As noted in a recent Chicago Tribune editorial, the term “deaths of despair” is not something that emerged from refugee camps or war-torn cities or famine-wracked villages in poverty-stricken countries. It is a term used to describe a crisis born in one of the most advanced societies on the planet, and we own it.
It was first coined in 2015 by Princeton University researchers Anne Case and Angus Deaton to describe death rates that were rising dramatically among middle-aged white Americans caused by suicide, drugs and alcohol and the sudden and unprecedented reverse of longer life expectancy in this country.
“In a sense, they are all suicide,” Deaton said in an interview with The Guardian. As the term “deaths of despair” makes clear, these deaths stem from hopelessness, where life becomes so painful that death or escape seems the only recourse. The researchers could dissect the cause of these tragic early deaths. The deeper question was why and what was driving them.
Further research over the past few years has revealed a lot of social dysfunction building up over time around the nation. There has been a decline of religion and other sources of meaning. Many people have lost a sense of status and belonging. Clinicians would say these are all classic preconditions for suicide. Nevertheless, does it fully answer the question of what is it about life in modern America that drives so many into self-destruction? There seems a lack of both answers and readily available solutions to it all.
This brings us to today. The United States remains in the grip of two lethal epidemics: suicides and drug overdoses. According to a report recently released by the Commonwealth Fund, rates of deaths from suicides, drug overdoses and alcohol have now reached an all-time high in the United States. As reported by the Chicago Tribune, on a typical day, approximately 175 people die of drug overdoses and 123 by their own hand. That is one “death by despair” every five minutes in this country.
Much of this is happening without provoking the kind of urgent public response such a crisis should generate. Since 1999, suicides alone have risen by 30% nationally, amounting to nearly 45,000 in 2016. As the Tribune editorial notes, if hundreds of our fellow citizens were dying every day from terrorist attacks or Ebola, the reaction would be far different. “The reason for the relative silence is that we have no simple, quick ways to combat these scourges,” they write. “They kill one person at a time, often out of sight of anyone but those closest to them.”
There exists no part of the country that has not been touched by this epidemic. The Commonwealth Fund report’s investigators have been particularly struck by regional disparities and differences in the death rates from suicide and alcohol.
Hardest hit are the mid-Atlantic states of West Virginia, Ohio and Pennsylvania, which show the highest rates of drug overdose deaths in the country. Fueled by the opioid epidemic, West Virginia drug overdose death rates rose by a mind-boggling 450% from 2005 to 2017.
Following West Virginia, according to the report, the District of Columbia, Kentucky, Delaware and New Hampshire had the next highest drug overdose death rates in the country. People died at higher rates by suicide or from alcohol than from drugs in Montana, Nebraska, the Dakotas, Oregon and Wyoming.
As the report points out, it is not just prescription painkillers and heroin that are driving these death rates. Fentanyl and other potent synthetic opioids have become a major concern as they have worked their way into other illicit drugs such as cocaine. The National Institute on Drug Abuse reports that fentanyl is 50 to 100 times more potent than powerful drugs such as morphine.
The fact that no one has any magic cure for either epidemic should not stop us from searching more aggressively for at least partial cures in the short term. A lack of ready solutions is no excuse for inattention or inaction in the face of such a crisis.
The Chicago Tribune points out that drunken driving was once seen as a fact of life but growing public awareness and assorted policy changes have drastically reduced the number of traffic deaths involving alcohol-impaired drivers. It is believed that wider public knowledge of risk factors of suicide and greater access to and less stigmatizing of mental health treatment could help at least some of those who feel life has nothing to offer.
These epidemics demand more urgent attention from policymakers as well. We are starting to see it. Last year, a presidential commission chaired by former New Jersey Gov. Chris Christie offered more than 50 proposals on how to combat opioid abuse. In moving forward, it won’t do to merely treat symptoms without addressing causes. As the Tribune editorial reminds us: “A tragedy is raging every day. It demands our action.”
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