Combined deaths from alcohol, drugs and suicide in the U.S. plateaued in 2018 for the first time in two decades, according to a report published Thursday.
Troubling data, however, lay beneath the overall findings: Deaths due to alcohol, synthetic opioids, cocaine and suicide increased, particularly among people of color, according to the report from the Trust for America's Health, a nonprofit health policy organization in Washington, and the Well Being Trust, a nonprofit started by the health care company Providence St. Joseph Health that focuses on advancing mental health in the U.S.
Some experts worry that the COVID-19 pandemic will make the problems worse.
The isolation, economic uncertainty, grief and stress brought on by the pandemic will likely aggravate the inequalities that drive drug overdose, alcohol-related and suicide deaths, said co-author Benjamin Miller, chief strategy officer of Well Being Trust. Another report, released earlier this month by Well Being Trust, predicted that COVID-19 could cause an additional 75,000 deaths of despair.
"There are several risk factors that contribute to a higher number of people dying from deaths of despair, but it's the structural inequalities piece that stands out," Miller said. "Where you live, your ability to get meaningful employment, to get out of poverty, all factor into whether or not you have a fighting chance at optimal health.
"The progress we've made is not applying to all communities equally, and that is the epitome of inequity," he said.
The report found that the rate of overdose deaths that involved synthetic opioids, such as fentanyl, grew for the sixth year in a row, rising by 10 percent, from a rate of 8.7 deaths per 100,000 people in 2017 to 9.6 deaths per 100,000 people in 2018. Such overdoses killed black Americans at a higher rate than they did any other racial or ethnic group.
In addition, from 2017 to 2018, overall drug-induced mortality increased at the highest rates among Asian Americans (increasing by 6 percent, to 4.2 deaths per 100,000 people in 2018) and Native Americans (increasing by 5 percent, to 4.2 deaths per 100,000 people in 2018) and decreased by 6 percent among whites, to 23.3 deaths per 100,000 people. Rates of death by suicide increased most significantly among Latinx Americans and Native Americans.
A factor contributing to the disparities is that people of color, more often than white Americans, are funneled into a single type of addiction care, which may not fit their needs, said Caleb Banta-Green, principal research scientist at the University of Washington Alcohol and Drug Abuse Institute.
For example, requiring people to receive doses of methadone in person six days a week for the first three months of recovery can create an access barrier for people whose only available care is methadone clinics. Other factors that create an economic and racial divide in addiction care in the U.S. are biases that result in doctors' not prescribing lifesaving drugs like naloxone to stop overdoses as often to certain groups of people, unequal insurance coverage and less physical access to treatment.
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Dr. Ayana Jordan, an assistant professor of psychiatry at Yale University School of Medicine, said people of color are more often prosecuted for drug use, instead of being guided toward treatment.
"They are sent to jail instead of being sent to treatment," she said. "There is this unjust system where we are punishing those who are minorities and showing compassion to white people."
Our country has treated the broader issue around addiction as if it was only about opioids, and that is our failing.
The report documented a steady increase in the rate of alcohol-related deaths for the ninth year in a row, with the highest increase among Native Americans, white Americans, females and adults ages 18 to 34. Banta-Green said the same factors that drive drug use also drive alcohol misuse. The difference, he said, is that alcohol is cheaper, more readily available and more culturally acceptable than illicit substances.
"Our country has treated the broader issue around addiction as if it was only about opioids, and that is our failing," said Miller, who said that demands addressing not only alcohol and non-opioid drug addiction but also the underlying factors that drive addiction, such as poverty and access to mental health care.
Prioritizing mental health care
The report showed that deaths by suicide continued to grow, reaching rates that were 25 percent higher in 2018 — 14.8 deaths per 100,000 people — than they were a decade before. Suicide deaths remained the highest among males, Native Americans and whites, but all minority groups had more sizable increases in suicide rates than white Americans did. Latinx Americans had an 8 percent increase in rates of suicide in just one year — 7.2 deaths per 100,000 people in 2018 — the highest jump among racial or ethnic groups. Among age groups, deaths by suicide among adolescents increased most significantly, nearly doubling from 2008 to 2018 to a rate of 2.5 deaths per 100,000 people.
There are social, economic and mental health factors that all contribute to deaths of despair, and all three of those things need to be addressed at once.
Substance abuse disorders and suicide deaths are deeply intertwined, Jordan said.
"When people use substances in a maladaptive way, it will often start because of untreated mental disorders," Jordan said. "If we don't give people a healthy alternative, they will figure out another way to feel better. It becomes a double-edged sword, because people are looked down upon if they have substance use disorder, which can cause suicide ideation."
Funding, access, cost and the stigmatization of mental health care are stark roadblocks that play roles in addiction recovery and deaths by suicide.
"There are social, economic and mental health factors that all contribute to deaths of despair, and all three of those things need to be addressed at once," Miller said. "You also cannot apply a one-size-fits-all approach to all communities in the same way, and that's what these data show. We have got to take a different approach to different communities if we do ultimately want to decrease disparities."
If you or someone you know is in crisis, call the National Suicide Prevention Lifeline at 800-273-8255, text HOME to 741741 or visit SpeakingOfSuicide.com/resources for additional resources.