The epidemic that’s shortening American lives

The story of modern life has been one of people enjoying better health and living longer. In the United States, life expectancy at birth has inched up almost every year over the past half century, going from under 70 years in 1963 to nearly 79 years in 2014. But the progress that once seemed automatic has stopped. Last year, for the second consecutive year, life expectancy declined.

This is not because of a surge in heart attacks among retirees. In fact, life expectancy at age 65 rose a bit in 2016. The overall decline stems from an increase in the death rate among younger people. In the 15-24 age group, mortality rose by almost 8 percent; among those 25-34, it jumped by more than 10 percent. Only among seniors did the death rate decline.

What’s going on? More than anything else, the increase is attributable to an epidemic of fatalities from drug overdoses. Last year, 63,632 people died this way — up from 16,849 in 1999. The number of fatalities exceeded the number of Americans who died from auto accidents and gun homicides combined.

More than 3 in 4 of the overdose deaths involved opioids. Heroin and prescription painkillers account for the majority, but the newest and most lethal drug is fentanyl, a synthetic opioid 50 times more potent than heroin. Deaths involving this and other synthetic opioids (excluding methadone) more than doubled last year, to 19,413.

Drug overdoses now have eclipsed the AIDS epidemic at its height. In October, President Donald Trump declared the problem a public health emergency. Soon after, a White House commission chaired by New Jersey Gov. Chris Christie published a report recommending dozens of changes, including giving states more leeway in the use of federal funds, tightening regulation of opioid prescribing and expanding medication-assisted treatment with such drugs as methadone and buprenorphine.

As is, nearly 90 percent of those who need this therapy go without. Treatment would be especially useful among lowlevel drug offenders, who could be diverted from incarceration, and among inmates, who are prone to dying of overdoses when they resume using opioids after months or years behind bars.

A serious effort would cost money. “I would say that you’re going to see this president initially ask for billions of dollars to deal with this,” Christie predicted. But Trump has yet to do so.

Some helpful options, however, were passed over. One is encouraging states to allow the use of cannabis through medical dispensaries. A study in the Journal of the American Medical Association showed that states that legalized medical marijuana saw a sharp percentage decline in opioid-related deaths.

Another option: expanding programs that provide clean syringes to drug users — a method proven effective in combating the spread of HIV. As governor of Indiana, Mike Pence suspended the state ban on needle-exchange programs for a county that was suffering an outbreak of HIV spread through drug use.

More vigorous law enforcement may help, but it can also have unwanted side effects. Fentanyl has spread partly because it is so strong and easy to make in labs, inducing illicit dealers to mix it with heroin. But because of its potency, unwitting users can easily overdose. And the usual doses of naloxone, which is used to reverse overdoses, are not always sufficient to save someone on fentanyl.

Suing drug companies for their role in the expanded use of opioids isn’t a promising route. Courts are likely to balk, given that medical drugs, doctors and pharmacies are subject to extensive regulation. Unlike cigarettes, these drugs have important uses and considerable value for suffering patients.

Most important in turning the tide is for governments at every level to recognize the scope and severity of the epidemic — and soon. For the tens of thousands of Americans at risk of dying from drug overdoses next year, time is running out.