disease and alcohol-related conditions, a steep rise from 1999, when 36,000 died from those causes. Women used to die at lower rates from these conditions, but that gap has closed.2 As reported first by Case and Deaton and reiterated in their upcoming book, rising morbidity and mortality among whites due to accidents, drug overdoses, alcoholism, liver disease, and suicides means reduced overall longevity. These deaths are alarming businesses, too, as there are more suicides in the workplace than in the past.3 I expect that suicides, as well as overdose deaths, are undercounted. The most recent Florida data suggests that 1 out of 3 opioid overdose deaths, and an even greater share of cocaine deaths, are not reported.
For complete article go to Addiction Policy Forum
Trump drug policy director touts first decline in overdose-related deaths in 30 years
1/18/2020
Jim Carroll, director of the Office of National Drug Control Policy, said Friday that the United States has seen a drop in drug overdose deaths for the first time in nearly three decades.
“[For the] first time in almost 30 years, we’ve seen a decline in the number of Americans dying from an overdose – it’s a 5 percent reduction,” Carroll, who was appointed by President Trump in 2018, told Hill.TV.
\”It’s a result of everything – it’s working on the supply of drugs that are coming in but it’s also working on demand. It’s getting more people into treatment and it’s spreading the message on prevention,\” he added.
The Centers for Disease Control and Prevention (CDC) estimated that 70,237 people died of a drug overdose in 2017, with synthetic opioids such as fentanyl being the main driver behind those deaths. On average, the CDC estimates that 130 Americans die every day from an opioid overdose.
The states with the highest rates of drug overdoses in 2017 were West Virginia, Ohio, Pennsylvania, the District of Columbia and Kentucky.
In response to the opioid epidemic, some states that have been particularly ravaged have started programs to address the issue head-on…
Trump has made combating the opioid crisis one of his signature issues. After declaring the nation’s opioid crisis a public health emergency, the president signed the Substance Use—Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act. The bipartisan legislation directs funding to federal agencies and states to help expand access to addiction treatment.
According to U.S. Customs and Border Protection statistics, 89,207 pounds of cocaine were seized along the border along with 5,427 pounds of heroin, 68,585 pounds of methamphetamine and 2,545 of fentanyl.
Carroll said the U.S. needs to better secure its southern border, predicting that the number of seizures will go up even more.
“Border patrol has been able to focus in on what they’re supposed to do – it says on their patch, ‘border patrol’ that’s what they need to do, now that they’re back doing that, that the humanitarian part of that is over, we’re seeing seizures come up,” he said.
Last summer, border patrol authorities faced a record influx of undocumented immigrants at the southern border, topping 144,000 at one point.
For complete article https://thehill.com/hilltv/rising/478768-trump-drug-policy-director-touts-decline-in-overdose-related-deaths-in-30-years
WASHINGTON LEGISLATORS PROPOSE CURB ON HIGH POTENCY MARIJUANA CONCENTRATES
A bipartisan group of 22 Washington state legislators introduced a bill to curb the potency of marijuana concentrates.
Citing concerns about the connection between cannabis and psychosis, the lawmakers want to slash the potency of cannabis products, limiting THC levels to no more than 10%. The ban would be limited, because it doesn’t cover products sold as “medical.”
House Bill 2546, would outlaw the vast majority of state-licensed vape cartridges, dabs, wax, extracts and other concentrates. These products account for nearly 40% of state-regulated marijuana sales in 2019.
In Washington, as in Colorado, typical strains of raw cannabis flower average around 20% THC. However, this bill only applies to extracts, and it would still allow the high-potency raw marijuana.
Hamza Warsame, a Seattle teen, jumped 6 stories to his death after smoking pot for the first time. An older friend purchased the high-potency marijuana at a legal pot shop. Investigators on the case called the 16-year-old’s death an accident, not a crime.
In 2016, Colorado citizens introduced a ballot to cap the THC at 16%. The industry objected and used hundreds of thousands of dollars to buy off the petitioners of this sensible public safety suggestion.
Alex Berenson’s concerns about marijuana and psychosis
A year ago, writer Alex Berenson published Tell Your Children the Truth about Marijuana, Mental Illness and Violence. The book will become available in paperback on February 18, 2020.
USA Today has published a provocative series on the links between marijuana and psychosis, as well as the problems related to vaping THC. Although Washington did not ban vaping products, this bill would affect marijuana vapes.
For more go to Stop the Pot Rot
American Dystopia: San Francisco in decline –
Drug use not just permitted – it is enabled and endorsed #preventdontpromote \”We have insanity, it is disgusting and it has got to stop!\”
Marijuana detected in homicide victims nearly doubles: Over two-thirds of adolescent victims aged 15-20 tested positive in 2016
Date: January 8, 2020 Source: Columbia University\’s Mailman School of Public Health
Summary: Researchers assessed the time trends in alcohol and marijuana detected in homicide victims and found that the prevalence of marijuana almost doubled, increasing from 22 percent in 2004 to 42 percent in 2016. Alternately, the prevalence of alcohol declined slightly from 40 percent in 2004 to 35 percent in 2016.
\”Our findings are of public health significance because previous research has established marijuana use as an important risk factor for homicide victimization. The impact of increased permissibility and availability of marijuana on violence and injuries needs to be closely monitored and rigorously studied,\” said Dr. Li.
https://www.sciencedaily.com/releases/2020/01/200108160300.htm
Police forced to take drugs policy into their own hands by Government failings, says ex-Met police chief
Charles Hymas, Home Affairs Editor Telegraph16 January 2020
Police are being forced to take drugs policy into their own hands because of failings by Government and Parliament, says a former Scotland Yard Commissioner.
Lord Stevens said the apparent “backdoor decriminalisation” of cannabis by police revealed by The Daily Telegraph yesterday (Thur) was taking place “without proper discussion and proper decision-making in Parliament.”
He said: “The police should not be making the law, it’s Parliament that makes the law. I would be very worried if this kind of thing went on in terms of decriminalising by the backdoor.
“I believe in a Parliamentary democracy and Parliament needs to be involved in it although I can understand why it is happening because of a [lack of] resource.”
Lord Stevens, who was Metropolitan Police Commissioner from 2000 to 2005, urged the Government to set up a six-month inquiry to develop a drugs strategy that would include giving a clear direction to police on how Parliament wanted cannabis users tackled.
He was backed by Hugh Order, a former President of the Association of Chief Police Officers and Northern Ireland chief constable, and Lord Blunkett, a former Home Secretary, who both criticised the current “ad hoc” approach to drugs.
Their comments follow the disclosure yesterday by The Telegraph that up to two-thirds of users in parts of Britain are being let off with informal “community resolutions” without getting a criminal record.
Community resolutions provide an alternative to formal charges, fines, cautions or police warnings and have increased more than ten-fold in just three years in some forces.
Lord Stevens said he was opposed to legalising cannabis having carried out research in Amsterdam where he had seen people become addicted due to the availability of cannabis and hard drugs including one young girl of 17 who died as a result.
However, he was also against the criminalising of young first time offenders and people who might need cannabis for medical reasons including a friend whose multiple sclerosis had been eased by taking the drug.
“It’s a complex business but it is not beyond the wit of working parties or Government or the proposed royal commission to come up with an answer,” said Lord Stevens.
Mr Orde said laws on cannabis needed to be reviewed because of the current “ad hoc” approach but he was opposed to decriminalisation because of its risk as a gateway to harder drugs. “It’s the thin end of the wedge, there are progressively stronger strains and it is a real issue in prisons,” he said.
Lord Blunkett said: “It is long overdue to have an overhaul of the whole system and to give very much clearer guidance not just to the police but to health and social services on the whole issue of drugs and related substances.
“The test has to be how do you reduce harm, how do you stop usage leading to transfer to class A drugs and how do you get consistency in the approach across the country. If we can address those three elements, we make a coherent policy.
“At the moment we are staggering from one revelation about a new substance to another. It is almost as if we are following the market, which is not the right approach.”
For complete story https://www.telegraph.co.uk/politics/2020/01/16/police-forced-take-drugs-policy-hands-government-failings-says/
GOVERNMENT SETTING WRONG EXAMPLE ON POT
The following article comes from the “Your Views” section of The Daily Herald, a Chicagoland newspaper, on January 7, 2020.
What was Illinois Lt. Gov. Juliana Stratton thinking when she purchased recreational marijuana in Chicago on the first day of its legal sales in Illinois? Does she not understand that as a public official, she is setting a reckless and foolish example, especially for children and teens?
Illinois policymakers are sending a dangerous message to our young people. First, we called it “medicinal.” Now, we call it “recreational.” Gone are the days of “this is your brain on drugs.” Instead, elected officials like Stratton are celebrating drug use by welcoming the marijuana industry to communities throughout the state.
Their feckless example will mislead citizens into a diminished understanding of the dangers of drug use until it affects them personally. As the perception of risk plummets, drug use (and addictions) will climb.
Not only have lawmakers failed to do their due diligence before passing this marijuana law, but they have also failed to heed the compelling research that indicates how regular use of marijuana affects young people, including an increased risk of psychiatric illnesses and loss of IQ points.
Parents, grandparents, teachers, and religious leaders would do well to counter Stratton’s irresponsible example by returning to the sensible message, “just say no to drugs.”
David Smith, Executive Director, Illinois Family Institute
Trump Just Announced A Nationwide Ban Of Flavored Vape Cartridges Except Tobacco And Menthol
Around 1 in 4 high school students has vaped in the last month, according to national surveys.
Dan VerganoBuzzFeed News Reporter Last updated on January 2, 2020,
Justin Sullivan / Getty Images
The Trump administration on Thursday announced plans to bar sales of flavored e-cigarette cartridges, except for menthol and tobacco flavors.
\”The United States has never seen an epidemic of substance use arise as quickly as our current epidemic of youth use of e-cigarettes,\” Health and Human Services Secretary Alex Azar said in a statement about the change, which goes into effect in 30 days.
The FDA released its statement announcing the new policy on Thursday, saying the move was not a \”ban\” but an announcement prioritizing the agency\’s law enforcement powers against tobacco products. The agency \”has attempted to balance the public health concerns,\” the statement said.
The move would exclude refillable vaporizer liquid flavors also sold in vape shops. Unlike the cartridges, which are commonly used in e-cigarette devices like Juul, the exempt liquids are used in vaping devices that come with a refillable reservoir tank.
The partial flavor \”enforcement policy\” comes as a retreat from the president first saying he would ban all flavored vapes in early September. Last month, Trump signed the federal spending bill that raised the age to buy both tobacco cigarettes and e-cigarettes to 21, up from 18 nationwide. That age increase covers flavored nicotine liquids sold to refill larger vaporizers, which are exempted from the new ban.
“We’re going to protect our families, we’re going to protect our children, and we’re going to protect the industry,\” said President Donald Trump on New Year\’s Eve. \”People have died from this.\”
In November, survey results reported by the Journal of the American Medical Association suggested that more than 1 in 4 high school students (more than 5 million teens nationwide) now use flavored e-cigarettes monthly, a significant increase from last year that alarmed public health officials. Mint was the most popular flavor among high school students, according to the surveys, followed by mango.
Jose Luis Magana / Getty Images
In October, the e-cigarette giant Juul announced the suspension of US sales of mango, creme, fruit, and cucumber flavors, but not mint and menthol flavors. The company added mint to its suspended list in November, following the release of the JAMA results about teens\’ use of flavored e-cigarettes. Fifty-nine percent of the students surveyed reported using Juul, by far the leading brand used among high schoolers.
Much of the furor over e-cigarettes has sprung from a nationwide outbreak of vaping-related lung injuries that peaked in September, now at more than 2,500 cases nationwide, with at least 55 deaths. Although those cases largely appear to be related to vaping of illicit THC-containing liquids in refillable devices, pressure has increased on public officials to stem use among teens of e-cigarettes amid the outbreak.
E-cigarette advocates called the Trump administration\’s announcement only a partial victory. In May, the FDA will require shops to prove the exempted flavored liquids pass a costly public health review process to remain on the market.
\”President Trump will get the blame if America\’s vape shops are forced to close their doors in May,\” American Vaping Association President Gregory Conley told BuzzFeed News in an email.
Public health experts decried the ban\’s exemptions for menthol flavors and refillable tank liquids, with a coalition of health organizations such as the American Heart Association and Parents Against Vaping E-Cigs protesting the announcement on Thursday as a capitulation to the tobacco industry.
\”This isn\’t solving the problem – it\’s prolonging it,\” the American Lung Association\’s Erika Sward told BuzzFeed News. \”Keeping menthol-flavored cartridges and flavors sold in vape shops on the market will keep kids addicted.\”
Roughly 1 million high school students are daily e-cigarette users physically dependent on nicotine, surveys suggest. They are likely to just switch to menthol cartridges or start using refillable bubble-gum liquids bought at a vape shop, Sward said, rather than quitting nicotine cold turkey because of the partial ban.
\”It is disappointing to see that this is the industry policy that they have put forward when this should be about kids\’ health.\”
https://www.buzzfeednews.com/article/danvergano/trump-juul-flavor-ban