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>
- Opioids Found in Seattle Mussels Could Put Salmon, Other Fish at ... ›
- FDA Failed to Make Sure Opioid Prescriptions Were Safe, Documents Show - EcoWatch ›
The FDA has the ability to place tight restriction on opioid distribution, but it has dragged its feet in doing that. Scharvik / iStock / Getty Images Plus
The U.S. Food and Drug Administration (FDA) failed to use its regulatory power meant to protect consumers to make sure that a program meant to stop improper prescribing of opioids was effective, according to a new study published in JAMA Internal Medicine.
EcoWatch Daily Newsletter
For 21 years, Doug Distaso served his country in the United States Air Force.
He commanded joint aviation, maintenance, and support personnel globally and served as a primary legislative affairs lead for two U.S. Special Operations Command leaders.
But after an Air Force plane accident left him with a traumatic brain injury, post-traumatic stress disorder (PTSD), and chronic pain, Distaso was placed on more than a dozen prescription medications by doctors at the U.S. Department of Veterans Affairs (VA).
- Marijuana Is More Than Just THC: A Look at the Untapped Healing ... ›
- Fireworks Can Trigger PTSD. Here’s How to Be Considerate on July 4th - EcoWatch ›
- Texas' New Medical Marijuana Law Doesn't Cover Veterans ... ›
- As Vets Demand Cannabis for PTSD, Science Races to Unlock Its ... ›
- Medical Marijuana for PTSD? | Psychology Today ›
- Vets face obstacles to using medical marijuana ›
- VA could prescribe medical marijuana to veterans where legal, if bill ... ›
By Amy Jamieson
Indigestion, a bacterial infection, or constipation: Thanks to the marvels of modern medicine, there are widely available medications to combat all of these things.
But when you take these medications, you may be getting more than you bargained for.
- When's the Best Time to Consume Probiotics? - EcoWatch ›
- 8 Surprising Things That Harm Your Gut Bacteria ›
The cocaine trade and efforts to combat it, including the U.S.-led war on drugs, are helping to drive deforestation in Central America, new research shows.
By Brian Bienkowski
When fish swim in waters tainted with antidepressant drugs, they become anxious, anti-social and sometimes even homicidal.
New research has found that the pharmaceuticals, which are frequently showing up in U.S. streams, can alter genes responsible for building fish brains and controlling their behavior.
Antidepressants are the most commonly prescribed medications in the U.S.; about 250 million prescriptions are filled every year. And they also are the highest-documented drugs contaminating waterways, which has experts worried about fish. Traces of the drugs typically get into streams when people excrete them, then sewage treatment plants discharge the effluent.
Exposure to fluoxetine, known by the trade name Prozac, had a bizarre effect on male fathead minnows, according to new, unpublished research by scientists at the University of Wisconsin-Milwaukee.
Male minnows exposed to a small dose of the drug in laboratories ignored females. They spent more time under a tile, so their reproduction decreased and they took more time capturing prey, according to Rebecca Klaper, a professor of freshwater sciences who spoke about her findings at a Society of Environmental Toxicology and Chemistry conference last fall. Klaper said the doses of Prozac added to the fishes’ water were “very low concentrations,” one part per billion, which is found in some wastewater discharged into streams.
When the dose was increased, but still at levels found in some wastewater, females produced fewer eggs and males became aggressive, killing females in some cases, Klaper said at the conference.
The drugs seem to cause these behavioral problems by scrambling how genes in the fish brains are expressed, or turned on and off. The minnows were exposed when they were a couple of months old and still developing.
There appeared to be architectural changes to the young minnows’ brains, Klaper said at the toxicology conference. Growth of the axons, which are long nerve fibers that transmit information to the body, was disrupted.
The new findings build on Klaper’s previous research, which tested minnows with the gene changes to see how well they avoided predators. They swam longer distances and made more directional changes, which suggests that the drugs induced anxiety.
The drugs used in the study were among the most common in sewage: Prozac, Effexor and Tegretol. The researchers tested each drug alone and in combination.
“At high doses we expect brain changes,” Klaper said. “But we saw the gene expression changes and then behavioral changes at doses that we consider environmentally relevant.”
However, there is too little evidence to know whether pharmaceuticals are having any impacts on fish populations in the wild, said Bryan Brooks, an environmental science professor at Baylor University who has extensively studied pharmaceuticals in streams and fish.
Any changes in reproduction, eating and avoiding prey can have devastating impacts for fish populations, Klaper said.
The most vulnerable fish populations are those downstream of sewage treatment plants, where prescription drugs consistently show up in higher levels than in other waterways. It’s only within the past decade that technology has allowed plants to test for the chemicals in their wastewater and in waters downstream, though most still don’t, said Steve Carr, supervisor of the chemistry research group at the Los Angeles County Sanitation Districts.
One of the antidepressants tested in the fish—Tegretol—comes into the treatment plants and goes out at near constant levels, said Eric Nelson, a senior chemist with the Los Angeles County Sanitation Districts.
That means the county’s treatment technology does not seem to have any effect on the drug. It comes in and leaves in a very tight range, about 150 to 400 parts per trillion, Nelson said.
Nelson said the two other drugs tested on the fish—Prozac and Effexor—are discharged in effluent at even lower levels: between about 20 and 30 parts per trillion. In comparison, the levels that altered behavior of the lab fish were 50 times higher.
When monitoring an Iowa and a Colorado stream, the U.S. Geological Survey found most drugs at levels similar to Los Angeles County’s. However, these low levels could still find their way into fish brains, according to their 2010 study.
Researchers found elevated levels of pharmaceuticals in the stream water two to six miles from the sewage treatment plants. But the chemicals at the highest levels in the water were not the ones most prevalent in the fish brains.
“The fish downstream of the wastewater treatment had elevated concentrations of two antidepressants … Zoloft and Prozac,” said Edward Furlong, a research chemist at the U.S. Geological Survey based in Boulder, CO. “And these were relatively low in water compared to others.”
Even if the levels released into streams seem low, they are constant, which is problematic, Brooks said.
“The drugs may not be classically persistent like PCBs [Polychlorinated biphenyl],” Brooks said. “But they’re pseudo-persistent. The [continuous] exposure of organisms in a stream is equivalent to a chemical that is persistent.”
Some drugs bioaccumulate, or build up, in rainbow trout, according to Brooks’ research. Also, rainbow trout exposed to sewage effluent have pharmaceuticals in their blood at levels as high as those that affect the brains of people, according to research in Sweden.
Brooks said the likelihood of bioaccumulation for pharmaceuticals is high. “People have to take these drugs for weeks before they start having effects. They slowly bioaccumulate in your system,” which suggests bioaccumulation potential in fish, too, said Brooks.
Changes to the brain can affect all kinds of things in fish, Klaper said. And since humans have a similar brain gene structure, the findings raise questions about whether traces of these drugs in drinking water might harm human health.
The U.S. Environmental Protection Agency (EPA) considers pharmaceuticals an “emerging concern,” and has concluded that the chemicals may pose risks to wildlife and humans. There are currently no federal regulations of the compounds in waste or drinking water. However, 12 pharmaceuticals are currently on the EPA’s Contaminant Candidate List, which are chemicals that may require regulation under the Safe Drinking Water Act.
Studies have consistently found prescription drugs in drinking water at parts-per-trillion levels. U.S. Geological Survey scientists sampled 74 waterways used for drinking water in 25 states in 2008 and found 53 had one or more of the three dozen pharmaceuticals they were testing for in their water. Forty percent of the pharmaceuticals were found at one or more of the sites.
Fifty-four active pharmaceutical ingredients and 10 metabolites have been detected in treated U.S. drinking water, according to a 2010 EPA review.
But health officials say the levels found in some drinking water are too low to cause harm.
According to a 2012 World Health Organization report, the “trace quantities of pharmaceuticals in drinking water are very unlikely to pose risks to human health.” The report said that the amount found in drinking water is usually 1,000 times lower than doses expected to have an effect on a person.
But Klaper said that in light of the gene changes in fish brains, officials may need to rethink what is considered safe.
“Fish do not metabolize drugs like we do,” Klaper said. “Even if environmental doses aren’t thought to be much for a human, fish could still have significant accumulation, and, it appears, changes in their brain’s gene expression.”
Visit EcoWatch’s BIODIVERSITY page for more related news on this topic.