Young white adults dying at rates not seen since peak of AIDS crisis

Rates rising faster in rural areas

A rise in drug overdoses is driving up the death rate of young, white, U.S. adults to levels not seen since the worst years of the AIDS epidemic 20 years ago, Gina Kolata and Sarah Cohen report for the New York Times.

The Times examined about 60 million death certificates collected by CDC between 1990 and 2014.

During that time, the death rates for blacks and most Hispanic groups fell, driven in part by medical advances that have reduced mortality for common conditions, such as heart disease.

But drug overdoses—both from prescription and illegal drugs— and suicides appear to have "erased" the benefits of those medical advances for most age groups of whites, Kolata and Cohen write. Between 1999 and 2014, the overdose death rate for whites ages 25 to 34 rose fivefold, while the rate for 35- to 44-year-old whites tripled. Suicide rates also increased for both age groups during that time.              

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Who is at risk

The rate of overdoses is accelerating overall, from nine deaths per 100,000 people in 2003 to 15 deaths per 100,000 in 2014. Jonathan Skinner, a Dartmouth University economist, likens it to a disease. "It is like an infection model, diffusing out and catching more and more people," he says.

But unlike many other public health trends, blacks and Hispanics have been largely protected from the negative effects of the opioid epidemic. Andrew Kolodny, a senior scientist at the Heller School for Social Policy and Management at Brandeis University, attributes the difference to doctors being less likely to prescribe painkillers to minorities.

"Racial stereotypes are protecting [minorities] from the addiction epidemic," he says. And a result, Skinner says, is that the gap in mortality between young whites and blacks is the smallest it has been in more than a century.

Other researchers tell the Times they are unsure why whites in particular are seeing heightened levels of opioid misuse. Some attribute the trend to a subset of white Americans being increasingly isolated from society and the economy, making them more likely to misuse prescription drugs.

The hardest-hit communities

According to new county-level estimates released by CDC, nearly every county in the United States has experienced an increase in deaths from drug overdoses in recent years, Haeyoun Park and Matthew Bloch write in a separate report for the Times.

CDC Chief of Mortality Statistics Robert Anderson says the nationwide death rate from overdoses is similar to the peak of HIV deaths in 1995. While HIV was a more prevalent issue in urban areas, death rates from overdoses are prevalent in both rural and urban areas.

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Some of the hardest hit areas of the country say they need more resources to combat the opioid epidemic.

West Virginia has one of the highest rates of opioid overdoses in the country. Carl Sullivan, the director of addiction services at West Virginia University School of Medicine, says that many of the state's blue-collar workers were initially prescribed painkillers to treat injuries, but new laws designed to crack down on the misuse of prescription painkillers drove some to use heroin.

Today, the state doesn't have the resources to treat everyone who is struggling with substance misuse, Sullivan explains. "We've had this uptick in overdose deaths despite enormous public interest in this whole issue" (Park/Bloch, New York Times, 1/19; Cohen/Kolata, New York Times, 1/16).

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