From 1980 to 2014, 2.84 million Americans died of alcohol, drugs, suicide, domestic violence or abuse, according to a study published Tuesday in the medical journal JAMA. Perhaps most alarming, drug deaths increased by more than 600 percent in this time period.
More than half a million people lost their lives to “drug use disorders” in this period, the study says. Although the rates of death varied widely, with increases between 8.2 percent and 8,369.7 percent, drug deaths were up in nearly every single county in the United States.
Boone County, West Virginia was the county with the largest increase, 8369.7 percent, in deaths due to drug overdose followed by Wyoming County, West Virginia which saw a rise of 6973.1 percent. In addition to West Virginia, many of the regions that saw the biggest jumps are familiar from stories about the nation’s raging opioid epidemic. Counties in Kentucky, Ohio, Indiana and eastern Oklahoma saw the greatest increases in drug deaths: more than a 5,000 percent increase.
“This study is the first to consider alcohol and drug use disorders, apart from other types of unintentional poisonings and distinct from intentional overdoses, at the county level in the United States,” the researchers explained in the study.
“It is important to show the local burden of these diseases so health officials and others can better plan programs and interventions in their own communities,” said study co-author Ali Mokdad, a professor of global health at the Institute for Health Metrics and Evaluation at the University of Washington.
The researchers created small-area estimation models to help interpret death records from the National Center for Health Statistics and population data from the center, the US Census Bureau and the Human Mortality Database to estimate the county-level mortaility rates.
In this time period, more than 1.28 million Americans died of self-harm. Most counties nationwide also saw increases in the suicide rate, with those in the West seeing the most, but deaths overall decreased 6 percent.
Nationally, there were 256,432 deaths from alcohol-use disorders during this time period, a decrease of 8.1 percent. The National Institutes of Health defines those disorders as “a chronic relapsing brain disease characterized by compulsive alcohol use, loss of control over alcohol intake, and a negative emotional state when not using.”
There were some counties with higher than average increases of deaths in Wisconsin, South and North Dakota, Montana, Nebraska, New Mexico, Arizona, Utah and Alaska. Alcohol deaths were down in counties in South Carolina, North Carolina, Virginia, Florida and Georgia.
Although more than 760,749 people died between 1980 and 2014 due to interpersonal violence, meaning domestic violence or abuse, those deaths decreased nationally by 34.6 percent between 1980 and 2000. Between 2000 and 2014, the country saw an overall decrease of 44.9 percent. At the county level, the Midwest and Atlantic states still had problem areas, especially along the southern half of the Mississippi River and in Alabama.
“This is a really important paper because it debunks a popular argument,” said Dr. Andrew Kolodny, executive director of Physicians for Responsible Opioid Prescribing, who was not involved in the study.
That argument, he said, is that deaths from drugs are not unique and are “deaths of despair” rather than deaths of addiction. This would mean opioids aren’t to blame for the soaring death rates; rather, it’s the shrinking middle class and downward economic mobility that is killing people.
“If this was a ‘deaths of despair’ phenomenon, you would likely see alcohol deaths and suicides and all these factors rising together in the same areas,” Kolodny said. “But this paper debunks that. There are geographic differences, and the rates of deaths didn’t all go up together.”
Alcohol-related deaths, for instance, are down in Appalachia, where the study found the biggest increases in drug deaths, he said. “This paper shows that opioids are really part of the overall problem,” Kolodny said. “People are drugging themselves to death because this is an epidemic of addiction.”
In October, President Donald Trump declared the opioid crisis a public health emergency. He vowed that “we can be the generation that ends the opioid epidemic.”
His Commission on Combating Drug Addiction issued a report in the fall that offered more than 50 suggestions on how to end the crisis, including expanding treatment, increasing drug courts and doctor education about prescribing addictive pain pills.
Critics called out the commission for doing nothing. Among commission member and Democratic Rep. Patrick Kennedy, who said that the Republican-led Congress had turned the work of the commission into a “charade” and a “sham,” in part because there was no new funding made available when these recommendations were made.
In February, an additional $6 billion was added to the budget deal to fight the crisis, but treatment advocates voiced concerns that it isn’t enough and won’t be spent wisely. County-level data like these may help lawmakers better target problem areas, experts say.
“In our previous work, we showed that many factors drive health outcomes such as access to and quality of health care, risk factors and socioeconomic factors,” Mokdad said. “Understanding the drivers of drug use from education, income or mental factors is crucial to best develop and implement programs or policies to address the epidemic. Our data provides such an opportunity for our country to do so.”
Trump shared some of his ideas for combating the epidemic this month during a meeting to discuss the opioid epidemic, talking about the “drug dealers and drug pushers” who are “really doing damage.”
“Some countries have a very, very tough penalty. The ultimate penalty. And by the way, they have much less of a drug problem than we do. So we’re going to have to be very strong on penalties,” Trump said.