There were 93,331 overdoses in 2020. This shattered the previous record high of 70,000 in 2017.
The question then is: Why are so many people overdosing?
Unfortunately, there is no short or simple answer to this question. Though some have tried with answers like accessibility of fentanyl, or social media, or over-prescribing, each one of these answers represents only one chapter in a far more layered and complex narrative.
Indeed, from 2014-2017 the United States saw life expectancy falls for 3 years straight, but for this, the cause was actually quite clear: Deaths of Despair had risen so much and so fast, that despite improving medical technology, for the first time in 100 years, life expectancy went down for three years in a row.
If we break down those numbers a bit, we find that in 2017 we had 158,000 deaths of despair in the United States. This number breaks down to 70,000 ODs, 47,000 suicides, and 41,000 alcohol related liver disease deaths. Until about 5 years ago, these statistics were historically less than annual car accidents (around 37,000).
For comparison, in 2000 we had about 17,000 OD deaths…
So why is this happening? Here’s my best abbreviated shot at 13 reasons why this is happening. Here goes!
Reason 1: The Prevalence of the American Personal Responsibility Myth
In many ways, life is like a race that we’re tricked into believing gives us all equal opportunities as American citizens. We’re taught that if you work hard enough, anyone can achieve success in America.
The trouble is, it’s not the race analogy that’s wrong, it’s the thinking that we all have an equal chance to win that’s the myth. We do not all start at the same starting line. Rather, life is a race with staggered starts that’s rigged from the beginning. To think that it’s more about personal responsibility than it is about starting point is the wrong lens in which to think about the world.
Reason 2: A Strictly Biological Model of Health
In mental health treatment, it’s an over-reliance on the “Serotonin Story” of happiness and an under consideration of the environment factors that are driving us towards unhappiness.
There are many more reasons why one may be depressed that just levels of serotonin, just as there are many more reasons why one stays addicted to opiates beyond just endorphin levels.
And this lens is not just prevalent in mental health leading to overprescribing, it permeates every aspect of American healthcare. The best way I’ve heard it described is, rather than a Bio-Psycho-Social Model, we tend to only use the “Bio-Bio-Bio Model” of healthcare.
To put this one other way, in the words of the late Dr. Neil Capretto, “Any doctor can say ‘yes’ and take 3 minutes and write a script. It takes a really great doctor to say ‘no’ and take 30 minutes to explain why.”
Unfortunately, our current medical model does not incentivize this type of treatment.
Reason 3: Stigma
Though it has been reduced in recent decades, it’s estimated that of all of the people struggling with addiction in America, only 1 in 10 people with addiction gets appropriate treatment for their condition.
Reason 4: Our For-Profit Medical System
The CEO of United makes $77,000…
PER DAY! And he’s not even one of the highest paid!
In addition, America spends 18-19% of our federal budget on medical. Canada spends only 10-11% and has similar or better outcome measures.
I don’t know exactly what the answer is to fix this, but I believe that starting with limiting CEO pay and getting more competition for prescription drug prices would be a good start.
Reason 5: Big Pharma
Perdue Pharma was sued 600 million dollars for the misrepresentation of OxyContin as “virtually non-addictive.”
Whereas this may seem like a lot, it’s essentially equivalent to a 2% fine which is nothing to them.
In addition, did you know that Big Pharma spends more on marketing rather than research and development?
Reason 6: Direct-to-Consumer Advertising and Overprescribing
The only countries that allow DTCA are the US and Papua New Guinea.
The act particularly upset me several years ago when “Blu” e-cigarettes were advertised by Jenny McCathary directly appealing to young consumers. Here, I thought we had learned our less with Joe Camel…
In terms of overprescribing, in one year, there were more opiate scripts written in Ohio than there were people in the state of Ohio. In addition, 200 million scripts were written in 2014 for a US population of 327 million. That’s a lot of opioids.
Reason 7: Trauma
Trauma is more correlated with addiction than obesity is to heart disease.
Let that sink in for a bit.
One’s ACE score (adverse childhood events) is more directly correlated with the likelihood of addiction than increased weight is linked to heart disease.
Reason 8: The War on Drugs Creates a War For Drugs
In the US we spend $41 billion on policing and punishing drug-related crimes, and only $4 billion on all of treatment, education, prevention and job placement programs combined. Now, this stat may be slightly outdated, but regardless, this ratio ought to be the opposite of what it is.
Indeed for every dollar we spend in treatment, we save $11 in reducing court and preventing health costs.
Reason 9: Accessibility of Fentanyl
If we can’t keep it out of our jails, we can’t keep it out of our walls.
With unregulated labs China producing it, and a global market spreading it, we’d have a better shot at lower overdoses with decriminalization, legalization, and/or regulation than we would with our current system of punishment and penalties.
Basically, we need to create a world that looks more like Rat Park than creating more cages.
Reason 10: Improving Technology and Social Media
Social media doesn’t turn off when the school day ends. Teens and pre-teen suicides have increased 56-70% between 2006 and 2016.
Reason 11: Job Displacement
“Work saves us from three great evils: boredom, vice, and need.” – Voltaire
Work is of great importance to our mental health and yet the American Labor Force Participation is less than 60%. With unemployment acting as one of the greatest correlates of depression, this is terrible news for people’s mental health.
In addition, since 2000, on the whole we’ve lost 5 million manufacturing jobs: four million to automation and one million to outsourcing.
Whether it’s in automation in manufacturing, cashier-less checkout lines, out-sourced call centers, or Amazon sales leading to retail apocalypse, we’re trying to do more with less, but there’s a very real human consequence to this.
Reason 12: Income Inequality
If you were born in the 1950’s, you had a 90% chance of doing better than your parents financially. If you were born in the 1990’s, that became a 50/50 change. Now, the odds are that if you’re born today, you will likely not do as well as your parents financially.
Real wages haven’t changed in 40 years.
In 2016, the median wealth of white households was $171,000. That’s 10x the wealth of black households ($17,000) – a larger gap than in 2007 – and 8x that of Hispanic households.
The average student enters the work force with $38,000 in debt to a world where 40% of the people with a degree are unemployed or underemployed.
America’s top 10% now average more than 9x as much income as the bottom 90%.
Put another way, 400 individual Americans at the top own the wealth equivalence of 150 million Americans, or roughly half of US citizens. Read more here.
If a monkey were hoarding all the bananas while the other monkeys starved, we’d assume something was wrong with it. In America, we often accept this as commonplace behavior.
Not having enough money makes people depressed and is painful. Depression leads to drugs to escape pain. Increased drug use leads to increased overdoses.
Reason 13: Dissolution of the Community
We’re facing a loneliness epidemic where we generally now have increased floor space in our homes, but fewer close friends than ever.
We now live in a time where 36% of Americans are seriously lonely as defined by feeling “frequently” or “almost all of the time” lonely.
So if those are some reasons why all this is happening, what can we do about it?
First off, we need to care and keep asking why! As a child, we ask “why” all of the time and try to get to the root causes of new observations as we notice the world around us.
As adults, we ought to tap back into our child-like questions, keep asking why, and start figuring out some better solution to bring back the American Dream that once was.
Secondly, there’s actually a lot we can do! Anything from taxing Amazon, to following other country’s models of success, to rethinking the way we spend money, to treatment vs. punishment, etc.
And with that, this is precisely where I’ll be focusing our next blog post!