The spread of deaths of despair in the USA

Americans in the prime years of life—aged 25 to 44—are dying at an increasing rate, and the increase is mainly due to “deaths of despair”—drug overdoses and alcohol-related disease.

I recently wrote a post about the Case-Deaton study, which shows a rise in “deaths of despair” among white Americans, especially those age 45 to 54, since 1999.

Now reporters for the Washington Post have done their own study which shows a rise in the death rate since 2010 among Americans of all races in the prime of life—age 25 to 44.

As in the Case-Deaton study, the increase is due to “deaths of despair”—drug overdoses and alcohol-related diseases.

Since 2010, death rates have risen

• 16 percent for young white American adults.
• 18 percent for young native American adults
• 7 percent for young Hispanic American adults
• 4 percent for young African-American adults
• 3 percent for young Asian American adults.

Why is this happening?

The majority of Americans are doing badly economically.  Wages are stagnant.  Good jobs are scarce.  Many have educational, medical or other debts they never will be able to pay.

Except for the professional classes and the ultra-rich, few expect to do better economically than their parents, and few expect their children to do better than themselves.

In the past generation, some of us have been sold in the idea that medications, such as Prozac, are the solution to our psychological and personal problems.   A journalist named Robert Whitaker did a good job of documenting this in his book, Anatomy of an Epidemic, and his book and website, Mad in America.

This new respectable drug culture made it easy for Purdue Pharmaceuticals to market Oxycontin, an addictive pain killing prescription drug, and widespread use of Oxycontin made it easy for illegal drug traffickers to sell heroin as a cheap substitute.  For some, drugs provided an easier escape from dead-end lives than individual initiative or political struggle.

Heroin addiction comes to West Virginia

As a boy and well into adulthood, I thought of heroin addiction as a product and problem of big city slums—a world completely alien to me.

My old friend Steve called my attention to a harrowing article in The New Yorker about heroin addiction in the eastern panhandle of West Virginia, just across the river from western Maryland where the two of us grew up.

The Eastern Panhandle as I remember it

I am shocked, although I know I shouldn’t be, that heroin addiction could capture so many people with the same small-town white Protestant background as me.  But in fact rates of drug addiction are higher among non-Hispanic white people than among Hispanic or black people.

Like much of Appalachia, as well as the Rustbelt along the Great Lakes, the city of Martinsburg, W.Va., lost its main manufacturing employer, the Interwoven textile mill, and nothing has ever taken its place.

Citizens of Martinsburg today are thinking of converting part of the old Interwoven plant into a drug rehabilitation center.

Margaret Talbot, the author of the New Yorker article, gives harrowing descriptions of how drug addition has become normalized.  She opens with a description of a mother and father suffering a drug overdose while attending a Little League game.

She reported on how marketing of painkillers such as Oxycontin enabled West Virginians to self-medicate for physical and psychic pain, and then how heroin was introduced as a cheaper substitute.  She went on to write:

Michael Chalmers is the publisher of an Eastern Panhandle newspaper, the Observer. It is based in Shepherdstown, a picturesque college town near the Maryland border which has not succumbed to heroin.

Chalmers, who is forty-two, grew up in Martinsburg, and in 2014 he lost his younger brother, Jason, to an overdose.

I asked him why he thought that Martinsburg was struggling so much with drugs.

“In my opinion, the desperation in the Panhandle, and places like it, is a social vacancy,” he said. “People don’t feel they have a purpose.”

There was a “shame element in small-town culture.” Many drug addicts, he explained, are “trying to escape the reality that this place doesn’t give them anything.”

He added, “That’s really hard to live with—when you look around and you see that seven out of ten of your friends from high school are still here, and nobody makes more than thirty-six thousand a year, and everybody’s just bitching about bills and watching these crazy shows on reality TV and not doing anything.”

Source: The New Yorker

As I see it, large numbers of Americans think that what gives meaning to life is economic success, or at least being able to pay your way and be a breadwinner for others.  When that meaning is no longer available, they feel worthless and fall into despair.

Opioid abuse and the white American death rate

I wrote blog posts some time back about the Case-Deaton study of the rising death rate in the 21st century among middle-aged white people without college educations—a strange trend because the death rate continues to fall for all other demographic groups and also for Europeans.

I also reviewed a book, Dreamland, about over-prescription of optoid drugs and how this has led to a heroin epidemic specifically among white people.  I didn’t make the obvious connection with the Case-Deaton study.

A blogger who calls himself Lambert Strether pointed out that the body count from opioid overdoses approaches the number deaths from AIDS.  If you think of opioid overdose as a disease, the vector of the spread is not a microbe and not unsafe sex, but the marketing strategies of certain drug companies—especially Purdue Pharma, manufacturer of OxyContin.

I accept that there are deeper reasons for the rise in drug abuse than the unethical marketing of one drug by one company.  Purdue Pharma would not have been so successful if there hadn’t been a big potential demand for its product.  I still think drug prohibition hasn’t worked, just as alcohol prohibition didn’t work and gun prohibition wouldn’t work.

This is another question for which I don’t have good answers.  What do you think?

LINKS

Genocide by Prescription: The ‘Natural History’ of the Declining White Working Class in America by James Petras and Robin Eastman Abaya [added 7/14/2016]

Credentialism and Corruption: The Opioid Epidemic and the Looting Professional Class by Lambert Strether for naked capitalism.  Very much worth reading.

Poison Pill by Mike Mariani for Pacific Standard.

Drug abuse and suicide: Why death rates have spiked among middle-aged white Americans, an interview of Angus Deaton, one of the authors of the study, by Christina Cauterucci for Slate.

Opioid Addiction 2016 Facts & Figures by the American Society of Addiction Medicine.