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2017 saw highest rate of death due to alcohol, drugs, suicide in US history [pdf] (paininthenation.org)
136 points by vector_spaces 16 days ago | hide | past | web | favorite | 129 comments

For me, the most useful page of the linked PDF is page 22, the tables of 1999-2015 stats, without any projections. I see numbers from the CDC for general population like:

    Alcohol deaths per 100,000
    1999  2015  Pct Increase
    7.0   10.3  47%

    Drug deaths per 100,000
    1999  2015  Pct Increase
    6.9   16.3  136%

    Suicide deaths per 100,000
    1999  2015  Pct Increase
    10.5  13.8  31%
So, devil's avocado -- anecdotes aside, is this all just due to the opioid epidemic?

Ie, the US is in the middle of a widespread opioid problem right now, and suicide and alcohol use may correlate.

I would love to see some tables that compare this specific data across multiple countries over the same time frame, as that could help tease apart how much of this is really fallout from one single problem in the US, the opioid crisis -- and, if not, what factors might be involved ('are there other countries on a similar track? What do they have in common with the US?').

I wonder if OurWorldInData might be interested ...

Edit: others have posted the link below, with what might be 1 of the 6 sources of data that would be helpful for this comparison: recent global suicide stats by country. (Ideally we'd have this for all 3 causes, and then also for 1999).


There is the Werther-effect[1] aka copycat suicide, which could explain the problem. But probably compounded by other factors such as rising uncertainty (job security, financial struggle) many face today. E.g. for rich nations the problem might be that losing something (job/credit) is harder on people than never having had that "thing" (whatever is "lost") in the first place. (the latter is probably a philosophical point but having gone through rough times after good times myself it always felt harder digging myself out than it felt working hard initially to reach the "good life")

Speaking of philosophy I also have seen claims that the damage that is done to the environment would feed back into the social fabric - so people would kind of feel the tension from the damage that is done to nature. I was unable to find anything that could corroborate these claims nor do I subscribe to it, but fwiw the thought has stuck with me. (my interpretation of it is that many people today are hooked to some form of news on social media which is mostly negative. When I grew up news seem to be something only old people read now everyone is engaged in the problems of far away issues. Or maybe it's because I'm old myself now in comparison and am more prone to consuming news with all its negativity ...)


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:


[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

Relevant question: If someone dies and they have both alcohol and an opioid in their bloodstream, do they count against alcohol, opioid, both, or do they try to work out which one killed them?

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.

Funnily enough, I happened to be on the page that answers this.

Page 160: "Alcohol-induced deaths and drug-induced deaths are mutually-exclusive. However, these deaths may also be considered suicide deaths."

Also, I can't find any more info on what is included here. They just say it doesn't use ICD-10 codes:

>"NCHS has defined selected causes of death groups for analysis of all ages mortality data: Drug-Induced causes, Alcohol-Induced Causes, All Other Causes. The group code values are not actual ICD codes published in the International Classification of Diseases, but are "recodes" defined to support analysis by the Selected Causes of Death groups." https://wonder.cdc.gov/wonder/help/mcd.html#Drug/Alcohol%20I...


If I go to CDC WONDER (https://wonder.cdc.gov/controller/datarequest/D76) and click "Drug/alcohol induced causes" a box populates showing (presumably) ICD-10 codes: X40-44, X60-64, X85, Y10-Y14

That includes stuff you wouldn't expect:


  agents primarily acting on smooth and skeletal muscles and the respiratory system
  anaesthetics (general)(local)
  drugs affecting the:
  · cardiovascular system
  · gastrointestinal system
  hormones and synthetic substitutes
  systemic and haematological agents
  systemic antibiotics and other anti-infectives
  therapeutic gases
  topical preparations
  water-balance agents and drugs affecting mineral and uric acid metabolism 

So this could be partially due to "better access to healthcare". More people are being put on blood pressure, etc medications and are dying from over/under-dosing on them. I don't see any reason for them to include X44 in the current study besides trying to mess with the numbers...


Indeed, when I selected only x44 on CDC WONDER, here are the results:

  Year Deaths per 100k Pop
  1999  1.5
  2000  1.7
  2001  1.9
  2002  2.4
  2003  2.6
  2004  2.9
  2005  3.3
  2006  3.8
  2007  4.2
  2008  4.5
  2009  4.7
  2010  5.0
  2011  5.6
  2012  5.3
  2013  5.5
  2014  5.8
  2015  6.3
  2016  7.4
  2017  8.1
So the death rate from normal (not addictive or recreational) medications is 5.4x higher in 2017 than in 1999.

The full information is available on this via WONDER, it's just harder to find.

ICD coding features both an underlying cause of death, the X40-X44 range you're checking, and a "contributing cause" code which attempts to specify the substance involved. In this case, that's the T40.0-T40.6 range. The government guidelines on using WONDER to study opioids include "Please note: X and Y codes must be used in combination with T codes to identify opioid-related deaths."

That's because X42 only covers certain narcotic opioids like heroin, so an X44 opioid overdose is a possibility. Since that's "Accidental poisoning by and exposure to other and unspecified drugs", it could accompany T40.2 ("other opioids") or T40.6 ("unspecified narcotics"). And if the coroner doesn't record anything beyond "accidental drug overdose", then even heroin overdoses will result in X44, T50.9 ("unspecified drugs"). That last case alone apparently describes 25% of all US overdoses.

There's no slight of hand here, just a confusing two-layered classification system.


edit: here's a CDC page listing which primary and contributing causes can go together. Both prescription and illicit opioid deaths can be be filed as X44. https://www.cdc.gov/drugoverdose/pdf/pdo_guide_to_icd-9-cm_a...

Thanks. Any insight into how they justify grouping in unknown poisonings with those due to common medications?

...poorly? The ICD-10 has been criticized quite a lot for where it splits categories; arcane problems get specific codes, while common issues are both fuzzily spread across buckets and conflated within overlarge buckets.

That said, I think the specific rationale is that X44 is meant to hold all types of low-frequency poisoning by drugs, and 'unknown drug' usually means "not one of the notable drugs that gets its own code and is tested for". This usually works alright. X45-X49 handle cases like "alcohol poisoning", "tainted food", "inhaled chlorine fumes", and "other/unspecified chemicals", so X44 is only representing drugs. And "poisoning" is separate from "adverse effects" (Y40-Y84), so an allergic reaction or a standard risk like bleeding from warfarin won't get mixed in here. Given that, X44 is just a reasonably narrow category to assign a group of T## codes to. Those go into enormous detail, and have secondary "unknown" categories to handle the case where you know the class of drug but not the specific drug. Totally unknown poisonings are restricted to X44/T50.9 and should be extremely rare.

But this was all designed by 1990; it looked reasonable to divide both X and T categories by "non-opioid analgesic", "anesthetics", and "narcotics". It wasn't until we started widely prescribing strong opioids for pain that "painkillers plus heroin" became a key grouping you'd want to research. That, plus the international nature of the system, also left us with "heroin", "opium", and "other opioids" as the only 3 T codes for this topic. The listed examples for 'other' are morphine and its prodrug codeine; as a result we've got fentanyl and morphine in the same category despite a 100x difference in strength.

Compounding that, the narcotic poisoning (X42/T40) grouping was basically doomed from the beginning through no fault of the designers. It tries to replicate the legal/treaty category of narcotics, which has no biological coherence; what on earth do cocaine and morphine overdose have in common? Why is "cannabis derivative poisoning" singled out in the 'narcotics' section of a document created when the only synthetic cannabinoid in use was a rare antiemetic no one abused?

tl;dr: It was supposed to be a low-frequency grouping with subcategories clarifying about specific drugs, but that fell apart for opioids.

Muscle relaxers, certain types of steroids, GHB, NO2, and even cocaine are all technically part of that list.

Your not wrong, but it's not that super clear cut either.

Yes, they are grouping together the (lets call them) "DARE drugs" with "medical drugs".

Presumably this is strategic to hide whatever issue is going on with the "medical drugs" and inflate the apparent problem with "DARE drugs".

This is a good point, but it's not just that; X44 includes opioid deaths!

X42 governs accidental narcotic poisoning, but only in cases where the drug is specified, and isn't necessarily applied for prescription opioids. The list above for X44 is the 'including' list of suggestions, but the category includes any death from "unspecified drugs". And contributing causes of death are handled under a separate system making it possible to list more drugs in more detail, so the CDC says that both prescription and illicit opioid deaths can crop up under X44.


>or do they try to work out which one killed them?

Yes, they put their best medical experts to the task...


Is this per 100,000 deaths? In that case, wouldn't lower rates of traffic accidents and lung cancer contribute to higher relative deaths of drug-related deaths?

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".


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.

Have a read off https://www.economist.com/international/2018/11/24/suicide-i.... The causes are wide and varied and can be specific to certain countries and cultures.

Did they control for age? We have an unprecedented number of older people now, too.

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.

> across multiple countries

It's really difficult to compare suicide rates across countries, especially across time, because how they count suicide is different in different countries and changes across time.

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.

Yep, suicide comparisons between developed countries are very possible - you just can't use headline reported numbers.

I had occasion to look into this one recently, actually. In the UK, for example, undetermined-intent drug and injury deaths among adults are included in suicide statistics by default. (That's based largely on the logic that intent is hard to show and false positives are quite painful, while determination of an accident is comparatively easy and harmless.) The US doesn't include those deaths as suicides, but with standardized ICD codes we can easily recover the data. Adding them in raises the US suicide rate about 11%.

Demography is also available, and pretty significant. The US suicide spike is overwhelmingly in adults, so while the US suicide rate is 66% higher than the UK (without definition correction), the age-adjusted death rate is 40% higher.

And you're right about the mixed causes, too. There are probably a nontrivial number of suicides which are explicitly ruled 'accidental', but stats like "overdoses plus suicides" do a lot of work correcting for that. Even for laypeople it's enough to start with, and then actual researchers of course go into specific data on traffic deaths, drownings, and so on.

But even in the UK you have variation across years.

For one example - the burden of proof used by coroners changed in 2018. This means it's going to be a bit tricky to compare deaths before and after this date, and there's going to be variation as this information is applied by coroners as they get used to the new level.


And the coroners numbers do affect the ONS data.

The ONS describe the difficulties of comparing data across nations here: https://www.ons.gov.uk/peoplepopulationandcommunity/birthsde...

People feeling left aside by society always find a way out, it's more of a systemic issue than an alcohol or drug one.

I guess having a for profit health industry trying to prescribe as much opioid as possible doesn't help.

As long as we keep putting the blame on individuals* and not on the system they live in we're doomed to fail. Putting tax on alcohol, war on drugs and banning beer sales on Sunday aren't going to fix any of the underlying problems.

* which is very easy and relieving, after all I don't have to do anything if that's just how people are.

Perhaps. It’s not a simple issue though. Thoroughly affluent kids get hooked. Affluent parents get hooked. Runaways get hooked, homeless get hooked. Working poor get hooked.

It’s more than “society sucks.” If it really sucked people would be escaping our borders going to Mexico and Canada in droves but it’s the opposite.

If a Mexican citizen is worse off on average than an American, why are Mexicans never the less less impacted by this kind of epidemic?

What do people in depressed areas of Japan do, do they fall for this, why or why not?

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.

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.

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


(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.

* 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.

I think it’s something very much societal. In Japan or China, Vietnam, etc., drug use is almost always seen in a negative light. It’s not about sowing wild oats, having forbidden fun, an outlet for hardship, etc. They’re always denigrated in all media, in society, in school, in music, films, at work, etc. It’s never any kind of cool in any way. It’s shunned ostracized outlawed and unaccepted. Does that map well to our society? I’m afraid not much. We’ll have to find another way out.

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

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.

This assumes helplessness is a main cause, if it were, why aren’t helpless people in other places equally affected, say Japan, India, Zimbabwe, Costa Rica, etc?

I agree that alcohol taxes aren't enough on their own, but their effect is likely very large and positive. This meta-analysis found that doubling the alcohol tax would reduce alcohol related mortality by 35% which is an incredibly high metric in the public health world.


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.

>>The state should not be in the business of saving people from themselves

What should the state be in the business of exactly? It's in the business of defending people from other people. You could frame it as "saving people from themselves" or you could justifiably frame it as "saving people from companies seeking to poison them".

Also, the state has account for these people in the form of emergency care and treatment when they kill themselves (and often times others on their way out). These people are unfairly burdening the tax base when they decide to kill themselves in a spectacular flaming car crash, so why doesn't it make sense for the state to protect the interests of the group as a whole?

That would be a good argument if the state and the corporations it is in cahoots with weren’t creating the problem in the first place.

Those evil robber barons, directly colluding to get me to drink IPAs with my friends after work! The evil! The horror!

Yes. Literally that. You can't advertise cigarettes on TV. You can't even have a business bank account if you run a medical marijuana dispensary. But somehow you can advertise alcohol on network television during prime time.

Alcohol related deaths are the 3rd highest preventable form of death in the US. It's great that you can responsibly enjoy an IPA with your friends. Pretending it's only fun and good times on the larger scale is naive at best.

> Alcohol related deaths are the 3rd highest preventable form of death in the US.

It is not your right to choose what others do with their life. When it's abortion, some people are all "her body, her choice!", and when it's alcohol or cigarettes, it's "her body, our choice!".

Why do you think the sanctity of somebody's own life is yours to weigh against the risks of alcoholism or a tobacco habit, or a taste for soda?

And if they want to do that, they can. Nobody is removing your ability to drink. You're taxing it more heavily because this specific choice results in societal problems that everyone else has to clean up. You'll notice I'm not calling for a ban on alcohol sales. You still have the right to buy it. But it's being priced in a way that reflects the extra burden you put on the rest of us with your choices. This hypothetical tax is meant to represent my desire not to have to deal with the consequences of your choices.

> And if they want to do that, they can. Nobody is removing your ability to drink. You're taxing it more heavily because this specific choice results in societal problems that everyone else has to clean up.

Apply the same argument to healthcare. The main difference is that you think that you have the right to tell people what's good for them.

> This hypothetical tax is meant to represent my desire not to have to deal with the consequences of your choices.

If a man and his son crack a couple beers by the fire in Wyoming, why should their private activities be any of your business? Why impose your will more on the poor than on the middle class or the rich? Your desires are not relevant to the right of ordinary Americans to buy and sell alcohol to and from the willing, just as they are irrelevant to the right of a single mother to raise her own son, or for teenagers to get pregnant; it's just none of your business what people do once you've said your piece, no matter what you think of the risk that they might tend to be more likely to behave in a way you dislike.

> The state should not be in the business of saving people from themselves

Then who should ?

You can blame everything on individuals: "they're lazy", "they're dumb", "they didn't work as hard as I did", "they could save themselves", that's very easy to do, and reassuring in a way. But that's also a very bleak view on our social organization.

Or you can admit that we're all infinitely small parts of a gigantic machinery, that we're all mutually responsible for the system we live in, and that some of the issues raised here are direct consequences of "the state" and its policies.

Just like some people are born in good conditions, probably a majority of hn readers are, a lot of people are not. You don't have to care, you don't have to help them, but at least don't criticize people trying to better society.

Even if you don't care about people and just think in numbers, getting these people out of misery/addiction is a net positive for society on purely a monetary perspective.

> You can blame everything on individuals: "they're lazy", "they're dumb", "they didn't work as hard as I did", "they could save themselves", that's very easy to do, and reassuring in a way. But that's also a very bleak view on our social organization.

I think the lazy people are those who think they should attempt to fix social ills by levying regressive taxes, rather than doing the actual work of convincing and helping people to do better.

> Or you can admit that we're all infinitely small parts of a gigantic machinery, that we're all mutually responsible for the system we live in, and that some of the issues raised here are direct consequences of "the state" and its policies.

But you are not responsible for, nor entitled to, deciding what people do to themselves in private. When a lone free man hurts himself, no injustice is carried out in the act.

> Just like some people are born in good conditions, probably a majority of hn readers are, a lot of people are not. You don't have to care, you don't have to help them, but at least don't criticize people trying to better society.

You can try to better society all you want, but do it without worsening the part of society where people drink responsibly but live on a budget. Minimum pricing punishes all people who buy alcohol for the perceived benefit of those who are presumed to be prone to abusing it, that is why it is unjust. If you just want to better society, work with your local chapter of alcoholics anonymous. If you're just going to sign off on the minimum pricing laws and feel morally righteous about it (because you have no skin in the game), then surely you are the one who is failing morally; the compulsion to "do something, anything!" about each perceived societal ill does not make you a good person.

> Even if you don't care about people and just think in numbers, getting these people out of misery/addiction is a net positive for society on purely a monetary perspective.

I think the whole thing is an exercise in not caring about people and just thinking in numbers. It is not your right to go around imposing your vision of the moral duties one owes to oneself.

The moral wrong of imposing a regressive tax on your personal pet peeves is long lasting, and indicates a lack of commitment to principle. Society does not benefit, on the whole, from standing in favour of an endless stream of petty tyrannies.

Your compulsion to control other people's alcohol consumption by fiat is purely selfish, no matter what you tell yourself, and no matter what word games you choose to impugn the character of those who don't agree.

People with substance misuse disorders have huge impacts on other people - often spouses and children - so the state has a role to play in protecting those people from violence.

Minimum unit pricing is a good way to do this, especially if the money raised is hypothecated for alcohol treatment programmes.

> People with substance misuse disorders have huge impacts on other people - often spouses and children - so the state has a role to play in protecting those people from violence.

What about forcible vaccination? Forcible quarantine? This issue hits close to home, but I still don't see how it is better to prohibit lawful access to alcohol to the poor than it is to support CPS in their overlapping duties.

> Minimum unit pricing is a good way to do this, especially if the money raised is hypothecated for alcohol treatment programmes.

Why do middle class alcoholics get to risk abusing their families more readily than poor alcoholics?


We have (33.5%, per capita [similar difference in median]) lower household disposable incomes in Canada, and very high minimum unit prices. In 2015, the rate of death due to conditions entirely caused by alcohol was around 8.6 per 100,000; about 150% the rate of death in motor vehicle accidents. It's hard to compare the stats between the two countries since the U.S. tends to track "alcohol-related deaths", whereas Canada tends to track "hospitalization due to conditions entirely caused by alcohol" and "death due to conditions entirely caused by alcohol". The National Hospital Discharge Survey indicated in 2010 that approximately 390,000 hospital discharge episodes for persons ages 15 and older had an alcohol-related principal diagnosis, so assuming the worst, one person per discharge, an annual rate of ~126 per 100,000 2010 census persons; in 2015 there were ~77,000 hospitalizations entirely caused by alcohol (a stricter subset, I think), assuming again one person per hospitalization, an annual rate of ~214 per 100,000 estimated Canadians.

I do not think it is settled that particularly high unit prices will reduce rates of death and hospitalization; and as far as I'm aware, we don't have the comparable numbers between the U.S. and Canada (let alone the U.S. and the world at large relative to minimum unit prices), let alone finer grained jurisdictional comparisons, to draw any conclusions like that.

And all of this notwithstanding, I think it is unamerican (as a dual citizen of Canada and the U.S.) to tell free adult people what personal risks they are not entitled to, especially in the form of a regressive price fixing scheme, and I think this is not a proper or appropriate solution to alcohol-related domestic violence.

I wasn't clear in saying the National Hospital Discharge Survey is a U.S. survey.

You don't give any reason for your claim, so I'm not sure if you're serious or trolling, but I'll bite.

What's wrong with trying to stop people dying?

(The regressive aspect I get, but you seem to be against non-regressive measures too.)

If you're interested in these issues, the book Lost Connections by Johann Hari is very good: https://jakeseliger.com/2018/07/26/lost-connections-uncoveri...

>Scanning Facebook is easier than getting a drink

If only it were that easy.

How do beer sales and alcohol taxes have anything to do with the other things you mentioned? Sunday sales laws have been in effect for 3-4 generations it’s just a way for politicians to get the conservative Christian vote.

Alcohol taxes are a valuable source of revenue for cities. The area I’m moving to is trying to incorporate. The alcohol taxes and restaurant permits will directly fund police, fire, and sanitation. It will allow us to improve services without relying on the county.

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.

The "for profit" nature of the health industry isn't the problem.

The problem is that American voters let the health industry get away with stuff like the fraudulent opiate prescription practices...

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.



Again, other first world countries don't let the health industry get away with highly fractionized buyers which are powerless against service providers.

A few of the "highly fractionized" buyers are larger than most first world national health systems, so that can't be the major issue.

There are probably many factors, but there seems to be too little negotiating power on the demand side, even with the bigger insurances. And I assume the bigger buyers are getting better prices, right? Are those buyers bigger by the number of insured members or just according to expense volume?

Again, mostly the government should tell the industry to knock it off, mainly by empowering the demand side rather than the supply side.

Once again, alcohol listed separately from "drugs", and it's the most harmful drug of the lot.

Can we even be surprised that alcoholism is such a problem when we cannot even recognise as a society that it's actually a drug?

In addition to what the other commenter said, it's also worth breaking alcohol out into it's own statistic since it occupies a different place culturally and in people's minds than other drugs. Combining them would just muddle the waters, and make it even harder to make a good argument as to how dangerous alcohol is.

Alcohol's dangers get whitewashed frequently, but they don't hold a candle to the likes ketamine, crack cocaine, and methamphetamine.

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.

It was touch and go there for a while, but I'm happy to have avoided contributing to those statistics.

Every day is a gift, folks.

Glad you're still with us! Surround yourself with people you can talk to.

Despair is the absence of hope. People have been given an unrealistic view of what life should be and when it is so much worse than their expectations they fall into despair.

The media hurts because we are exposed to the "lifestyles of the rich and famous". Im gen X which seems to have the suicide problem. Gen X was raised with "greed is good" and glamorized miami vice. That is a hollow empty promise even when fulfilled.

I think another of the key problems is a lack of life philosophy (spirituality?) where people can find meaning in their lives outside of material goods. This is partially due to the death of religion. There also is a lack of understanding that life is fundamentally unfair and there somehow is the expectation that it should be fair. Without religion people are missing a clear moral compass that guides their life to find meaning. There needs to be a new modern philosophy that has moral underpinnings, but incorporates science, without necessarily having a deity.

Finally, children (including my generation) have been sheltered from lifes daily challenges by being given too much. I suspect when they become adults they simply can't handle what their lives actually are.

I think the current generation of kids are being raised to try to change the world and to seek meaning in helping other people. However they are also being raised to think that life should be fair and they are going to be bitterly disappointed.

The material conditions of life have been annihilated in the areas that have been ravaged by the opioid epidemic. My brother died of a drug overdose on one of them, and it wasn't because of a lack of moral underpinning. It was because almost nobody who is born and grows up in one will ever have a chance of a stable life. No steady access to income, healthcare or a chance of escaping the working class. Hoping for the chance to lead a stable middle class life isn't a moral failing.

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?


<<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.

I have always wondered, what is our life expectancy if we removed all deaths of despair from the statistics? This is a little different than the delta from the change in the deaths of despair (e.g., the report does say that our life expectancy is decreasing because of the deaths, but I didn't see the total impact of all of them on the stat). If I know I'm not going to die because of a death of despair, how long should I expect to live?

How can you know that? Serious question.

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?

For starters, why is your assumption that every overdose death is a "death of despair"? Are you assuming that only people in despair use recreational drugs? Neither of those sounds reasonable to me.

I'm using the terminology from the report.

What part are you asking about?

I am not grenoire, but a large fraction of deaths in America at least are from lifestyle diseases. Heart attacks from obesity, etc. Should these be considered deaths of despair?

The report itself uses the term deaths of despair. It's not talking about obesity.

I think grenoire is asking that should over-eating because one is in despair and dying due to health-related diseases be included in that statistics.

What about adrenaline-junkies that might be doing it due to despair.

I think your question is:

Everything being nominal in an average human's life, what's the age where natural systems cause death?

I think the answer is probably related to the number of cycles before the heart goes out. There some research that there is a set amount of beats per life.

>Studies have concluded that all mammals get about a billion heartbeats per lifetime.


You can actually acutely treat opioid overdose (with antagonists) and so presumably the actual issue here is people use drugs alone in locations where nobody is going to check on them for something like an hour. There may be an education campaign there so that people prescribed painkillers know to never use them alone.

Also, we probably need to invest in lifestyle education for preventing depression like we do for preventing obesity. Have campaigns asking people if they've had one pleasant conversation today. Force workplaces to give people a midday break where they are allowed to leave the facility in winter. Sensitize parents to symptoms of their child developing persistent anxiety or sadness like they are to the height/weight curves. (Also, develop ways of treating mild depression that aren't SSRIs -- light therapy, animals, caffeine, sleep deprivation, whatever, but a ton of people are refusing to seek help because they don't want meds that they see as having too many problematic side effects.)

Maybe I'm missing something, but your source seems to only have data for 99-2015, and references a projection study done by the Berkeley Research Group.

The most interesting part of this report is the huge difference between the numbers for men and women.

Are there any programs in the US helping solve this enormous divide?

This is the hundredth nub of a massive problem of the regression and deterioration of society in the usa. Yes, opiates. Yes, for profit health care. But even those things in isolation are only part of the problem.

Keep going after fentanyl. It's poisoning us.

Fentanyl is dangerous, sure, but until we address the root issues that cause people to take up opiods in the first place (over-prescription, sometimes, but certainly also hopelessness and mental health issues), it'll be an endless game of whack-a-mole.

I think the most cost-effective thing we could do right now to reduce fentanyl deaths is offer test kits free in pharmacies across the country. Anecdotally, the majority of fentanyl deaths I hear of are from people who think they're shooting heroin and don't realize their dope is laced with fentanyl.

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.

No, I really don't- that's why I think it's important that it'd be free. Not every heroin user is under a bridge shooting up with dirty needles; they actually go and buy/exchange clean needles believe it or not. I don't think it's a big jump from there to testing your junk so you can keep your addiction on the down-low rather than having a family member find you blue one evening.

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

Yes this is true but the U.S. handles these things is the worst possible way. So when you say "Going after" it - the statistics show that the current means simply does not work and in fact may actually make the situation worse.

If you isolate everyone the way the modern world does this shouldn’t be surprising.

I have an outstanding hypothesis that suggests that even if the opoid epidemic went totally away tomorrow, this is not the steepest increase, and the increase will continue for the next 20 years.

The suicide rate should bump itself up substantially above 50 per 100k, especially for younger demographics. It should then plateau for the foreseeable future.

I really really really really hope that I am wrong. We have folks with no vision in charge, and they drove a big ship into the rocks: my hypothesis is that this is onset/ramp-up of body count.

I wonder what is the impact of social media in this rate increase. People are getting more and more addicted to it, thus making people more depressed about their lives which in turn find their relief in drugs and alcohol. I am not saying that social media is to blame for everything but as a former heavy user of Snapchat and Instagram, it must be up there as one of the main causes. The sad and hopeless part is that its all by design...

Social media is also an important way to connect for people who are socially isolated, so we should avoid demonising it.

We need to worry about promotion of self harm and suicide being distributed on social media, but most companies are taking action on the worst content.

I suspect it's more the opiods that are the problem. I could be wrong though.

Let me guess, isolation - both social and physical, brought about by cell phones and social media cancer is making people lonely and depressed. They turn to alcohol but that doesn’t quite do it so they turn to opioids and then decide to take their life. Perhaps I’m just pulling on unrelated strings to make a rope, or perhaps there is some truth to it?

Social media and cell phones are the partial solution to the isolation brought about by the way we design our communities - sprawl, no town centers, etc. Also, drunk driving becoming more penalized (rightly so) so less gathering in bars, people becoming less religious. Isolation is the cause of the rise of social media, not the opposite, in my opinion.

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.

I wanted to see what ICD-10 codes they used for "drugs" since I have seen similar claims before that grouped in "drug" over/under-doses in a general sense. Ie, it included stuff like deaths from blood pressure medications.

I was disappointed to find that the "source" was apparently a (no longer found) Washington Post article:

> "The United States is facing a new set of epidemics — more than 1 million Americans have died in the past decade from drug overdoses, alcohol and suicides (2006 to 2015).1"

1 Hohmann J. “The Daily 202: Trump over performed the most in counties with the highest drug, alcohol and suicide mortality rates.” Washington Post December 9, 2016. https://www.washingtonpost.com/news/ powerpost/paloma/daily-202/2016/12/09/ daily-202-trump-over-performed-the-most- in-counties-with-the-highest-drug-alcohol- and-suicide-mortality-rates/584a2a59e9b- 69b7e58e45f2e/?utm_term=.d3109d2f4877 (accessed September 2017).

I have trouble taking this document seriously after that.

Per Appendix B, the source of the data is the CDC's Wonder "multiple cause of death" data, which does include the codes you mention:


"... The Multiple Cause of Death database contains mortality and population counts for all U.S. counties. Data are based on death certificates for U.S. residents. Each death certificate contains a single underlying cause of death, up to twenty additional multiple causes, and demographic data. The number of deaths, crude death rates, age-adjusted death rates and 95% confidence intervals for death rates can be obtained by cause of death (4 digit ICD-10 codes, 113 selected causes of death, 130 selected causes of infant death, drug and alcohol related causes of death, injury intent and injury mechanism categories) ..."

The fact that a study-cum-policy-paper happens to also cite reporting on the problem is par for the course.

Why is the title title phrased as if 2017 was special, when most of the previous years also seen highest death rates from those causes? A lot of charts in the paper end at 2015.

This is a real National Emergency.

I hate to say this, but we brought this on ourselves. It's just one aspect of the decline of America.

At one time, we could identify with, "Land of the free, home of the brave." I remember my Grandpa, saying that to me, and then telling me, "So kid, stay free, and be brave about it. I did my best, and when you grow up, do yours, right? You're an American." Of course, I'm like 10 and know nothing of the world, but I honest felt like I was part of a greater thing, that I was now going to be following in the footsteps of Grandpa.

Then I grow up, and America slowly gives away her freedoms. Not just personal freedom, but the freedom to excel. The middle class slowly fades, education becomes prohibitively expensive. Upward mobility wanes.

Then 911 happens and America loses it's shit. We're shown to just be a bunch of pansies. We react by becoming a (worse) global bully, frightened and trying to control the uncontrollable. And we trade freedom for perceived safety. Ever think the Patriot Act will be allowed to expire?

Then of course we get the perfect to represent the coward bully that is now all of us.

And oh boy do we like our guns and drugs. Now that's the new America. That's our refuge. More guns, and more drugs. We suck down so many drugs that the rest of the world works really hard to keep us supplied. We work hard to keep us supplied (Afghanistan).

And then lastly, we isolate ourselves, unable to make friends, interacting over the internet instead of in person. We shape our world and ideas with constant confirmation bias. We work hard to reinforce our prejudices. Nation of tribal haters. The charade of Democrat and Republican and Ford vs. Chevy and Cowboys vs Patriots. Choose a side, get angry, espouse.

So what's left in an America like that for a man? Sure, it affects women to, much the same, but as a man I particularly feel it. This ain't my America, the one I read about from our past. It's seriously depressing.

This might seem like pining for the old days. "Things are better than ever now!" you say. So, really? Why are people opting out in record numbers then?

None of those things should have any impact on your daily life. If you didnt plug into the internet (your choice) you wouldnt know about any of those things and they simply wouldnt matter.

I live in the same country and I have a great life based on the actual people around me, not based on news media that pulls the worst things from around the country to try to generate more clicks.

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.

Today I worked from home. Had a nice cup of tea. Listened to classical music and spend a number of hours getting aws cli to play nicely with org more. I used the internet without touching social media for 18 hours and this is not unusual. Get off the outrage machine and do something with your life. The only people who benefit from you constantly being outraged are the ones selling you the outrage.

I'm doing great. I'm very disconnected from most outrage media. Haven't used social media in forever. Have plenty of close friends, and family. Successful career. Also working from home today.

I'm just saying the outrage machine is unavoidable. I've had friends and family that are deeply effected by it even if they don't openly admit it. Friends that are in rehab for opioids. Friends and co-workers that do nothing but smoke pot so they don't have to worry about their lives. Family members that became fox news addicts and blatant racists. I'd even argue that you're effected by it. You have to actively avoid it right? You understand the outrage machine and have actively decided to disconnect yourself from that world. Not saying that you're doing the wrong thing, just saying the outrage machine effects everyone. People that aren't particularly smart, financially successful, strong or mentally stable get hit by it much worse.

Sure, it’s possible and plenty of people do turn it off or minimize use. Internet use is voluntary, and one can choose their level of use/interaction with it. Try it for a week! Unplug and just live your life.

I’ve always thought one of the few real extraordinary strengths of the USA culturally is the extent to which “going off grid” is acceptable. If you want to, you can live a fine life without social media, Netflix, and cable TV. If you want, you can move to the middle of nowhere, dig a well and put up solar panels. You can homeschool your kids. You can hunt your own food. Not all of these things require lots of money. Compared to many places in the developed world, by and large you have an extraordinary ability to choose your own level of societal interdependence.

Yea I agree. You can definitely disconnect completely from society. I've been off social media for a while and don't really follow much outrage media. But you can't tell your friends and family what to do. They can still have an unhealthy fixation on the latest media/culture war and unless you disconnect from those people it will become a part of your life. Technically you can always be a hermit. I just don't find that a very appealing choice.

All of those things are "lots of money" if you are living paycheck to paycheck. They are even lots of money if you make six figures and save 25% of your income.

You've made some undeniably good points, and it is true that the current state of our country is in many ways lamentable, but a fair analysis of our current condition reveals that the negative news is only half the story; it is important to keep in mind the dualistic nature of our situation, both for ourselves as individuals, and for the greater society we are components of.

Alongside all of the tragedies you mentioned, an entire host of miracles have occurred as well. Technological advances in healthcare show no sign of slowing, market forces (and public pressure) are slowly but surely moving us toward a future powered by green energy, US-based companies are now sending missions to the ISS and mass-producing electric vehicles, and the USA still has the greatest institutions of higher learning in the world. On a minor technical note that may seem insignificant but is near and dear to my own heart: it's 2019 and there are now more flavors of *Nix (and users of the same) than ever before - free software is still going strong despite the tech behemoths' anti-choice tendencies. On the front page of HN right now is a story about the mass exodus of users from FaceBook (an indicator that the public is waking up to the damaging effects of emotionally-predatory social media).

In the political sphere, too, there are signs of significant improvement. The 2018 midterm elections revealed a public who is more informed about and interested in governmental oversight than at any point in the past decade at least, more attention than ever is being paid to white-collar corruption and chicanery, the best efforts of our unindicted co-conspirator in-chief (and his merry band of sycophants) haven't succeeded in quashing the myriad investigations into his (and his family's) business and political activities, and the most popular politician in the country (according to some recent polls) is an avowed anti-corruption advocate who supports universal healthcare, a resolution of wealth inequality, and an end to endless overseas warfare. On your drug points: every major contender for the Democratic presidential nominee (that I'm aware of) favors a rebalancing of federal drug enforcement priorities to bring sanity to the discussion (funding for research into the use of psychedelic drugs for therapy & the decriminalization of marijuana). On the gun front: there has never been more public support for (slightly) more sane gun restrictions than there are now.

There are many places we need to improve, but there is much to be grateful for, optimistic about, and proud of as well. The reason I say this is not in an attempt to refute or mitigate your points, but to emphasize the need to periodically remove oneself from the negative data streams and pay attention to the good evidence as well.

Political choices matter.

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.

All of that, except obviously 9/11, has been that way since 'the old days'

The American dream was always unsustainable. It relied (and still does) on exponential growth, the idea of unlimited free land, and the exploitation of other nations.

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.

We have different definitions of the American dream. Just the idea of 'your kids should have a better life than you had," which I think has been fundamental to the dream seems unsustainable.

Our infrastructure grows and technology makes things cheaper. Why not a steady state where everyone has enough? With growing automation, fewer have to work and then not as hard. That could be a better life for everyone if we could make it equitable.

About 1.9 million deaths in the US. About 45K or 2% of those are suicides.


And people here are saying that is the national emergency?

The US is nowhere near the top in terms of suicide rates in the world.


If we really wanted to help people, we'd focus more on heart disease, diabetes, etc. But I guess we don't want to tackle the food industry, soda industry, process food industry, etc.

I don't who is behind all the "alcohol, drugs, suicide" scaremongering. But I have a sneaking suspicion that the "solution" will be pump people with more pharmaceuticals.

I'm not saying suicide is not a terrible thing, but it certainly isn't a "national emergency" compared to heart disease, strokes, cancer or diabetes.

It's about what's trending. Recent stats on US life expectancy showed an overall drop. Heart disease and (I think) cancer trended down (as it has for years), but that was more than offset by the up trend in suicide and overdoses. I'm not sure what the definition of "emergency" is, but I'd say the data shows suicide and OD are the top concerns at the moment.

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.

OP is saying the rate of change is cause for alarm, not the overall distribution.

Interesting that Soviet republics figure so heavily on the top of that list. And they uniformly have huge male:female ratios.

Also that Japan, notorious for a suicide culture, is only 30th. Maybe if they counted all the murders made to look like suicide, they would be further up.

Suicide is a mostly preventable death. Other countries are seeing reducing rates of death by suicide. Why is the US seeing rising rates?

Pretty sure I lost some brain cells reading your comment

> The US is nowhere near the top in terms of suicide rates in the world.

... Is that really an argument against action?

> compared to heart disease, strokes, cancer or diabetes.

Because studies have shown that making a small effort will make a large difference in suicide rates... It would be great if we could cure cancer, but we just can't.

That would require people taking a hard look at themselves and their own habits, which won't happen. Hard to scare people with what they are familiar with (even if it's slowly Killing them.) See also: climate change.

And in other news, "2017 saw largest total population in US history".

How about "2017 saw highest increase in death due to alcohol, drugs and suicide in US history"?

I'm not sure what population has to do with it. The headline and the PDF itself talk about the rate of death — the text refers to deaths per 100,000 throughout.

Headline says "rate of death", implying a correction for total population.

I suspect it might rise more. With a culture that predominantly revolves around party/fun culture where you drink alcohol and consume drugs, when youth of other cultures are busy planning their life and studies & career, where youth in U.S. is more inclined towards partying and porn and care free lifestyle; No wonder the numbers might rise.

Pardon? The highest increases in suicide and overdoses is in the 45-54 year old demographic (see page 23).

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