After all the arguing over drug prices, the cost of healthcare and many of the related disputes, most Americans take comfort from the fact that the nation as a whole is getting healthier and living longer. But—at this time—that is no longer true. Just-released life expectancy data from the Centers for Disease Control show that for the latest year, 2017, life expectancy declined to an estimated 78.6 years, from 78.7 years in 2016; in fact, it has been declining since the all-time peak of 78.9 in 2014.*
“Tragically, this troubling trend is largely driven by deaths from drug overdose and suicide,” said Dr. Robert Redfield, CDC Director. “Life expectancy gives us a snapshot of the Nation’s overall health and these sobering statistics are a wakeup call that we are losing too many Americans, too early and too often, to conditions that are preventable.” Suicide and overdose were the infamous “deaths of despair” that became recognized back in 2015; all that can be said is that the trend has continued.
For the 2015-2017 period, based on preliminary data, death rates for suicide rose from 13.3 per 100,000 population to 14.0; “unintentional deaths” (which includes accidents, homicide, poisoning including drug overdose) rose from 43.2 per 100,000 to 49.4. A different CDC compilation states that drug overdose deaths per 12-month period peaked at 70,908 reported deaths as of December 2017; the 12-month running rate in May 2018 had fallen to 68,255 reported deaths. (These “reported” death rates are provisional, pending further review of death certificates.) So it’s possible that by the time life expectancy for 2018 is counted, the decline might have been arrested because drug overdose deaths have moderated—but how much of that is due to reduced drug abuse, and how much to better distribution of naloxone, the overdose antidote?
Taking a step back, one realizes that the unifying theme for drug overdose and suicide is addressing mental health needs. IQVIA’s annual Use of Medicines report issued last spring noted that the number of prescriptions for mental health diseases had increased from 394 million in 2012 to 489 million in 2017, and that “the greatest advance for mental health treatment has been the ACA provision requiring coverage by insurance, with the continued growth and usage of these therapies attributable to both the chronic nature of the diseases and the availability of insurance coverage.” Anecdotal reporting lately shows that the states or regions where drug overdose deaths have been declining are where increased public funding for therapy and counseling exist; one only hopes this can continue.
*There is some ambiguity whether this is three continuous years of decline, or two with a span of no change during the three-year period, based on the US Mortality annual reports issued by CDC’s National Center for Health Statistics. CDC notes that there hasn’t been a decline at any time for the previous 20 years, and one would have to go back to the 1961-63 period to find two consecutive years of decline.