2017 saw highest rate of death due to alcohol, drugs, suicide in US history [pdf]

They try to work out which one killed them. If they can't, it should to my knowledge be filed as an unknown-substance drug death, although the toxicology report would have the details.

Forensic toxicology screens are pretty thorough, and benefit from being able to take invasive samples like heart blood, brain, liver, and even eye tissue samples. That provides a lot of flexibility to find any substance that's present and look at relative concentrations and metabolites. Toxicology is usually sufficient in combination with the coroner's report on proximate cause of death; even if multiple substances are found, it's only a problem if they're all able to kill by the relevant mechanism.

In this example, someone with a high alcohol tolerance might die with a potentially-lethal level of alcohol in their blood, and also test positive for opioids. A tox screen should then be able to estimate that they had stopped drinking a few hours before (e.g. high acetaldehyde levels in blood and urine, no alcohol in stomach fluids), then freshly used opioids just before the time of death.

This gets harder if you have drugs with additive effects (e.g. death by respiratory depression, testing positive for heroin and ketamine); the autopsy would list both, but I don't know how the stats are handled. And it seems like a nightmare in the case of drug interactions; I have no idea what happens if somebody dies of serotonin syndrome triggered by mixing alcohol with MAOIs.

Mass/cluster suicide is, unfortunately, a poorly understood and researched phenomenon. The Werther-effect seems to be a good first pass at describing what is likely to be a manifestation of many underlying causes [0]. Though this may sound like a broken record: more funding is needed.

Suicide can be described like any other disease [1]. It has a coefficient of communicability/spread. Though I can't find the citation, it is thought that social media has increased this coefficient by ~22x ; meaning that suicide has become much easier to 'catch'. In the US, a fair few suicide 'clusters' have sprung up and many more are likely being hidden by empathetic, yet mis-guided, coroners. One famous one was in at Palo Alto HS in California[2], where a lot of Stanford's Professors sent their kids. Another, still ongoing, is in Colorado Springs' religious High School network[3]. I'll let Newsweek speak for the true horror that is possible via new technology:

>“This is the part that kills me—I know she was texting other kids at the time and letting them know,” he says. She wrote, “My feet are off the floor,” and “Everything is getting hazy and dark.” None of the kids intervened; one responded by suggesting she “unhang.”

Suicide is also prevalent in east Africa currently [1] and there have been spats of it throughout time in a wide variety of place and for a large range of reasons[4].

Even talking about suicide at all, like I am currently doing, can increase it's reach. It's a very tricky thing to research and combat, as a consequence.

PLEASE, if you are feeling suicidal, reach out! Call a friend, a family member, or someone you feel safe with. CALL THIS NUMBER NOW:

1-800-273-8255

[0] Like describing a stuffy nose; it has many causes.

[1] https://en.wikipedia.org/wiki/Epidemiology_of_suicide

[2] https://www.theatlantic.com/magazine/archive/2015/12/the-sil...

[3] https://www.newsweek.com/2016/10/28/teen-suicide-contagious-...

[4] https://en.wikipedia.org/wiki/Suicide_epidemic

This is an excellent question, but my first impression is that they aren't doing anything sneaky.

I see that some of the data is labeled "per 100,000 individuals," not deaths.

Obviously, there is a specific policy push and point of view outlined in the paper, which is probably why most such papers are published.

But a lot of this data is from the CDC and should be independently verifiable and from Appendix B of the paper, I see that the ultimate source is something called "CDC Wonder".

https://wonder.cdc.gov/

And it looks like one can make a request for that data: https://wonder.cdc.gov/controller/datarequest/D77

It's "crude rate per 100,000", which is the number of people in a sample of 100,000 who would die of that cause in a given year. It's basically a death rate multiplied by 100,000 to be more readable. If you check the CDC WONDER stats, the total annual death rate is ~840/100,000.

I suppose there is some replacement effect in here, where if fewer people die in car crashes they're more likely to live long enough to die of Alzheimers. That's part of why the death rate has been climbing; the population is aging overall. To handle that, there are also "age-adjusted" death rates available, which standardize years of life lost. That can be a big difference; for instance the UK suicide rate is much lower than the US one, but also skews much younger so the age-adjusted rates are closer.

Yeah, but I'll bet it's high-quality and comparable enough among some countries to be useful.

Tracking these three causes together would probably help as well; if one culture is biased towards over-counting overdoses, for instance, and under-counting suicides (which makes me think of the Ray Bradbury line, that someone had "jumped off a pill bottle"), tracking stats for a few proximate causes probably helps get a better overall picture.

They do break it out by age as well.

snipped to imgur: https://i.imgur.com/yLTwL3J.png

Edit: my original comment may have implied that I was minimizing the importance of the issue, which I hope wasn't the impression I gave -- it's striking that the only good news whatsoever is a small reduction in alcohol deaths among black people, which was canceled out and then some in drug deaths.

There are so many issues with the US health industry that it's hard to pin point which one is the worst. It's almost an example of what shouldn't be done.

For profit isn't an issue per say, but when you add greedy executives in the mix you're in for a disaster. Look at insulin or other basic necessities, companies clearly put profit over people. I don't think that would fly in any other first world country.

https://www.healthsystemtracker.org/chart-collection/health-...

https://www.thebalance.com/causes-of-rising-healthcare-costs...

I think you're missing the point. OP is just saying that contrary to some politicians they aren't realy relevant to this issue, as you say as well, not necessarily that they are bad things as such.

In other words, by effectively prohibiting (legal access to) alcohol to the poor you can save them from their freedoms.

This is a disturbing way to think about people. The state should not be in the business of saving people from themselves, least of all with a deeply regressive tax.

Well, politicians and American media tend to sell Mexico as a 3rd-world hellhole (which it isn’t) and Canada as a socialist utopia with death panels and high taxes (which it isn’t). So people find another escape while feeling helpless.

It’s not a simple issue, and everyone is at risk, but higher risk groups are this on the bottom of the socioeconomic ladder.

https://aspe.hhs.gov/system/files/pdf/259261/ASPEEconomicOpp...

(1) The prevalence of drug overdose deaths and opioid prescriptions has risen unevenly across the county, with rural areas more heavily affected. Specific geographic areas, such as Appalachia, parts of the West and the Midwest, and New England, have seen higher prevalence than other areas. (2) Poverty, unemployment rates, and the employment-to-population ratio are highly correlated with the prevalence of prescription opioids and with substance use measures. On average, counties with worse economic prospects are more likely to have higher rates of opioid prescriptions, opioid-related hospitalizations, and drug overdose deaths. (3) Some high-poverty regions of the country were relatively isolated from the opioid epidemic, as shown by our substance use measures, as of 2016.

Still as 3 can attest and as you said, it isn’t simple.

You would say there’s a 1:1 relationship between countries and societies?

That some poor guys are trying to get to your country doesn't mean much, this can be said about most countries in the world these days in some way or the other. Its not easy, and often even feasible for people to move their life, probably forever, half around the world. I claim from my experience that most americans have no clue how life is different compared to say some western europe country. You can't grasp it from internet, nor few days tourist visit.

And another claim - if they knew, and moving would be painless easy cheap weekend effort, you would see much of US population move out someplace better, mainly those with lower incomes.

Its really THAT different. Less pressure for monetary success and pressures in general, much less crime, system generally helps you much more when you hit the bottom, healthcare is a topic on its own and so on. US used to be great place although never easy. Then it got OK. Now, if I would be moving, I would consider every single continent, including Antarctica as new home rather than US. And I am stating this as a person who in every country I lived so far belonged in say top 5% earners in population, and I would be a very much OK in US too.

Being affluent or rich doesn't makes your life meaningful by itself.

Some very poor workers enjoy their craft and are 100% fulfilled by it, some very rich celebrities lost themselves in their money and fame. I tend to think that having a community has more importance than money in that regard. People survived in the past by working 12+ hours a day 7 days a week, but they had strong family bond (someone sick wouldn't get paid, no welfare, no pension, &c ..).

If anything (too much) money enables you to go down the rabbit hole and amplify your vices.

* It’s not a simple issue though. Thoroughly affluent kids get hooked. Affluent parents get hooked.*

Didn't some affluent, highly educated guys go to Syria to join terrorists? Anyone can feel left out, ignored - even the wealthy and educated people. Maybe the breakdown of family structures, not having good friendships/relationships, loneliness contribute to these problems? People long to be a part of something- when that doesn't happen, they numb themselves with drugs, join criminal gangs etc.

This is not something that can be fixed by passing some laws or demonizing the affected people, it requires a more empathetic approach than use of force or law.

>Scanning Facebook is easier than getting a drink

If only it were that easy.

What's wrong with Ketamine? It's not particularly addictive, and it's worst side effect is kidney damage (which can be quite severe). Are you sure you don't mean Heroin or Fentanyl? Those are the worst of the bunch.

By "most harmful" I meant total harm to society, not personal harm per microgram or something.

How many families have been torn apart by alcoholism? How many drunk driving deaths? And yet it still doesn't get the stigma of being "drugs" - this is the bullshit I'm referring to.

Im sorry about your brother.

I never said it was a moral failing. What I did say is that people lack a values system to find meaning in their life. Even if you are poor, you can find meaning in your life, yet our society is completely geared around material goods= meaning. Religion used to fill that role.

That hole is often times filled with meaningless partying that can include experimentation with drugs. Of course many people get addicted via actual prescriptions. I havent done much research, but the article below suggests that few people are getting addicted via prescriptions.

why do people start using opioids in the first place?

https://tonic.vice.com/en_us/article/a3z98b/big-pharma-didnt...

<<The research actually shows that people who developed new addictions in recent years were overwhelmingly not pain patients. Instead, they were mainly friends, relatives, and others to whom those pills were diverted—typically young people. Among the older patients, many who appeared to be newly addicted had actually relapsed or never recovered from prior addictions: some faked pain to get pills from well-meaning doctors; others got them from pill mills where shady physicians wrote prescriptions for cash.>>

Condolences with regard to your brother.

I'm just not sure that all of this is down to material prosperity?

Blacks and hispanics have been much more poor, with far fewer prospects, for much longer, and yet this suicide and opioid overdose issue seems to affect whites disproportionately. That suggests maybe two things, either blacks and hispanics have been poor for so long that they are accustomed to it, or the suicide rate doesn't have as much to do with material prosperity as you seem to suggest.

It could have to do with material prosperity, I'm not saying you're definitely wrong. I'm just pointing out the fact that there is evidence, in black and hispanic poverty rates, that agitates against that explanation.

What part are you asking about?

How can I know I won't commit suicide, die via an overdose, or another kind of death of despair? As far as I'm aware, these are still choices for most of us. So if I choose to not die a death of despair, what would my life expectancy be?

No offense, but do you honestly believe most heroin users are going to buy a test kit to test their drugs and then if it tests positive not use them? The practical value of those test kits seems low to me, as I don't believe they would be heavily used and I don't believe that many herion users wouldn't continue in the fact of a positive test.

Never underestimate the power of Friction when it comes to reducing bad habits.

It’s peobably both, cause and effect. I agree with everything else you said. It’s just hard not to be depressed when I see everyone staring at their phone. I imagine back in the day people would strike up conversations and make random friends. Can anyone who was an adult pre-phones confirm this? There is no reason to make conversations with strangers anymore as anything you read online is likely more interesting and you can “pause” any time. I am guilty myself, and have to remind myself constantly that there is more to being in public than hiding behind a screen. Maybe I’m the weirdo who occasionally makes too much eye contact.

political choices are completely irrelevant to your ability to have a happy life.

People living in garbage dumps are able to figure out to be happy.

You think it's possible to unplug from the internet? All you have to do is to talk to one living person in America to feel the cultural impact of social media and the internet. There is no unplugging. Unless you go start a commune in the middle of no where. You can't just turn this off, it's in every aspect of our society. I agree putting yourself on a media diet is a good thing, but my diet isn't going to get my friends in shape.

Wow what a depressing idea! Of course with advancing technology we get more and more for less and less. The American Dream is very achievable. Not some imaginary infinite-resource world, but a society where everybody can work reasonable hours and have their own place. It doesn't rely on any exponential growth ideas at all. There are only so many Americans, and only so many needs.

And America was built on our own industry - the rest of the world had marginal input. Sure greed ran over our borders, but that was a sad side effect and not necessary for America's amazing growth.

The data clearly doesn't not say what you claim. As for trending? I wouldn't call anything going from 1.9% of deaths to 2% of deaths as trending. Focusing on the 2% rather than the 98% seems also doesn't seem to be sensible.