Pain in the Nation

The Drug, Alcohol and Suicide Epidemics and the Need for a National Resilience Strategy

February 2018

***This page was updated on Feburary 22, 2018 to add a new data analysis and brief, which found there was a disproportionately large increases in drug deaths among racial/ethnic minority groups, particularly among Black Americans, who experienced an increase of 39 percent in drug deaths between 2015 and 2016. And, Latinos saw drug death rates increase 24 percent, while the rate for Whites increased 19 percent from 2015-2016.*****

Deaths from drugs, alcohol and suicide could account for 1.6 million fatalities over the coming decade (2016 to 2025) according to a new report, Pain in the Nation: The Drug, Alcohol and Suicide Epidemics and the Need for a National Resilience Strategy, released by the Trust for America's Health (TFAH) and Well Being Trust (WBT). From 2006 to 2015, there were 1 million deaths from these three causes. 

This would represent a 60 percent increase compared to the past decade, if recent trends hold. The study found, however, that these numbers may be conservative, especially with the rapid rise of heroin, fentanyl and carfentanil use. If the nation continues along recent trajectories, death rates would actually double to 2 million by 2025.

******TFAH and WBT also created a new feature interactive tracking the recorded and projected change in rates from 1999 through 2025.*******

Pain in the Nation calls for the creation of a National Resilience Strategy that takes a comprehensive approach by focusing on prevention, early identification of issues and effective treatment. The report highlights more than 60 research-based policies, practices and programs.

State specific information and data breakdowns:

Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas

Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina

North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Current Nationwide Trends

• Nationally, in 2015, there were 127,500 deaths from drugs, alcohol and suicide. The epidemics currently are responsible for 350 deaths per day, 14 per hour and one every four minutes.
• According to the report's projections, this could reach 192,000 per year by 2025 (39.7 deaths per 100,000 in 2015 compared to 55.9 per 100,000 in 2025).
• At a state level, in 2005, 21 states and Washington, D.C. had death rates from these three causes above 30 per 100,000, and only six states had death rates above 40 per 100,000.
• As of 2015, 48 states and Washington, D.C. had rates above 30 per 100,000, 30 were above 40 per 100,000 and five states had rates above 60 per 100,000, including New Mexico which had the highest rate of 77.4 per 100,000.
• By 2025, 26 states could reach 60 deaths per 100,000 – and two states (New Mexico and West Virginia) could reach rates of 100 deaths per 100,000.
• Drug overdose deaths tripled between 2000 and 2015 (with a total of 52,400 deaths in 2015), with rural community opioid-related death rates increasing seven-fold. Provisional data shows drug overdoses could exceed 64,000 in 2016, with fentanyl deaths alone accounting for 21,000 of these deaths (and fentanyl-related deaths doubling between 2015 and 2016);
• Alcohol-induced deaths increased 37 percent between 2000 and 2015, reaching a 35-year high at 33,200 deaths in 2015. This excludes alcohol-attributable deaths related to injury and violence;
• Suicide deaths increased by 28 percent between 2000 and 2015 to more than 44,000 deaths (as of 2015). Rural suicide rates are 40 percent higher than in metro areas;
• As of 2015, more than 43 million Americans experienced a mental health issue, more than 20 million had a substance use disorder and more than 8 million experienced both – and these numbers are likely to be underestimates due to stigma and lack of available treatment; and
• Only around one in 10 people with substance use disorders receive recommended treatment.

Report Calls for a National Resilience Strategy

Pain in the Nation calls for the creation of a National Resilience Strategy that takes a comprehensive approach by focusing on prevention, early identification of issues and effective treatment. The report highlights more than 60 research-based policies, practices and programs, including:

• Improve Pain Management and Treatment by helping people heal physically, mentally and emotionally. Approaches must acknowledge that there are different types of pain and experts from mental health, medical care and other disciplines must develop team-based solutions that focus on proactively addressing pain before it gets worse.

• Stem the Opioid Crisis with a full-scale approach – including promoting responsible opioid prescribing practices (such as provider education and best practices for Prescription Drug Monitoring Programs); public education about misuse and safe disposal of unused drugs; "hotspot" intervention strategies; anti-trafficking to stop the flow of heroin, fentanyl and other illicit drugs; and expanding the use and availability of rescue drugs, sterile syringes and diversion programs.

• Address the Impact of the Opioid Epidemic on Children – and the Need for a Multi-Generational Response that includes substance use disorder treatment for parents and wrap-around services for children and families, including grandparents and other relatives who help care for children, and expand support for the foster care system.

  Model programs for families struggling with opioid and other substance misuse disorders have been twice as effective in helping mothers achieve sobriety, reduced state custody placement of children by half and had a return on investment of $2.22 for every $1 spent on child welfare programs.

• Lower Excessive Alcohol Use through evidence-based policies, such as by increasing pricing, limiting hours and density of alcohol sales, enforcing underage drinking laws and holding sellers and hosts liable for serving minors.

  For example, a 10 percent increase in the price of alcoholic beverages is shown to reduce consumption by 7.7 percent.

• Prevent Suicides by expanding crisis intervention services; anti-bullying and social-emotional learning in schools; and support systems for Veterans; and better integrating mental health into primary care.

  For instance, the Zero Suicide model program has shown 80 percent reductions in suicides.

• Expand and Modernize Mental Health and Substance Use Disorder Treatment Services – Toward a Goal of Focusing on the "Whole Health" of Individuals by prioritizing innovative integrated delivery models for rural and underserved urban areas and expanding the provider workforce, including those who can deliver medication-assisted treatment.

  Some effective substance use treatment programs have a return of $3.77 per $1 invested.

• Prioritize Prevention, Reduce Risk Factors and Promote Resilience in Children, Families and Communities by limiting trauma and adverse experiences, which have the biggest long-term impact on later substance misuse, and promoting better mental health.

  For instance, nurse family home visiting programs have a return of $5.70 for every $1 invested, and early childhood education programs have a $4 to $12 return for every $1 invested.

• Reboot Substance Misuse Prevention and Mental Health in Schools by scaling up evidence-based life- and coping-skills programs and inclusive school environments and increasing the availability of mental health and other services.

  Top school substance misuse prevention programs have a $3.80 to $34 return for every $1 invested; social-emotional learning programs have an $11 for $1 return; and school violence prevention (including suicide) programs have a $15 to $81 for $1 return.

The report was supported by grants from WBT and the Robert Wood Johnson Foundation (RWJF). Data analysis and projections were provided by the Berkeley Research Group. The full report is available on TFAH's website at www.healthyamericans.org.

2015 STATE-BY-STATE DRUG, ALCOHOL AND SUICIDE DEATH RATES AND 2025 PROJECTIONS

Based on an analysis of new state-by-state data from the Centers for Disease Control and Prevention's Wide-ranging ONline Data for Epidemiologic Research (CDC WONDER), current (2015) and projected (2025) rates of deaths per 100,000 people from drugs, alcohol and suicide from highest to lowest were:

Note: 1 = Highest rate, 51 = lowest.

2025 PROJECTIONS, STATE-BY-STATE DRUG, ALCOHOL AND SUICIDE DEATH RATES

1. New Mexico (105.7); 2. West Virginia (99.6); 3. Wyoming (88.8); 4. New Hampshire (88.1); 5. Alaska (84.4); 6. Kentucky (81.3); 7. Rhode Island (79.7); 8. Arizona (75.8); 9. Montana (75.6); 10. Nevada (75.0); 11. Ohio (74.6); 12. Oregon (72.8); 13. Maine (71.5); 14. (tie) Oklahoma (70.0) and Utah (70.0); (tie) 16. Colorado (67.8) and Tennessee (67.8); 18. Pennsylvania (67.7); 19. Massachusetts (66.6); 20. Michigan (65.9); 21. Vermont (65.8); 22. Idaho (63.4); 23. Washington (63.3); 24. Connecticut (61.2); 25. Indiana (61.0); 26. Delaware (60.4); 27. Florida (59.6); 28. (tie) Louisiana (58.5) and Missouri (58.5); 30. South Dakota (57.4); 31. Wisconsin (55.5); 32. South Carolina (55.4); 33. Arkansas (54.2); 34. North Carolina (53.1); 35. (tie) District of Columbia (52.2) and Maryland (52.2); 37. Alabama (51.9); 38. Kansas (49); 39. California (48.9); 40. North Dakota (47.4); 41. Minnesota (47.3); 42. Iowa (46); 43. Virginia (44.9); 44. Georgia (44.6); 45. (tie) Illinois (44.4) and 45. New Jersey (44.4); 47. (tie) Hawaii (43.3) and New York (43.3); 49. Mississippi (42.8); 50. Texas (38.9); 51. Nebraska (37.7).

2015 STATE-BY-STATE DRUG, ALCOHOL AND SUICIDE DEATH RATES

1. New Mexico (77.4); 2. West Virginia (67.4); 3. Wyoming (66.4); 4. Alaska (63); 5. New Hampshire (60.6); 6. Montana (56.7); 7. Kentucky (56.1); 8. Arizona (55); 9. Rhode Island (54.5); 10. Oregon (54); 11. Nevada (53.8); 12. Maine (51.1); 13. Ohio (50.8); 14. Oklahoma (50.5); 15. (tie) Colorado (49.7) and Utah (49.7); 17. Vermont (47.6); 18. Tennessee (47.3); 19. Idaho (47.1); 20. Pennsylvania (46.3); 21. Washington (45.9); 22. Michigan (45.8); 23. Massachusetts (44.9); 24. South Dakota (43.8); 25. Indiana (43); 26. Florida (42.9); 27. (tie) Connecticut (41.9) and Delaware (41.9); 29. Missouri (41.7); 30. Louisiana (41.2); 31. Wisconsin (39.9); 32. South Carolina (39.7); 33. Arkansas (39.5); 34. North Carolina (37.7); 35. Alabama (36.8); 36. Kansas (36); 37. (tie) District of Columbia (35.7) and North Dakota (35.7); 39. California (35.4); 40. Maryland (35.1); 41. Minnesota (34.5); 42. Iowa (33.9); 43. Virginia (32.3); 44. Georgia (31.9); 45. Illinois (31.3); 46. Hawaii (31.2); 47. Mississippi (30.9); 48. New Jersey (30.5); 49. New York (30); 50. Texas (28.4); 51. Nebraska (28.2).