[A baby born in the U.S. in 2021 has a life expectancy at the
lowest level since 1996. Native Americans, Black people and Hispanics
are hardest hit. “Our increasingly potent and deadly drug supply is
a result of the war on drugs.”]
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U.S. LIFE EXPECTANCY FALLS FOR SECOND STRAIGHT YEAR AS DRUG OVERDOSE
AND COVID DEATHS TAKE TOLL  
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Ambar Castillo
December 22, 2022
Stat News
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_ A baby born in the U.S. in 2021 has a life expectancy at the lowest
level since 1996. Native Americans, Black people and Hispanics are
hardest hit. “Our increasingly potent and deadly drug supply is a
result of the war on drugs.” _

Multi-jurisdictional investigation results in major fentanyl seizure
, by BC Gov Photos (CC BY-NC-ND 2.0)

 

Life expectancy for Americans fell for the second straight year in
2021, largely driven by increases in deaths from Covid-19 and drug
overdoses, according to new data
[[link removed]] from
the Centers for Disease Control and Prevention.

A baby born in the U.S. in 2021 has a life expectancy of 76.4 years,
down from 77 years in 2020 and the lowest level the CDC has recorded
since 1996. The age-adjusted death rate for Covid rose by 22.5%
between 2020 and 2021, while death rates from unintentional injuries
— one-third of which come from overdoses — rose by 12.3%.

Before Covid, life expectancy in the U.S. had gradually increased for
decades, said Kenneth Kochanek, a statistician in the CDC’s National
Center for Health Statistics (NCHS) and a co-author of the new report.
“Then this one disease comes along and just wipes everything out.
… I’ve never seen anything with this much of an impact in a short
period of time.”

Age-adjusted death rates for drug overdose rose by about 14% from 2020
to 2021. The rates spiked significantly in all groups aged 25 and
over. The largest percentage increase, 28%, occurred in adults aged 65
and older.

Broken down by racial demographics, non-Hispanic American Indian or
Alaska Native people had the highest drug overdose death rates in both
2020 and 2021. Non-Hispanic Black people had the second-highest rates
for both years. Also striking was the 47% increase in overdose death
rates among Native Hawaiian or other Pacific Islanders between 2020
and 2021.

One of the major reasons for the overall surge in overdose deaths is
the spike in access to fentanyl
[[link removed]] —
which is much more potent, addictive, and cheaper than other opioids
— coupled with scarce access to treatment, said Noa Krawczyk, a
substance use epidemiologist at NYU Langone’s Center for Opioid
Epidemiology and Policy.

On Tuesday, the Drug Enforcement Administration said
[[link removed]] it
had seized over 379 million potentially lethal doses of illegal
fentanyl this year alone. Fentanyl is also making it more difficult
[[link removed]] for
people to start addiction treatment because it causes intense
withdrawal symptoms for people on buprenorphine — a key drug for
treating opioid use disorder.

Fentanyl is also flooding the illicit drug supply
[[link removed]],
which means that people may use drugs like cocaine without being aware
that it’s been laced with fentanyl, said Monica Ruiz, associate
professor of prevention and community health at George Washington
University. “They don’t worry about needing Narcan because
that’s for opioid overdose,” she said, referring to the lifesaving
antidote.

Related: Addiction treatment got easier during Covid. A new proposal
would keep it that way
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While the rate of deaths involving synthetic opioids like fentanyl
climbed 22% between 2020 and 2021, the rate of deaths involving heroin
declined by 32% in the same period.

Heroin is “being replaced with fentanyl … because that’s all
[people] can get,” Shoshana Aronowitz, an assistant professor of
family and community health at the University of Pennsylvania School
of Nursing, told STAT via email. “As heroin is less potent …
we’d be seeing less overdose deaths if more folks were using heroin
rather than fentanyl.”

On Dec. 13, federal regulators moved to increase access to addiction
treatments,
[[link removed]] proposing
a measure that would make pandemic-era emergency policies that expand
access to buprenorphine and another medication, methadone
[[link removed]],
permanent.

Still, Krawczyk is frustrated that more sweeping governmental action
is “moving at a snail’s pace, … despite knowing a lot of
strategies that are effective.” Meanwhile, “deaths are continuing
to go up.”

Related: Under new rules, methadone clinics can offer more take-home
doses. Will they?
[[link removed]]

She sees prospects for broader change in bills such as the Opioid
Treatment Access Act of 2022
[[link removed]],
which would make methadone more available, and the Mainstreaming
Addiction Treatment Act (MAT) of 2021
[[link removed]]. MAT
would rev up buprenorphine’s availability by scrapping special
waiver requirements for physicians to dispense the narcotic. Currently
these waivers are more prevalent in whiter, less diverse communities
[[link removed]]. Methadone,
which is a much more controlled substance and therefore generally
harder to access, is more commonly prescribed in largely Black and
brown communities.

That’s just the tip of the iceberg when it comes to disparities
affecting overdose deaths.

“I’m talking about everything from families being forced to live
in dangerous neighborhoods where drugs are more readily available
because economic disparities won’t allow them to move to safer
places to inadequate access to culturally sensitive and culturally
competent addiction treatment services,” Ruiz told STAT. She also
cited the need for trauma-informed mental health care to target the
root causes of substance use.

The decades-long U.S. “war on drugs
[[link removed]],”
which disproportionately targeted Black and brown people, still
plagues these communities’ collective memory. Fear of the criminal
justice system prevents many people of color from coming forward to
seek substance use treatment, said Lori Freeman, chief executive
officer for the National Association of County and City Health
Officials.

Research also backs up the “Iron Law of Prohibition
[[link removed]],”
which explains how “our increasingly potent and deadly drug supply
is a result of the war on drugs,” said Aronowitz.

Related: Congress has its sights set too low on addiction, advocates
charge
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The collective pain and discrimination experienced by marginalized
communities also plays a role in addiction. To Freeman, it’s not
surprising that American Indians — a group that’s been stigmatized
for hundreds of years and whose land and livelihoods were seized by
the U.S. government, setting off a chain of disparities — had the
highest overdose death rates in the past two years. People who
experience this kind of intergenerational trauma may be more likely to
turn to addictive substances as a means to ease their suffering, she
said.

Across the board, the pandemic has also exacerbated many Americans’
mental health issues, chronic physical pain, and socioeconomic
problems, worsening rates of substance use and overdose deaths.

“I feel like we’re at the breaking point, unless we do
something,” Freeman said. “This is such a catastrophic loss of
life that we’re seeing … across all spans of populations.”

_This story has been updated._

_Ambar Castillo [[link removed]] is a
2022-2023 Sharon Begley Science Reporting Fellow at
STAT. [email protected]
[[link removed]]_

 

* health
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* war on drugs
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* COVID-19
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* racial inequality
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