The ‘Opioid’ Crisis Runs Deep

As we’ve noted before, while opioids rack up the highest body count, many kinds of drug use have become much more lethal:

Since 2011 opioid and opiate deaths combined in Ohio have increased from 1,228 to 4,365 in 2016–a 3.55-fold increase. But cocaine overdose deaths have increased by almost exactly the same amount during that period as well: 309 to 1,109 (benzodiazepine-related deaths have increased by fifty percent during that time frame). In terms of numbers, more people are using opioids and heroin, but the rate of increase in American Carnage (to use a phrase) is nearly identical for cocaine. In fact, psychostimulant (e.g., meth), hallucinogen, and alcohol-related deaths* have also skyrocketed, increasing 2.5 to 3-fold as well.

Based on Ohio’s population size, it has about triple the fentanyl, heroin, and cocaine deaths one would expect, while it’s doing somewhat better than one would expect with prescription opioids and psychostimulants (unfortunately, this modest improvement doesn’t come close to counteracting the deaths caused by the ‘big three’).

This does not appear to be a ‘drug-specific’ problem in Ohio, as lethal drug use of all kinds is increasing and essentially at the same rate. It’s not just ‘evil heroin pushers’, nor the deadliness of a particular drug (all drugs are becoming increasingly lethal). This suggests a general societal breakdown over the last five years in the state of Ohio.

There’s a similar pattern at the national scale as well (boldface mine):

It is not all about opioids. Policymakers often speak as if the epidemic will be over as soon as we tackle both legal and illegal opioids. Better control of opioids is essential, but, even without opioid deaths, there would still be as many or more deaths from suicide and liver diseases. Opioids are like guns handed out in a suicide ward; they have certainly made the total epidemic much worse, but they are not the cause of the underlying depression. We suspect that deaths of despair among those without a university degree are primarily the result of a 40-year stagnation of median real wages and a long-term decline in the number of well-paying jobs for those without a bachelor’s degree. Falling labor force participation, sluggish wage growth, and associated dysfunctional marriage and child-rearing patterns have undermined the meaning of working people’s lives as well.

There is something very wrong, even in (or especially in) the heartland. In many ways, it’s similar to the breakdown of urban areas in the 1970s and 1980s (and which began in the mid-1960s): decently paying jobs that did not require a college education left urban areas–New York City alone lost 500,000 manufacturing jobs in those years alone (mostly to non-unionized areas in the U.S.). Combined with a hollowing out of the welfare state in the late 1970s and 1980s, which further deprived these hard-hit urban areas of desperately needed resources, cities, and their minority communities, experienced social collapse as jobs disappeared, though it was blamed on ‘degenerate urban culture‘ (all those people with their hippity-hoppity music).

Unlike major cities, many hard-hit areas never had the social, cultural, and infrastructure capital cities had. When the factories disappear today, there’s nothing left. No museums, transportation infrastructure, or relatively low maintenance costs. Without a major commitment of federal resources–cities and states can’t deficit spend–and reduction of income equality, I’m afraid the areas hit hard by the ‘opioid’ crisis are going to be suffering for a long time. Neither the Democratic Northern Strategy or the Republican Southern Strategy are going to fix this.

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2 Responses to The ‘Opioid’ Crisis Runs Deep

  1. The write-ups on this always seem to take it for granted that the “deaths of dispair” hypothesis is the only one going.

    I hope to read the whole paper. The rise in mortality is unique to the US.

    Aren’t we also the only country that gave out official nutrition advice that would raise mortality? That deadly advice was adopted in mid-seventies and continues today on boxes of Cheerios. The mechanism of death is obesity. Is there a connection between obesity and liver function?

    Also, what is the use of meth in other countries? Is Fentynal as widely available in Europe?

    Does the study test the hypothesis that there’s not a North/South division? Or does it just jump into the urban vs rural question?

  2. kaleberg says:

    We’ve seen this kind of thing many times before. Look at the Russia after the Soviet Union collapsed. Look at the American Indian or Australian Aborigine tribes since outside contact. I often wonder how often this type of collapse has taken place in world history. An economic and symbolic system collapses and then the society destroys itself one person at a time.

    I also wonder if we are seeing more deaths from automobile accidents, fires and other such sources, the kind that don’t look like suicides but can result from a level of inattention or despair.

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