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Comment by theparanoid | Hacker News Reader

The US lifespan is decreasing due to opioid overdoses. Similar to Russia in the 90's with alcohol.

A quick google search would show this is untrue. Opioid overdoses kill 40,000 a year. 2.7 million Americans die per year.

Even if you were talking about a decrease in healthy lifespan, Opioids do not generally cause a person to transition from healthy to unhealthy (they are prescribed to treat a preexisting condition).

Sources:

https://www.cdc.gov/drugoverdose/index.html

https://www.cdc.gov/nchs/fastats/deaths.htm

That's not necessarily a disproof - if opioids are killing people who are disproportionately young, then they could have an outsize effect on life expectancy. Say life expectancy is 79 years. If a new cause of death occurs that affects 10% of the population and kills, on average, at age 78, then life expectancy goes down to 78.9. If a new cause of death occurs that affects 10% of the population and kills at age 29, then life expectancy goes down to 74. Same reason that infant mortality had a disproportionate affect on life expectancy: the numbers of deaths might be small, but the reduction in lifespan is large.

Personally I would bet on obesity being a bigger contributor to declining lifespans than opioids, but I'm just showing that raw numbers of deaths cannot automatically disprove the hypothesis that a decline in lifespan is due to opioids.

There's a great breakdown here [0]. The first chart shows age 15-44 deaths going up ~10% from 2010 to 2016. The third chart shows drug overdose deaths going up 50%(15-24), 80% (25-34), and 60% (35-44) from 2012 to 2016.

[0] http://www.calculatedriskblog.com/2018/05/lawler-us-deaths-j...

For a cause of death affecting 40000/2700000 it could only reduce life expectancy from 79 to 77.8, even if all the victims were age 0.

EDIT: I suppose it could be lowered a bit more if all those who died were those who would otherwise have lived longest.

> I suppose it could be lowered a bit more if all those who died were those who would otherwise have lived longest.

That would average out in a population size of 40k

No, I mean there could be some actual effect that selected for those people.

For example if rich people were culturally more likely to use heroin than poor people, then overdoses would lower the life expectancy more than you would expect, because rich people (when not overdosing on heroin) have better access to medical care and hence longer life expectancy.

Washington Post recent headline: "Fueled by drug crisis, U.S. life expectancy declines for a second straight year"

Quote: "Experts pointed then to the "diseases of despair" — drug overdoses, suicides and alcoholism — as well as small increases in deaths from heart disease, strokes and diabetes."

https://www.washingtonpost.com/national/health-science/fuele...

Deaths from "unintentional accidents", a large portion of which are opioid / heroin overdoses, is 4th leading cause of death in US

Many of these people die young. There are more years of life lost before age 75 due to suicide / overdose in the US than diabetes

40 of 2700 is 1.5% of deaths. If those are people decades younger than normal deaths, it will bring the numbers down. Not by several years, but by a decimal or two.

> Opioids do not generally cause a person to transition from healthy to unhealthy (they are prescribed to treat a preexisting condition).

This is a very naive view.

People start taking opioids in many different paths, legal and illegal. Some lie to get the prescription, no one can prove you don't have back pain. Some get a prescription after surgery and get addicted that week.

The super informative and well written book to read is Dreamland: https://www.amazon.com/Dreamland-True-Americas-Opiate-Epidem...

With a lot of the fentanyl flowing into the US market being made in China, it's almost like a reverse opium war between the east/west.

Make no mistake: the opioid epidemics is pretty much a self-inflicted harm. It is what happens when you underfund actually useful drug programs and let corruption (relabelled 'lobbying') by pharmaceutical companies run unchecked.

So yes, sure, China will make business if they can, but they are not "out there to get you".

Also blame the patent system, as implemented.

in both cases, it could be said as "out to make money" not "out to get you"

it just so happens that it's always very profitable to sell opium.

I remember a businessman from Hong-Kong, 15 years ago, telling me that as soon as USA realizes China is better at business than they are, they will switch overnight to hating capitalism and free trade.

At the time I thought it was a bit exaggerated.

> as soon as USA realizes China is better at business than they are

This is jingoistic at best. Let's ignore that "goodness at business" is an ambiguous and multidimensional metric. Or that defining a "better" direction is similarly dubious. The argument is simply "anything you can do I can do better." To that, the counterfactual is Ricardian comparative advantage.

More broadly, every culture says such things in times of growth and decline. It is never true. But a changing baseline combined with localisation bias reproduces it often. It is a case where the utterance of a thing is more meaningful than the thing itself.

I think I made it clear that this was a single person's opinion. And obviously biased that is. Still an interesting opinion in light of the recent trade war saber rattlings.

But realize that cities like Guangzhou (pop. 25 M) have been trading hubs for much longer than the USA has existed. And some families have had a continuous line of business for centuries. The business culture is very strong there.

What I've experienced in China is that trade can happen without any monetary transaction or contract and the chance of getting screwed over is very low in upper strata.

This is something, I never saw in the US.

Even at the lower strata, people understand what reputation is. And to be honest, only in the US does "buyers beware" feel like a sound business strategy. Most countries understand the need to go beyond that.

>actually useful drug programs

For example?

I think obesity has more to do with it. A lot of people seem to want to normalize being overweight but I really don't think that leads anywhere productive, especially when it comes to affordable health coverage.

I don't see many serious people advocating for normalizing obesity. I also don't think there's a clear productive outcome to obesity issues.

Telling fat people to burn more calories than they eat is like telling poor people to save more dollars than they spend. Yeah, it's the outcome we want, but it's not a mechanism to solve the problem.

A government program to influence calorie consumption is as distasteful as a government program to closely monitor home economics.

Pardon my utter ignorance/disbelief - are opioids killing/debilitating that many people to get this result?

No. I would guess the biggest factor is our number one killer, heart disease. Healthy lifespan.... People live a long time with heart disease, but they are never healthy again. Same with many terminal cancers, etc.

> No. I would guess the biggest factor is our number one killer, heart disease. Healthy lifespan.... People live a long time with heart disease, but they are never healthy again. Same with many terminal cancers, etc.

Those are the leading causes of death, but not the leading causes of the recent decline in life expectancy (heart disease has not contributed to a dramatic decrease is life expectancy).

The recent decrease is due to deaths from drug overdoses. They aren't the leading cause of death, but they have caused the life expectancy to decrease in the last few years.

60,000+ people are overdosing in the US. The Fentanyl China is dumping into the US killed 20,000 people in 2016, up from 3,000 just a few years prior. By comparison, Cocaine killed 10,000, Heroin killed 15,000, and prescription opiods killed 14,000.

The reason it disproportionately impacts life expectancy, is because a lot of the people overdosing are young.

If you suddenly have 250,000 people under 40 years of age overdosing over five years, you're going to see it in the life expectancy numbers even if your population is 320m. The small increases you'd expect to see in life expectancy year by year otherwise, will evaporate.

To get a picture of the overall health impact (non overdose deaths), one would need to look at how many additional addicts the opioid explosion has caused (eg in the last 10-15 years), study the health impact over time on those people, and so on.

Some quick maths. an increase of +17k Fentanyl deaths in a year. Let's say they all died at 20. Of the ~2.5million annual deaths, which average to be life expectancy (78.8 years). Life expectancy goes down to 78.4.

A net change of 0.4 years is not insignificant, but I think you're ignoring the elephant in the room (China's rapid development in the last decade).

On another vein, I'd argue overdosing on drugs is an intrinsic part to the American experience.

That matches the observed life expectancy numbers in the article - U.S. life expectancy decreased from 79 years to 78.5 years.

In the eighties Iran used to blame its drug problems on the US - I don’t think blaming the US’ on China has any more logical footing

Fetanyl is a prescription opioid, why did you separate the two?

And what does it have to with China "dumping" it? FDA approved Fetanyl and American doctors are prescribing it. It's on us to reign it in.

I'd imagine that opioid overdoses can be added to the figures of those caused by the US healthcare system, being largely driven by prescribing practices and the warped incentives that drive them.

For a developing country to increase life span in general, it makes most sense to decrease child mortality and increase vaccinations. Old and sick people don't matter much for the statistic, since a child dying with 2 years is much worse for the statistic than an old persons getting one year less out of life.

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