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.
Drug Epidemic More Serious Than Previously Thought<p>According to the National Center for Health Statistics (NCHS), the <a href="https://www.cdc.gov/nchs/products/databriefs/db294.htm" target="_blank">reported</a> 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.</p><p>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.</p><p>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.</p><p>"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," <a href="https://sociology.sas.upenn.edu/people/samuel-preston" target="_blank">Samuel Preston</a>, PhD, professor of sociology at the University of Pennsylvania and one of the study authors, told Healthline.</p><p>In 2017, more than <a href="https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates" target="_blank">70,000 Americans</a> died from drug overdoses, according to the National Institute on Drug Abuse.</p>
‘Deaths of Despair,’ Infectious Disease, and Heart Disease<p>According to Preston's findings:</p><ul><li>More than 20,000 men and almost 10,000 women died of circulatory diseases, like heart failure, linked to drug use.</li><li>Nearly 3,000 men and about 1,000 women died of infectious or parasitic diseases, which include HIV and hepatitis, due to drug use.</li></ul><p>Also, drugs were the likely cause of death from mental health or behavioral causes, like suicide.</p><p>Suicide is included with drug and alcohol overdoses as "<a href="https://www.jec.senate.gov/public/index.cfm/republicans/2019/9/long-term-trends-in-deaths-of-despair" target="_blank">deaths of despair</a>," something that affects <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5607702/" target="_blank">rural areas</a> of Middle America in particular.</p><p>Preston admits he wasn't surprised by the findings.</p><p>"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.</p>
Reasons Why Unknown<p>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:</p><ul><li>The drug supply has increased with the introduction of prescription opioids like fentanyl and oxycontin as well as nonprescription drugs like heroin.</li><li>Deaths that stem from the misuse of alcohol, other drugs, and suicide may be impacted by depression.</li></ul><p>"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 <a href="https://www.eurekalert.org/pub_releases/2020-01/uop-del011420.php" target="_blank">statement</a>.</p>
Impact Varies by State<p>Researchers found the drug epidemic seems to have had little impact on the Plains states like Nebraska, Iowa, Kansas, and the Dakotas.</p><p>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.</p><p>"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 <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0226732" target="_blank">wrote</a>.</p><p>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.</p><p>However, the researchers found the figures are more than twice as high in West Virginia, one of the states hit hardest by the <a href="https://www.ecowatch.com/tag/opioids" rel="noopener noreferrer">opioid</a> crisis.</p><p>Preston points out that Pennsylvania is another state especially affected by the current drug crisis.</p><p>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.</p><p>"It's saying something fairly deep about what's going on in this country, isn't it?" Preston concluded.</p>
Not All Experts Agree<p>"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 <a href="https://scholar.harvard.edu/ericding/home" target="_blank">Eric Feigl-Ding</a>, 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).</p><p>"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.</p><p>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."</p><p>Feigl-Ding also specifies this study is ecologic, and it uses another approximation method that has many assumptions in indirect modeling.</p><p>Feigl-Ding clarifies that "ecologic means the analysis is done at the generic state level and not county (better) or individual level (best)."</p><p>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.</p><p>"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.</p><p>"For example, 'alcohol and drug use' are lumped together, and percent mortality in the U.S. is presented here," he said.</p>
The Bottom Line<p>As the opioid epidemic continues to affect Americans, recent research finds that official government figures may be underestimating drug deaths by half.</p><p>Researchers included drug deaths due to infectious or cardiovascular disease and "deaths of despair," like suicide, in their estimate.</p><p>Although deaths due to drug use are increasing nationwide, West Virginia and Pennsylvania are among the states most severely affected.</p><p>However, not all experts agree with the research method that was used to produce these findings.</p>
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EcoWatch Daily Newsletter
By Roz Plater
It's 2020 and another year of health-related topics awaits us.
Medicare<p>Medicare is front and center as we kick off 2020.</p><p>That's in part because "<a href="https://www.healthline.com/health/what-medicare-for-all-would-look-like-in-america" target="_blank">Medicare for All</a>" is the single payer option health plan being touted by two of the top Democratic presidential candidates.</p><p><a href="https://www.forrester.com/Jeff-Becker" target="_blank">Jeff Becker</a>, the senior analyst for healthcare strategy at Forrester Research says there are also a number of bills in Congress looking to expand access to Medicare as a public option.</p><p>"When you look at the polling numbers, our call is that Medicare for All will die in the court of public opinion and become Medicare Advantage for more," Becker told Healthline.</p>
Affordable Care Act<p>The <a href="https://www.healthline.com/health/consumer-healthcare-guide/pros-and-cons-obamacare" target="_blank">Affordable Care Act (ACA)</a>, often referred to as Obamacare, will be in the courts again this year.</p><p>In December, a federal appeals court <a href="https://www.cnbc.com/2019/12/18/-.html" target="_blank">ruled</a> that the health insurance law's individual mandate provision was unconstitutional.</p><p>However, the justices sent back to a federal district court in Texas the issue of whether other parts of the law could continue to exist without the mandate that requires everyone to have health insurance.</p><p>Look for some sort of Obamacare case to wind up in the U.S. Supreme Court this year.</p><p>"Our call is whether or not it goes to the Supreme Court, the ACA will survive because the individual mandate is severable," Becker told Healthline.</p>
Price Transparency<p>Experts say you'll hear a lot of debate about price transparency, a move designed to increase competition and lower costs.</p><p>President Trump <a href="https://www.hhs.gov/about/news/2019/11/15/trump-administration-announces-historic-price-transparency-and-lower-healthcare-costs-for-all-americans.html?amp" target="_blank">signed an executive order</a> in November that requires hospitals and insurers to publish their confidential, negotiated rates for treatments.</p><p>"The reason this would be important is you'd be able to figure out what your out-of-pocket expenses would be" said Becker.</p><p>But a coalition of hospital groups has <a href="https://www.reuters.com/article/us-us-hospitals/hospital-groups-file-lawsuit-to-block-trumps-price-transparency-rule-idUSKBN1Y81YY" target="_blank">filed a lawsuit</a> to block the rule. They argue that the public disclosure of negotiated charges would create confusion about consumers' out-of-pocket costs.</p><p>The order is scheduled to go into effect January 1, 2021.</p>
Lower Prescription Drug Prices<p>"The thing about pharmaceuticals is, if you can't afford them, they don't work," Mosley said.</p><p>He predicts the move to lower the costs of prescription drugs will again be on the front burner of the healthcare debate in 2020.</p><p>"The problem is Medicare and Medicaid can't negotiate prices with these drug companies," Mosley told Healthline.</p><p>The House of Representatives has <a href="https://www.aarp.org/politics-society/advocacy/info-2019/house-passes-drug-price-bill.html" target="_blank">approved a bill</a> that would do just that. The legislation also caps out-of-pocket expenses for people enrolled in Medicare Part D.</p><p>However, the prognosis for this bill becoming law isn't good.</p><p>Political observers say the legislation won't go anywhere in the Senate, and the White House has indicated the president would veto it.</p><p>Republicans in the Senate have <a href="https://www.usatoday.com/story/news/health/2019/11/11/mcconnell-pelosi-clash-over-drug-price-bill-congress-act/2558426001/" target="_blank">crafted</a> their own prescription drug price plan. The president has indicated he would sign this bill, but it would need to be approved by the Democrat-controlled House.</p>
Access to Health Services<p>"One of the cross-cutting issues we see as a priority in 2020 is the social determinants in health disparities in our patients," said <a href="https://www.aafp.org/media-center/releases-statements/all/2013/amy-mullins-medical-director.html" target="_blank">Amy Mullins</a>, MD, FAAFP, medical director for quality improvement for the American Academy of Family Physicians.</p><p>"Patients need more than just access to a physician," she told Healthline. "They need access to good food, safe places to live, to exercise, transportation, community resources, access to medication."</p><p>"If you don't address those, it's really difficult to treat your patients effectively," she added.</p><p>Mullins says her group has an internal division called the Center for Diversity and Health Equity whose mission is to look at healthcare through that lens.</p>
Vaccine Hesitancy<p>Mullins also says the issue of vaccine myths is one you'll continue to hear about in 2020.</p><p>"We want to do more to counter the misinformation that's out there around vaccines that may be holding some people back from getting what they need," said Mullins.</p><p>A <a href="https://www.sciencedirect.com/science/article/pii/S0264410X1931446X?via%3Dihub" target="_blank">recent study</a> concluded that a lot of the false information is being spread on social media by a handful of anti-vaccine ad buyers.</p><p>"We're promoting vaccine education to physicians, their healthcare teams, patients, and communities" Mullins said.</p><p>A <a href="https://www.healthaffairs.org/do/10.1377/hblog20191212.484779/full/" target="_blank">2020 National Vaccine Plan</a> is currently being developed by the Department of Health and Human Services' Office of Infectious Disease and HIV/AIDS Policy.</p>
Vaping<p>"Another of the big priorities for health providers in 2020 is vaping and e-cigarettes," Mullins said.</p><p>"We really applaud and support the work the Centers for Disease Control and Prevention and the Food and Drug Administration is doing to try and get a handle on this crisis," she said. "But these products target adolescents and we think the marketing needs more regulation."</p><p>A <a href="https://www.drugabuse.gov/news-events/news-releases/2019/12/vaping-marijuana-rise-among-teens" target="_blank">study</a> released last month from the National Institute on Drug Abuse reported that more teens are vaping marijuana.</p><p>That's despite a lung illness linked to vaping that's killed <a href="https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html" target="_blank">more than 50 people</a> nationwide.</p>
Virtual Care Visits<p>On the digital front, Becker predicts there will be aggressive growth in virtual care visits.</p><p>That's where you interact with your doctor via text, video, or phone call.</p><p>Becker's group crunched the numbers after looking at outpatient visit data as well as talking to virtual vendors and tracking healthcare investments.</p><p>"The result was 36 million net new virtual care visits in 2020," he said.</p><p>He points to how employers and insurers are already embracing the concept. Amazon recently launched a pilot program called "<a href="https://www.cnbc.com/amp/2019/09/24/amazon-launches-employee-health-clinic-amazon-care.html" target="_blank">Amazon Care</a>," a virtual clinic for its employees in Seattle.</p><p>Walmart recently expanded its <a href="https://mhealthintelligence.com/news/walmart-expands-telehealth-services-for-employees-in-3-states" target="_blank">telehealth services</a> to workers in Colorado, Minnesota, and Wisconsin with $4 online or video care visits.</p><p>Humana has <a href="https://medcitynews.com/2019/04/humana-and-doctor-on-demand-launch-new-virtual-primary-care-health-plan/" target="_blank">teamed up</a> with "Doctor on Demand" to offer a virtual primary care plan at significantly lower monthly premiums.</p><p>"Everybody is moving toward a model where we're not using high-cost care centers like emergency rooms," Becker said.</p><p>"And consumers are demanding more cost effective services, too," he added. "In 2018, consumers took out <a href="http://nymag.com/intelligencer/2019/04/americans-borrowed-usd88-billion-for-health-expenses-in-2018.html" target="_blank">$88 billion</a> in personal loans just to pay for out-of-pocket medical costs."</p>
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In 1991, the Bay Area Air Quality Management District launched a Spare the Air program to keep residents in the San Francisco Bay Area informed of high ozone-level days, when air is smoggy and exposure to poor air quality poses health risks. Now, the air district might need to update its alert system for something other than just ozone: antibiotic-resistant genes (ARGs).
It's no surprise that chemicals can get flushed into our water supply from the pills we take. But as the world's population grows, the rampant consumption of pharmaceuticals has become an emerging threat to the world's freshwater ecosystems, researchers said.
The research, presented at the European Geosciences Union General Assembly on Tuesday, warns that if no action is taken to mitigate the flow, the amount of drug waste entering waterways such as rivers and lakes could increase by 65 percent by 2050, endangering fish and other species' health.
By Madlen Davies and Sam Loewenberg
Many of the world's leading drug manufacturers may be leaking antibiotics from their factories into the environment, according to a new report from a drug industry watchdog. This risks creating more superbugs.
The report surveyed household-name pharmaceutical giants like GSK, Novartis and Roche as well as generic companies which make non-branded products for the NHS and other health systems.
By Martha Rosenberg
Recently, Organic Consumers Association, along with Friends of the Earth and Center for Food Safety filed suit against chicken giant Sanderson Farms for falsely marketing its products as "100% Natural" even though they contain many unnatural and even prohibited substances.
Specifically, Sanderson chicken products tested positive for the antibiotic chloramphenical, banned in food animals, and amoxicillin, not approved for use in poultry production. Sanderson Farms products also tested positive for residues of steroids, hormones, anti-inflammatory drugs—even ketamine, a drug with hallucinogenic effects.
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Industrial pollution from Indian pharmaceutical companies making medicines for nearly all the world's major drug companies is fueling the creation of deadly superbugs, suggests new research. Global health authorities have no regulations in place to stop this happening.