Impact of growing opioid crisis on life expectancy in the United States is more evidence that neoliberal austerity kills

Posted on January 04, 2018, 1:13 am
8 mins

PHOTOS: This scene is in Paris. It could be anywhere in our “globalized,” that is, neoliberalized world. (Photo: Eric Poulhier, Wikimedia Commons.) Below: Rundown but dignified Havana, high-profile U.S. economist Paul Krugman (Photo: Flickr, Commonwealth Club) and political economist Alan Nasser (Photo: Evergreen State College).

Will Mexico eventually decide it wants to pay to build that wall after all?

Don’t laugh, new life expectancy numbers from the United States and related trends there suggest there are things no sane society would want to import from that country, whether or not it possesses the world’s largest economy.

Notwithstanding the deficiencies of the Cuban political system, the benefits of the island nation’s emphasis on heath care are well understood. But you have to wonder if the U.S. economic embargo of Cuba – which is a kind of wall, after all – helped too. After all, while the embargo has certainly kept out badly needed medicines, it also stopped the most pernicious neoliberal economic ideas.

Remember that for years infant mortality rates in Cuba have been better than those in the United States, which is a great credit to the beleaguered Cubans, of course, but a national disgrace for the supposed economic superpower next door to them and to us.

The number of infants that die each year in the still-Communist Caribbean nation has been comparable to the rate of Canadian infant deaths for years and well ahead of the United States – 4.4 per 1,000 births versus 4.5 here and 5.3 in the U.S. according to the latest estimates from the CIA World Factbook.

Race, class and poverty, obviously, play significant a role in the United States, where the infant mortality rate for African Americans (10.8) was more than twice that of whites (5.1) in 2015.

At the tail end of 2017, meanwhile, news media reported in astonished tones that skyrocketing overdose deaths had caused the average life expectancy of United States citizens to drop in 2016 for the second time in as many years.

A two-year drop like this hasn’t happened in the United States since 1962 and 1963, the BBC reported, and before that since the 1920s. The only other year in that general time frame the average U.S. life expectancy fell was 1993, during the AIDS epidemic.

The nearly 64,000 U.S. overdose deaths last year – about two thirds caused by opioids like fentanyl, the Associated Press reported – are known to have continued soaring through 2017. That means the U.S. is almost certainly in line for a third drop in average life expectancy when 2017’s numbers are calculated at the end of this year.

If there is a third drop reported for 2017, that will be the first such three-year decrease in average U.S. life expectancy since the Spanish Flu epidemic of 1917, the BBC noted. For people who watch such trends, that’s a deeply shocking development.

The just released 2016 figures had the effect of reducing the average life a baby born in the United States could be expected to live to 78 years and seven months, down from 78 years and eight months in 2015, and 78 years plus nine months in 2014.

According to slightly different calculations from the World Health Organization and the CIA, for 2015, the United States and Cuba, the world’s richest economy and the victim of its half-century blockade, were basically tied for average life expectancy.

Average life expectancy in Canada is a little over 82 years and in Japan, which has the world’s longest, the average is closing in on 84 years. Mexico still lags the United States – at different points between 76 and 77 years, depending on who’s doing the measuring.

Again, there are big regional – and, of course, class – differences in the United States.

Average life expectancy in half of all U.S. states and the District of Columbia is worse than in Cuba – with Mississippi trailing them all at 75 years in 2014. And that was before the opioid crisis really hit its stride.

It’s dangerous to reach profound conclusions about statistical trend stories, especially when you are sometimes forced to compare figures from different years and databases. But then, news analysis needs to be done quickly and, as they say, you don’t have to be a weatherman to know which way the wind is blowing.

It’s obviously reasonable to speculate that growing economic inequality south of the U.S.-Canadian border was having an impact on American life expectancy rates even before the opioid crisis got as bad as it is now – and it’s far from clear that our American neighbours have hit bottom, or that we Canadians have either.

Obvious too is that the impact of drug use on the U.S. population is also related to the despair that stems from the vast economic inequality in that country, as well as the lack of funds for treatment and mitigation programs – which would explain why the worst rates are found in the poorest and most southern states.

As political economist Alan Nasser bluntly put it just before Christmas at Counterpunch.org: “Neoliberal austerity kills.”

“There is decisive evidence that neoliberalism’s widening inequality tends to generate uncommon rates of physical and mental health disorders,” Dr. Nasser asserted, before moving directly to the question of life expectancy. “Disease is not the issue. The predominant causes of death are suicide, chronic alcohol abuse and drug overdoses.”

The more austerity is practiced in a country, he observed, “the more people became ill, and the more people died.”

Or as Paul Krugman, the Nobel Prize winning economist and New York Times economics columnist wrote in 2015, before the North American opioid crisis was in full swing, “the closest parallel to America’s rising death rates – driven by poisonings, suicide, and chronic liver diseases – is the collapse in Russian life expectancy after the fall of Communism.”

Dr. Krugman went on: “What the data look like is a society gripped by despair, with a surge of unhealthy behaviors and an epidemic of drugs, very much including alcohol.”

Since neoliberal politicians and agitators in Canada slavishly advocate and if possible follow the worst U.S. ideas, over time we can expect to see the same trends here.

So what’s the response of the Canadian neoliberal media to these frightening trends of the border? But of course! They deny neoliberalism is a thing.

11 Comments to: Impact of growing opioid crisis on life expectancy in the United States is more evidence that neoliberal austerity kills

  1. William Prettie

    January 4th, 2018

    Percy Bysshe Shelly,

    “Rise like Lions after slumber
    In unvanquishable number-
    Shake your chains to earth like
    dew
    Which in sleep had fallen on you
    Ye are many-they are few.”

    Once again, It is time.

    Reply
    • David Climenhaga

      January 4th, 2018

      More from PBS:

      An old, mad, blind, despised, and dying King;
      Princes, the dregs of their dull race, who flow
      Through public scorn,—mud from a muddy spring;
      Rulers who neither see nor feel nor know,
      But leechlike to their fainting country cling
      Till they drop, blind in blood, without a blow.
      A people starved and stabbed in th’ untilled field;
      An army, whom liberticide and prey
      Makes as a two-edged sword to all who wield;
      Golden and sanguine laws which tempt and slay;
      Religion Christless, Godless—a book sealed;
      A senate, Time’s worst statute, unrepealed—
      Are graves from which a glorious Phantom may
      Burst, to illumine our tempestuous day.

      Sound familiar? DJC

      Reply
      • Pogo

        January 4th, 2018

        Now, take from those quotes. Take what the people of Alberta need and light them on fire and shove them up the darkest corner of the Kenney! If he’s half the astute and capable politician everyone says he is? He’ll hit back. Depend on it! PS: I love it when a grey beard gets feisty!

        Reply
  2. Jerrymacgp

    January 4th, 2018

    The underlying issue is that neoliberals do not believe in such lefty ideas as social determinants of health. Their libertarian orientation and arguments about “individual responsibility” mean that they think obesity and other chronic diseases, poverty and addictions are completely caused by poor life choices. They reject many public health measures as “social engineering” and assail the “nanny state”, although they seem to accept, without a hint of irony, heavy-handed government restrictions on what recreational substances competent adults can freely and autonomously ingest. There is really no convincing these people, since they reject the assertion first articulated by John Donne, that “no man is an island”.

    Reply
    • Expat Albertan

      January 4th, 2018

      Also, don’t forget that libertarians are not adverse to government handouts when in suits them…as the 2008 Wall Street meltdown showed us. They remind me of teenagers who want their parents to stay out of their lives, but still live under mom and dad’s roof and eat their food.

      Reply
  3. David

    January 4th, 2018

    Someone once said “don’t bet against the US” so I think their decline is more temporary than permanent. However, that country right now (and the world) is too distracted by the antics of Trump to focus on solving real serious problems such as this. It is ironic that some of the places noted like Mississippi, are the ones most supporting the Republican led neo liberal approach. Parts of the country where the economy is moving ahead the most, like California and New York seem to have much more progressive ideas.

    In any event, the divisions between the haves and the have nots in the US certainly seem to be widening, I think soon to a point that will no longer be sustainable. I think after the Trump era ends, however that happens, there is going to be a dramatic change in US politics that will have to address the problems of economic and social inequality.

    Reply
    • Jim

      January 7th, 2018

      By what measure are the economies of California and New York moving ahead? California seems to be running out of water making producing actual things needed more difficult. New York is largely Wall Street which seems more of a drain on things.

      You did touch on an important point however, the distractions of Trump, ignore the distractions and Twitter and look at what he is actually doing. Have a look at his executive order on December 21st, interesting read.

      Reply
  4. Expat Albertan

    January 4th, 2018

    I was surprised at that Doug Saunders piece in the Globe and Mail…he’s usually much more astute about world affairs.

    Reply
  5. Scotty on Denman

    January 4th, 2018

    Of course the illegally-made fentanyl overdose crisis among users of illicit street drugs has affected Canada, too, and though considerable effort has been taken to conflate it with the American phenomenon in order to rationalize ‘crackdowns’ on opioid prescription by provincial physicians’ colleges, the two nations remain discernibly distinct in this respect, and I agree it has much to do with the difference in provision of medical services between Canada’s public healthcare model, founded on socialist principles, and the USA, founded on Neo-Right ideals: the illegally-made fentanyl crisis in Canada isn’t nearly as bad as in the States, the connection between addiction to street opioids and opioid prescription is statistically insignificant here whereas overprescription and illegal diversion of prescriptions and manufacturers’ wholesales appear endemically entrenched int he USA, and best remedial options such as prescribing clean heroin (or equivalent) to street addicts are more likely to be deployed in Canada.

    Opioid overprescription only ever happened in Canada because of the OxyContin fiasco when doctors really did overprescribe the newly licenced opioid on the maker’s claim it was less addictive than other opioids; the claim proved false within four years of OxyContin’s introduction over two decades ago. Purdue Pharma, the maker, has since paid almost a billion dollars in fines and class-action suits. Hundreds of thousands of unwitting patients became addicts because of Purdue’s lie.

    Purdue is currently being sued by a number of American state governments which claim the company knew significant amounts of wholesale OxyContin were being shipped to illegitimate retail pharmacy fronts for criminal organizations that thence peddle the pills on the illicit street market. There is no evidence these crimes also happen in Canada, and considerable reason why they don’t, most prominently our socialized healthcare system which affords better invigilation as well as better, more inclusive medical services. Chronic pain sufferers who cannot afford medical care in the USA are at risk of resorting to, and self-medicating with, street drugs—and with no one to monitor their health, either.

    Canadian physicians’ colleges cited significant diversion of prescribed opioids to premise arbitrary crackdowns on prescription for treatment of non-terminal-cancer pain, however, closer scrutiny of illicit drugs since the overdose crisis hit quickly revealed that virtually all opioids sold on western Canadian streets that look like manufactured prescription opioids are actually counterfeits laced with illegally-made fentanyl (also laced into a variety of ostensibly non-opioid illicit drugs like cocaine and ecstasy). The colleges have attempted to defend their weakened premise by presenting individuals to testify anecdotally that they used street-drugs only after they’d first become addicted to prescribed opioids; yet, aside from the fact that the typical tale of getting addicted to Tylenol-3 prescribed for a ‘sports injury’ leading directly to shooting-up street opioids is highly unlikely, and that addicts are motivated to lie about how they got addicted in order to shift blame for their self-indulgent recreation — that ended in addiction — no data or evidence have ever been presented that show a significant connection, in Canada, between legitimate prescription and addiction to street opioids.

    Other premises for the crackdowns are suspect, too. For example, the 400% increase in the number of opioid prescriptions (always given with critical amounts of qualifying information omitted) over the past decade has been cited often with obvious intent to alarm public opinion, however, the 400% increase in the number of seniors due to baby-boomers entering old age, in one of the most geriatric countries in history — and with long, cold winters too — is adequate to explain the increase in prescription: infirmities of old age are often accompanied by chronic pain. There are about ten million Canadians over the age of 65.

    The crackdown premises seem to disagree with plain evidence, even cursorily assessed: millions of Canadians benefit from safe, effective treatment of pain with prescribed opioids; the best national estimate of the number of opioid addicts, leaving aside how they got addicted, is less than ten percent of legitimate patients prescribed opioids; the number of overdose deaths in Canada last year, most due to illegally-made fentanyl sold on the streets, is a few thousand, three orders of magnitude less than, or a tenth of a percent of, the number of legitimate patients prescribed opioids. There seems little to refute that the vast majority of patients legitimately prescribed opioids do not divert, get addicted to or abuse their meds, and have nothing whatsoever to do with illicit street drugs.

    I think two reasons explain why unwarranted crackdowns—that potentially harm patients and public healthcare budgets—have been implemented: class-action suits stemming from the two-decade old OxyContin fraud have only just begun to be filed in the relatively non-litigious Canada, most recently in Nova Scotia: the crackdowns are one way for the medical profession to insulate itself from liabilities associated with prescribing opioids. Yet, given that protocols for safe prescription and monitoring have long pre-dated the OxyContin fiasco and that benefits of opioid prescription substantially outweigh risk, now effectively reduced by improved prescription registration and tracking like Pharma-Net (integrated pharmacy dispensing records which prevent ‘doctor shopping’ and ‘multi-scripping’), there must be another reason for the profession to maintain its crackdown when it appears so unwarranted and potentially harmful. My theory is that, by propagating a narrative that essentially demonizes opioids, blames patients — and coincidentally ameliorates perceived liability for the still smouldering OxyContin fiasco — doctors are absolving themselves from assisting with, or contributing to, solutions to the illegal fentanyl crisis on the streets that all frontline agencies from police, first responders and social workers to politicians recommend: treating addiction as a disease with prescription opioids.

    The medical colleges make it amply clear they don’t want to trouble with this street crisis, and that’s a shame because, here in Canada, socialized healthcare makes it at least possible — such as the Neo-Right ethos of American medicine cannot. Without the cooperation of doctors a cogent system to deal with this crisis will be greatly delayed, if not stalled completely—and the crisis will continue to kill addicts of all walks of life.

    If it’s this bad in Canada, with our socialized healthcare that can, at least, facilitate innovative solutions to what looks like a permanent scourge of fentanyl, it must be just hellish in the States

    Reply
  6. Farmer Brian

    January 5th, 2018

    I certainly agree that deaths due to overdoses of opioids or fentanyl are very tragic and are certainly on the rise. They seem to affect everyone from an addicted street addict to a college kid experimenting at a party. In my circle of friends addiction to opioids occurred and lack of affordable treatment spaces an issue. It would also appear that it takes 5-6 trips to rehab to be successful.

    I read the article in the New York Times. There were 20100 deaths attributed to fentanyl deaths and 14400 attributed to prescription opioids for a total 34500 or 54% of overdose deaths in the US. This works out to 10.7 deaths per 100000. I looked at a map put out by the public health agency of Canada. In BC the rate of fentanyl deaths is over 15 per 100000, Alberta was between 10-15 per 100000, Manitoba,,Ontario and the Maritime provinces were in the 5-9.9 per 100000 and Saskatchewan was between 0-4.9 per 100000. There were no numbers from Quebec, no surprise. With more looking I am sure I could find more specific numbers. It doesn’t appear to me that Canada is all that much better than the USA. With our universal health system I would have expected a greater difference. Also interesting that Saskatchewan is the lowest.

    Reply
  7. Jerrymacgp

    January 6th, 2018

    A couple of commenters here have cited our public single-payer health care system as factors in the differences between Canada and the US in how the opioid crisis is playing out… but with all due respect, IMHO they’re wrong. Firstly, Canada does not have a universal Pharmacare system, so prescription drugs, including legal opioids, are not generally covered by the public purse, although there is a patchwork of exceptions to that, such as the Alberta Seniors Benefit Blue Cross programme, and many people have private insurance via their employers or as individuals.

    Secondly, Canadian “medicare” only covers hospital and physician services, and does not universally cover other community-based health care services like physiotherapy, massage therapy, chiropractic, psychology, and so on. Again, these services are covered by a patchwork of private nsurance and some public programmes for selected sectors that differ by provincial/territorial jurisdiction.

    In addition, such services are not well distributed in our communities, and there is a paucity of organized, all-under-one-roof specialized chronic/persistent pain treatment programmes where people in pain can go for help.

    This situation means that for many primary care providers faced with a client living with chronic or persistent pain, the only tool in their toolbox to help that person is the prescription pad. We need a health care system with better access to non-pharmacological therapeutic options for people in pain if we are going to see root causes of this crisis addressed.

    Reply

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