America’s opioid epidemic is so bad it’s causing average life expectancy to drop

The typical American was expected to die a little earlier in 2015 than 2014 — and a dramatic rise in drug overdose deaths is largely to blame, according to a new study in JAMA.

The study examined changes in life expectancy between 2000 and 2015. It found that, overall, life expectancy at birth increased by about two years in that time span.

But drug overdose deaths made that number significantly lower than it would have been otherwise — by more than three months. And opioid overdoses in particular shaved about two and a half months from life expectancy at birth.

In total, the researchers said decreased death rates related to heart disease, cancer, cerebrovascular diseases, diabetes, influenza and pneumonia, chronic lower respiratory diseases, and kidney disease contributed to a gain of about two years and three months in life expectancy from 2000 to 2015. But increases in drug overdoses, suicide, chronic liver disease and cirrhosis, and alcohol poisonings pushed down the overall gains.

Here’s how all of that looks in chart form:

JAMA

The numbers show the deep impact of America’s ongoing opioid epidemic, which is the deadliest drug overdose crisis in history. We already knew, based on federal data, that US life expectancy saw its first major drop since 1993 in 2015 — from about 78.9 years in 2014 to 78.8 in 2015. Now we know that drug overdoses, especially opioid overdoses, played a big part in that drop.

This is likely to get worse. Preliminary data suggests that drug overdoses climbed even further in 2016, from more than 52,000 in 2015 to about 64,000 in 2016. And a forecast by STAT estimated that as many as 650,000 people — more than the entire population of Baltimore — could die from opioid overdoses alone in the next decade. Based on this new study, that could push US life expectancy down even further.

The opioid epidemic, explained

In 2016, more Americans died of drug overdoses than have ever died from car crashes, gun violence, or HIV/AIDS during any single year.

This latest drug epidemic, however, is not solely about illegal drugs. It began, in fact, with a legal drug.

Back in the 1990s, doctors were persuaded to treat pain as a serious medical issue. There’s a good reason for that: About 100 million US adults suffer from chronic pain, according to a 2011 report from the Institute of Medicine.

Pharmaceutical companies took advantage of this concern. Through a big marketing campaign, they got doctors to prescribe products like OxyContin and Percocet in droves — even though the evidence for opioids treating long-term, chronic pain is very weak (despite their effectiveness for short-term, acute pain), while the evidence that opioids cause harm in the long term is very strong.

Painkillers proliferated, landing in the hands of not just patients but also teens rummaging through their parents’ medicine cabinets, other family members and friends of patients, and the black market.

As a result, opioid overdose deaths trended up — sometimes involving opioids alone, other times involving drugs like alcohol and benzodiazepines (typically prescribed to relieve anxiety). By 2015, opioid overdose deaths totaled more than 33,000 — close to two-thirds of all drug overdose deaths. (The figures for 2016 aren’t added up just yet.)

Seeing the rise in opioid misuse and deaths, officials have cracked down on prescriptions painkillers. Law enforcement, for instance, threatened doctors with incarceration and the loss of their medical licenses if they prescribed the drugs unscrupulously.

Ideally, doctors should still be able to get painkillers to patients who truly need them (and they can work for some individual chronic pain patients) — after, for example, evaluating the patient’s history of drug addiction. But doctors, who weren’t conducting even such basic checks, are now being told to give more thought to their prescriptions.

Yet many people who lost access to painkillers are still addicted. So some who could no longer legally obtain painkillers have turned to illegally obtaining the cheaper, more potent opioids: heroin and fentanyl, a powerful synthetic drug.

Not all painkiller users went this way, and not all opioid users started with painkillers. But statistics suggest many did: A 2014 study in JAMA Psychiatry found 75 percent of heroin users in treatment started with painkillers, and a 2015 analysis by the Centers for Disease Control and Prevention found that people who are addicted to painkillers are 40 times more likely to be addicted to heroin.

So other types of opioid overdoses, excluding painkillers, also rose.

That doesn’t mean pulling back on the number of painkiller prescriptions was a mistake. It appeared to slow the rise in painkiller deaths, and likely prevented doctors from prescribing opioids to new generations of people with drug use disorders.

But it must be paired with more access to addiction treatment. According to a 2016 report by the surgeon general, just 10 percent of Americans with a drug use disorder obtain specialty treatment. The report found that the low rate was largely explained by a shortage of treatment options.

So federal and state officials have pushed for more treatment funding, including medication-assisted treatment like methadone and buprenorphine.

Some states, like Florida and Indiana, have taken a "tough on crime" approach that focuses on incarcerating drug traffickers. But the incarceration approach has been around for decades — and it hasn’t stopped massive drug epidemics like the current crisis.

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