Death rates from overdoses, alcohol, suicide raise national concern

Dr. Scott T. Anderson: Ask Dr. Scott

The Commonwealth Fund recently released a report based on data from 2017 summarizing death rates from drug overdoses, alcohol and suicides in 50 states and the District of Columbia.

These so-called “deaths of despair” seem to have climbed, alarming researchers.

The distribution of the opioid epidemic is not uniform.

West Virginia manifested the highest rate of drug overdoses, rising more than five-fold in the past decade and a half. The District of Columbia, Kentucky, Delaware and New Hampshire were also hard hit by the overdose death rate spike.

Davide Radley, a senior scientist for the Commonwealth Fund, described this problem as being “mind-boggling.”

The problem seems to involve both illicit drugs, such as heroin, and prescription narcotics.

Synthetic opioids, such as fentanyl, may be as much as a 100 times more potent than heroin preparations, leading to accidental overdoses. The National Institute on Drug Abuse, Commonwealth Fund scientists and others are examining the data further.

Suicide rates, and rates of death due to alcohol, are higher than the opioid overdose rate in Montana, Nebraska, the Dakotas, Oregon and Wyoming, according to Erika Edwards’ analysis in Health News.

Explanations are hard to come by. Could overall health status play a role?

The top four states, in terms of overall health status, are Hawaii in first place, followed by Massachusetts, Minnesota and Washington, in second through fourth place, respectively.

Mississippi is the least healthy, in 51st place if you count the District of Columbia. Oklahoma, Texas and Nevada rank 50th, 49th and 48th. Do overdose deaths and suicide reflect these rankings?

The data summarized in the Health News article by Edwards yield conflicting information, I believe.

Least-healthy Mississippi, contrary to what we might expect, emerges in the low-risk range for drug overdoses and alcohol-related deaths. Healthy Hawaii, as one might expect, suffers fewer drug overdoses and alcohol-related deaths. Massachusetts, although second-ranked in overall health, still finds itself in the high-risk category for drug overdoses.

There are clearly no simple answers to this public health puzzle. More research is needed.

The prescription habits of doctors took a turn toward the use of chronic opioids about two decades ago, fueled by concerns that pain was undertreated. This was a sea change, and we are still digging ourselves out from this approach.

It is one thing to prescribe a few days of narcotics for post-surgical pain or acute conditions such as kidney stones. It is another to endlessly refill narcotics for a chronically sore back.

I generally favor non-narcotic alternatives, such as anti-inflammatories, physical therapy, exercise, nutrition and a healthy lifestyle.

Obviously, every case is different. Narcotics are a blessing for end-of-life palliative care.

When forensic pathologists analyze a death, they typically comment on manner, cause and mechanism.

Manner, for example, may be natural, accidental, homicide or suicide. Cause may be related to pneumonia, for example, with mechanism being a lethal irregular heart rate.

You can imagine that determining a manner of death can be challenging if a toxicology screen comes back with moderate levels of multiple drugs, perhaps combined with alcohol. Is such a death an accidental overdose? Or an intentional suicide? There is a reason why forensic pathologists undergo extensive training over many years.

A sticky wicket, indeed.

On a practical basis, the potential impact of combining alcohol with sedating medicine is worth noting. For example, a so-called “minor tranquilizer,” or benzodiazepine, may be ingested in a prescribed manner that is unlikely to cause respiratory depression or death. If the individual consuming the pills washes them down with a couple of cocktails, however, the result may be tragic. Those labels on prescription bottles, cautioning against simultaneous use of alcohol, deserve careful attention.

Together, let us work to prevent unnecessary tragedies.

Scott T. Anderson, M.D., Ph.D., is a clinical professor at the University of California, Davis Medical School. This column is informational and does not constitute medical advice.

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