The opioid crisis in America has in recent years gained public awareness, but it is really only part of what have become known as ‘deaths of despair’ consisting of mainly drug-induced, alcohol-induced, and suicide deaths. The CDC reported 181,686 such deaths in 2018. Compare this to homicides (19,510), motor vehicle accidents (40,231) or ‘legal intervention’ (616). Together, these deaths accounted for a stunning 6.5% of deaths from all causes. The total deaths related to firearms was 39,773 and of those deaths, 60% were suicides.
The causes of deaths of despair are wide ranging and complex, but a number of studies have shown a clear relationship between unemployment and drug related deaths. For example, a recent study by Hollingsworth et al (2017) found that a 1% increase in unemployment rates was associated with a 3.3% increase in drug related deaths. The latest issue of the journal Epidemiology (July 2020) includes a study by Kara Rudolph that studied the relationship between unemployment and drug deaths over the last two decades and found similar results.
The Well Being Trust (www.wellbeingtrust.org) has used some of this research to estimate that an additional 75,000 additional deaths of despair may occur this year because of the stay-at-home orders, and no doubt this will have a continued impact for several years to come. The map below, from their report https://wellbeingtrust.org/wp-content/uploads/2020/05/WBT_Deaths-of-Despair_COVID-19-FINAL-FINAL.pdf shows the expected number of lockdown related deaths by county, with heavy concentrations in the rural west and Appalachia.
One of the responses to the opioid crisis has been the creation of a relatively obscure but important DEA program called ODMAP (Overdose Detection Mapping Application Program) that analyzes emergency calls from participating agencies and identifies emerging hotspots. According to ODMAP, since the first COVID-19 case was reported, suspected overdose incidents in February increased by 18% over last year, a figure that rose to 42% in April.
News reports from around the country are noting dramatic increases in drug overdose deaths in recent weeks. Alcohol-induced deaths have received less media attention, but as the national website for Alcoholics Anonymous notes, almost all meetings of this large and important network of support groups have had to go virtual, and it is unclear at this point what effect the lack of direct interaction will have on relapse rates. It will not come as any surprise if the tally of deaths of despair for 2020 are alarmingly higher than they were for 2019.
For analysts interested in looking at local patterns of incidence, updated and projected demographic data can be invaluable with location decisions related to facilities, staffing, and awareness. Even more, our health care data can be used to compare expected caseloads across a network, using estimated current and projected rates for a range of detailed categories such as –
- Expected hospital discharges for alcohol/drug abuse broken down by those who leave against medical advice, who enter a rehabilitation facility, or who leave without further treatment
- Emergency room visits for alcohol and substance related disorders, and attempted suicide
When we look back at the pandemic years from now, we will need to take into account the increased number of lives lost to despair and weigh this against the number of lives which may or may not have been saved by the intervention in the first place.