Drug Epidemic: Death Toll May Be Twice as High as Previously Thought
By George Citroner
- Recent research finds that official government figures may be underestimating drug deaths by half.
- Researchers estimate that 142,000 people died due to drug use in 2016.
- Drug use decreases life expectancy after age 15 by 1.4 years for men and by just under 1 year for women, on average.
Government records may be severely underreporting how many Americans die from drug use, according to a new study by researchers from the University of Pennsylvania and Georgetown University.
Researchers analyzed more than 44 million death certificates issued nationwide over an 18-year period to identify nearly 670,000 deaths that coded as drug-related.
Their models showed these drug-coded deaths, which included drug overdoses and mental health and behavioral conditions related to drug use, only accounted for about half of all drug-associated deaths.
The study was published in PLOS One.
Drug Epidemic More Serious Than Previously Thought
According to the National Center for Health Statistics (NCHS), the reported rate of drug-related deaths among 15- to 64-year-olds was 9 percent in 2016. This is already a significant rise from about 4 percent 7 years earlier, when the NCHS classified 63,000 deaths as drug-related.
However, that estimate didn't include deaths that aren't related to overdose but can still involve drug use, such as HIV, suicide, and blood vessel damage.
Including these factors, researchers estimate the actual figure is more than double the NCHS figures, at 142,000 people dead due to drug use in 2016.
"These findings should be accentuating the wakeup call that has already been announced year after year, as the drug overdose deaths are revealed by the National Center [for] Health Statistics. The fact is that, apparently, the drug epidemic is twice as serious as indicated by those analyses," Samuel Preston, PhD, professor of sociology at the University of Pennsylvania and one of the study authors, told Healthline.
In 2017, more than 70,000 Americans died from drug overdoses, according to the National Institute on Drug Abuse.
‘Deaths of Despair,’ Infectious Disease, and Heart Disease
According to Preston's findings:
- More than 20,000 men and almost 10,000 women died of circulatory diseases, like heart failure, linked to drug use.
- Nearly 3,000 men and about 1,000 women died of infectious or parasitic diseases, which include HIV and hepatitis, due to drug use.
Also, drugs were the likely cause of death from mental health or behavioral causes, like suicide.
Preston admits he wasn't surprised by the findings.
"I think we believed that there would be residual effects of drug use that were not showing up in overdose deaths, and that's what we found. We didn't know what the multiplier would be exactly, but I think two [double the NCHS number] is not an unreasonable, unexpected outcome," he said.
Reasons Why Unknown
While this study reveals the magnitude of a disturbing trend, researchers say it doesn't establish the reasons why. However, there are two prevailing theories:
- The drug supply has increased with the introduction of prescription opioids like fentanyl and oxycontin as well as nonprescription drugs like heroin.
- Deaths that stem from the misuse of alcohol, other drugs, and suicide may be impacted by depression.
"It's not just about the supply of drugs, but that there's something else behind all of it that causes people to either use drugs or alcohol or commit suicide because they've lost interest in their life," co-study author Dana Glei, senior research investigator at Georgetown University, explained in a statement.
Impact Varies by State
Researchers found the drug epidemic seems to have had little impact on the Plains states like Nebraska, Iowa, Kansas, and the Dakotas.
However, the regions experiencing higher drug death rates are dispersed across the country. They include the Appalachian states, parts of New England, and most of the Southwest, including Utah.
"Among deaths at ages 15–64 in 2016, the drug-associated fraction is highest in West Virginia at 39% for men and 27% for women and lowest in Nebraska," the study authors wrote.
The study also finds that drug use decreases life expectancy after age 15 by 1.4 years for men and by just under 1 year for women, on average.
However, the researchers found the figures are more than twice as high in West Virginia, one of the states hit hardest by the opioid crisis.
Preston points out that Pennsylvania is another state especially affected by the current drug crisis.
The study found that in 2016, Pennsylvania deaths attributable to drugs were 34 percent in males and almost 25 percent in women, between ages 15 and 64 years.
"It's saying something fairly deep about what's going on in this country, isn't it?" Preston concluded.
Not All Experts Agree
"It's an interesting analysis. But my initial reaction is that drug-related is highly complex and vague. There are so many drugs, from prescription to illegal drugs, and drug-related is nebulous," said Eric Feigl-Ding, a health economist, epidemiologist, and nutrition scientist at the Harvard T.H. Chan School of Public Health and an expert adviser to the World Health Organization (WHO).
"It includes not just opioids but also HIV-fighting drugs, chronic disease drugs, and others. Also, this analysis covers so many diseases too. It's hard to interpret, and hard to use to inform the drug crisis," he said.
Feigl-Ding adds it's very tricky to interpret data between states because, as researchers noted in the study's limitations, "the practice of identifying, or capacity to determine, intent for drug poisonings varies across states."
Feigl-Ding also specifies this study is ecologic, and it uses another approximation method that has many assumptions in indirect modeling.
Feigl-Ding clarifies that "ecologic means the analysis is done at the generic state level and not county (better) or individual level (best)."
He emphasizes the study authors used drug deaths as a proxy of other nondrug deaths that are likely drug-related, and that makes the results very difficult to interpret.
"This method is not used at all by major U.S. Burden of Disease expert groups or WHO-supported Global Burden of Disease groups," Feigl-Ding said.
"For example, 'alcohol and drug use' are lumped together, and percent mortality in the U.S. is presented here," he said.
The Bottom Line
As the opioid epidemic continues to affect Americans, recent research finds that official government figures may be underestimating drug deaths by half.
Researchers included drug deaths due to infectious or cardiovascular disease and "deaths of despair," like suicide, in their estimate.
Although deaths due to drug use are increasing nationwide, West Virginia and Pennsylvania are among the states most severely affected.
However, not all experts agree with the research method that was used to produce these findings.
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By 2030, almost a third of all the energy consumed in the European Union must come from renewable sources, according to binding targets agreed in 2018. Sweden is helping lead the way.
Sweden is a world leader in renewable energy consumption. Swedish Institute/World Bank
Naturally Warm<p>54% of Sweden's power comes from renewables, and is helped by its geography. With plenty of moving water and 63% forest cover, it's no surprise the <a href="https://sweden.se/nature/energy-use-in-sweden/#" target="_blank">two largest renewable power sources</a> are hydropower and biomass. And that biomass is helping support a local energy boom.</p><p>Heating is a key use of energy in a cold country like Sweden. In recent decades, as fuel oil taxes have increased, the country's power companies have turned to renewables, like biomass, to fuel local 'district heating' plants.</p><p>In Sweden these trace their <a href="https://www.sciencedirect.com/science/article/pii/S0360544217304140#fig3" target="_blank">origins back to 1948</a>, when a power station's excess heat was first used to heat nearby buildings: steam is <a href="https://www.sciencedirect.com/topics/engineering/district-heating-system" target="_blank">forced along a network of pipes</a> to wherever it's needed. Today, there are around 500 district heating systems across the country, from major cities to small villages, providing heat to homes and businesses.</p><p>District heating used to be fueled mainly from the <a href="https://www.sciencedirect.com/science/article/pii/S0360544217304140" target="_blank">by-products of power plants</a>, waste-to-energy plants and industrial processes. These days, however, Sweden is bringing more renewable sources into the mix. And as a result of competition, this localized form of power is now the country's<a href="https://www.sciencedirect.com/science/article/pii/S0360544217304140#fig3" target="_blank" rel="noopener noreferrer"> home-heating market leader.</a></p>
Sweden is using smart grids to turn buildings into energy producers. Huang et al/Elsevier
Energy ‘Prosumers’<p>But Sweden doesn't stop at village-level heating solutions. Its new breed of energy-generation takes hyper-local to the next level.</p><p>One example is in the city of Ludivika where 1970s flats <a href="https://www.buildup.eu/sites/default/files/content/transforming-a-residential-building-cluster-into-electricity-prosumers-in-sweden.pdf" target="_blank">have recently been retrofitted with the latest smart energy technology</a>.</p><p>48 family apartments spread across 3 buildings have been given photovoltaic solar panels, thermal energy storage and heat pump systems. A micro energy grid connects it all, and helps charge electric cars overnight.</p><p>The result is a cluster of 'prosumer' buildings, producing rather than consuming enough power for 77% of residents' needs. With <a href="http://www.diva-portal.org/smash/get/diva2:1232060/FULLTEXT01.pdf" target="_blank" rel="noopener noreferrer">high levels of smart meter usage</a>, it's a model that looks set to spread across Sweden.</p>
<div id="d7bf9" class="rm-shortcode" data-rm-shortcode-id="8757b138d5570bec9d6aad18074a429a"><blockquote class="twitter-tweet twitter-custom-tweet" data-twitter-tweet-id="1273556364263071744" data-partner="rebelmouse"><div style="margin:1em 0">Read more about Western Harbour and book a visit: https://t.co/ujSmVs9rNK 🏡🌳🌊 https://t.co/C5PuPziqIM</div> — Smart City Sweden (@Smart City Sweden)<a href="https://twitter.com/SmartCitySweden/statuses/1273556364263071744">1592474473.0</a></blockquote></div>
Scaling Up<p>A recent development by E.ON in Hyllie, a district on the outskirts of Malmö, southern Sweden, <a href="https://www.eonenergy.com/blog/2019/February/sweden-smart-city" target="_blank">has scaled up the smart grid principle</a>. Energy generation comes from local wind, solar, biomass and waste sources.</p><p>Smart grids then balance the power, react to the weather, deploying extra power when it's colder or putting excess into battery storage when it's warm. The system is not only more efficient, but bills have fallen.</p><p>Smart energy developments like those in Hyllie, Ludivika, and renewable-driven district heating, offer a radical alternative to the centralized energy systems many countries rely on today.</p><p>The EU's leaders have a challenge: how to generate 32% of energy from renewables by 2030. Sweden offers a vision of how technology and local solutions can turn a goal into a reality.</p>
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