These measures included instituting prescribing limits, monitoring prescribing to identify excessive levels, and implementing “pill mill” laws requiring providers to submit clinical documentation from medical records to support their prescribing of opioids (Kiang et al., 2019). These forces created a “thick market” for heroin (Quinones, 2015), lowering its prices and introducing a new clientele to the drug. This new market, combined with the existing heroin client base, ushered difference between drugs and alcohol in the second wave of the opioid overdose crisis, in which the consolidation of the heroin supply chain in Mexico and the much more widespread availability of heroin in the United States than in the past led to an increase in heroin overdose deaths.
Alcohol-Related Deaths: What to Know
With the exception of fatal injuries caused by alcohol intoxication, drugs (particularly opioids) kill people more quickly than does alcohol. This complicates the ability to draw a clear link between cohort-based trends in the availability and consumption of alcohol among younger adults and subsequent period changes in mortality among older adults. Relative to drug poisoning, the extended period of consumption before the onset of many diseases caused by alcohol provides greater opportunity for intervention before alcohol-induced mortality occurs, as well as greater opportunity for deaths from other causes. In contrast, drug poisoning mortality may be more likely to track contemporaneous trends in the supply of particularly lethal drugs.
Results of Study on U.S. Life Expectancy
- Theoretically, “despair” or other forms of psychological distress may help to explain substance-related deaths because they reflect behaviors of individuals who are potentially depressed, distressed, and without hope for the future (Baines, Jones, and Christiansen, 2016; McLean, 2016).
- The increases in alcohol-induced mortality reported above likely reflect much earlier changes in consumption patterns.
- Many of these studies show strong dose-response relationships; for each additional ACE, the odds of mental illnesses and SUDs in adulthood increase.
- Other research suggests that the relationship between drug overdose rates and economic decline may vary depending on the specific drug being considered.
A recent study found that one in eight total deaths among U.S. adults aged 20–۶۴ years during 2015–۲۰۱۹ resulted from excessive alcohol use (9). Because of the increases in these deaths during 2020–۲۰۲۱, including among adults in the same age group, excessive alcohol use could account for an even higher proportion of total deaths during that 2-year period. In this study, fewer than one third of deaths from Alcoholics Anonymous excessive alcohol use were from fully alcohol-attributable causes, highlighting the importance of also assessing partially alcohol-attributable causes to better understand the harms from excessive drinking, including binge drinking. If these preventable deaths were eliminated (and other causes of death remained the same), U.S. life expectancy at birth would increase by 1.6 years, narrowing the current life expectancy gap by about half, the report says. Targeted public health interventions and investments in mental health and social services—as opposed to making changes in clinical care—would help minimize alcohol, drug, and firearm deaths, and potentially other preventable causes of death, across the country.
Group 2 study selection and data extraction, 2018–۲۰۲۲
Over the past five years, the U.S. has been losing roughly 110,000 people to fatal drug overdoses every year. It’s possible drug deaths are declining in part because a heartbreaking number of people using fentanyl and other high-risk street drugs simply didn’t survive. CDC’s OD2A program provides the United States with robust data through its fatal (SUDORS) and nonfatal (DOSE) overdose data systems.
EXPLANATIONS FOR THE RISE IN WORKING-AGE MORTALITY FROM DRUG POISONING AND ALCOHOL-INDUCED CAUSES
Some of these explanations focus on factors proximate to individuals—physical pain, mental illness, adverse childhood experiences (ACEs), and psychological distress or despair—and others on factors more structural and distal—macro-level economic and social changes. This section first provides an overview of conceptual models of addictive behaviors and then summarizes the evidence for these explanations. Even conscientious physicians contributed to the glut of opioids on the market through opioid overprescribing after surgical procedures (Ladha et al., 2019; Neuman, Bateman, and Wunsch, 2019). In a review of the research evidence on the extent of opioid overprescribing after surgery, Neuman, Bateman, and Wunsch (2019) summarize several studies showing that U.S. physicians prescribe opioids after surgery at rates several times higher than those of their European counterparts.
Data Sources and Measures
Drug and alcohol addictions also create additional vulnerabilities in the population groups they impact. The addictive and destructive nature of opioids, many other drugs, and alcohol puts pressure on the social and economic fabric of families and communities, resulting in downward spirals that lead to further addiction. Between 2002 and 2022, combined rate of deaths due to alcohol, drugs, and suicide have increased by 142 percent from 74,003 deaths in 2002 to 207,827 deaths in 2022. Most of the 145 countries that reported data did not have a specific budget line or data on governmental expenditures for treatment of substance use disorders. Although mutual help and peer support groups are useful resources for people with substance use disorders, almost half of responding countries reported that they do not offer such support groups for substance use disorders.