Between 2021 and 2022, rates of drug overdose deaths decreased for people ages 15–34 and increased for adults age 35 and older. It appears clear that the lethality of opioids (relative to other drugs) contributed in important ways to the increase in drug poisoning mortality rates (regardless of whether SUDs themselves have actually increased). It would be valuable to understand the extent to which changes in the types of alcohol consumed alcohol rehab by Americans (e.g., greater consumption of hard liquor) or the quantities consumed during drinking sessions (e.g., binge drinking) have increased the toxicity of the behavior and contributed to rising alcohol mortality rates among Whites. Demand-related explanations for the surge in substance use and overdose over the past three decades focus on why certain subpopulations and geographic areas appear to be more vulnerable than others to increased exposure to opioids and other drugs. These explanations include those that are both proximate to individuals (physical pain, mental illness, ACEs, psychological distress or despair) and those that are more structural and distal (macro-level economic, family, and social changes). As policy makers, state health officials, and physicians became aware of the surge in prescription opioid addiction and diversion, policies and strategies were employed to control the misuse of opioids.

FIGURE 7-6

They conclude that men whose occupational expectations were unmet because of labor market declines were at higher risk of death from suicide or drug poisoning relative to men with different occupational expectations. In some ways, the trends in mortality due to drug poisoning and alcohol-related causes suggest similarities in the affected populations.8 Both causes of death increased steadily over the 1990–2017 study period among working-age Whites. Mortality due to substance use generally (drug and alcohol use) explains most of the growth in the socioeconomic gap in mortality among men and about half of the growth in the gap among women.

Alcohol-Induced Mortality in the USA: Trends from 1999 to 2020

In 2019, 30 states had alcohol-related death rates in the double digits compared to 2006 when only 10 states had alcohol-related deaths in the double digits. Researchers have known for some time that people who use drugs overwhelmingly prefer heroin to fentanyl. When drug traffickers began mixing fentanyl into heroin a little over a decade ago, many unaware heroin users became overdose victims.

General Population Substance Use (Ages 12+)

Rather than chasing an endless cycle of enforcement and adaptation, policymakers should focus on harm reduction strategies that save lives and empower individuals to make safer choices. Heroin, which is roughly 50 times less potent than fentanyl, had been nearly entirely replaced in the black market during the pandemic. The border closures and supply chain disruptions drove drug trafficking organizations to switch from heroin to fentanyl, which was easier to produce and distribute under those conditions. When the public health emergency ended, these organizations opted to continue what was effective—producing fentanyl products in underground labs—rather than alcohol overdose relying on growing, transporting, and processing opium into diacetylmorphine (heroin). Yet in dominating the early 2020s, Covid-19 also distracted from what is arguably a more significant public health emergency.

• Alcohol-attributable deaths for 58 causes of death, as defined in the Centers for Disease Control and Prevention’s Alcohol-Related Disease Impact application.
• Indiana’s overdose death rate has risen dramatically over the past decade, with synthetic opioids like fentanyl driving the crisis.
• They also provide evidence of increasing morbidity, reporting concurrent declines in self-reported health, mental health, and ability to conduct activities of daily living and increases in chronic pain and inability to work.
• Average annual number of deaths from excessive alcohol use increased 29.3%, from 137,927 during 2016–2017 to 178,307 during 2020–2021; age-standardized alcohol-related death rates increased from 38.1 to 47.6 per 100,000 population.
• For example, they found that among those ages 45 without a bachelor’s degree, the birth cohort of 1960 faced a risk 50 percent higher than that of the cohort born in 1950, and the cohort of 1970 faced a risk more than twice as high.

Research on temporal trends in ACE prevalence is sparse, so it is also difficult to determine whether the changes observed in working-age drug- and alcohol-related mortality can be attributed to a posited increase in ACE prevalence. Data limitations also have resulted in a paucity of research on geographic differences in the prevalence of ACEs among U.S. adults. The Behavioral Risk Factor Surveillance System (BRFSS) is the only ongoing national dataset that includes responses to questions about both ACEs and health behaviors. However, not all states include the ACE module in their annual BRFSS administration, and starting in 2015, county identifiers were no longer included in the publicly available BRFSS data. In the most recent study of pain trends available to the committee, Zajacova, Grol-Prokopczyk, and Zimmer (forthcoming) examined the prevalence of joint, low-back, neck, migraine, and jaw/facial pain among adults ages 25–84 using the 2002–2018 National Health Interview Survey. They found a large escalation in pain prevalence among adults over this period, with overall reports of pain in at least one anatomic site increasing by 10 percent (from 49% in 2002 to 54% in 2018), representing an increase of 10.5 million adults experiencing pain.