Dying from overdoses… making sense of the senseless

A few years ago, while speaking with a colleague on the phone, I shared my sorrow over the death of a young friend who’d just turned 21. My colleague instantly supportive asked me what she’d died of. When I confessed that it was a heroin overdose, my colleague’s voice hardened and she said in an accusing tone, “Well you know more people like that.”

What I didn’t say then was that we all do. Drug overdoses in the U.S. are now the leading cause of accidental deaths. In 2013, that was close to 44,000 Americans, far more than the 35,000 who died in auto crashes that year or the 16,000 who were murdered.

Many of us, like my former colleague, hold stereotypes about what heroin users are like and may even assume that their overdoses are morally deserved. But in reality, people who abuse medications or illegal drugs look and sound like you — no matter who you are. CDC data shows that every demographic slice is effected and that most of those who died from an opiate overdose were white, suburban (often middle class) people between 25 and 54 years old. At least half of those who died, overdosed on prescription analgesics.

Perfect Storm

Perfect storm of cheap street drugs, over prescription of painkillers, helicopter parents, performance stress, and changes in perception of risk

The fast rise in drug and alcohol abuse has been influenced by economics and societal trends. “Popular” drugs trend with availability and price. For example, heroin’s popularity was bolstered by the last decade’s influx from Afghanistan that drove its price well-below the street value of prescription drugs. Meanwhile, we saw (and are still seeing) substantial leakage out of our medical system as U.S. prescribers write more scripts for opiate painkillers each year than there are adults in the country. QRCs who have the opportunity to “listen in” on discussions by insurers and health systems know that at multiple places in our healthcare system, physicians and administrators are discussing and implementing changes to their policies and to how they incentivize providers. Their goal is to safely address a systemic over-reliance on pain killing medicines.

Even as access to pharmaceutical drugs tightens and street drugs get cheaper, we see a confluence of social and cultural trends that conspires to make younger generations more vulnerable to addiction. SAMSHA surveys show teens and twenty-something’s perception of harm of misusing marijuana, drugs, and alcohol declining while the consequences as measured in related deaths, emergency room visits, and arrests soar. The thinking goes something like “if it’s legal (somewhere) it must be safe to use.” And, by extension, “if one pill makes me feel good then more pills will make me feel even better.”

These are the children of parents, many of whom are conflicted about the harm of drugging and drinking — after all they did it too. Often referred to as “helicopter” parents, many have over-protected their children from failure, unhappiness, and consequences. The consequences of being protected from disappointments, of not hearing the word “no,” and from being given “every opportunity” has resulted in “gifted” teens and young adults who don’t know how to internally manage the natural bouts of anxiety, performance stress, frustration, and sadness that is integral to growing up.

Some channel their feelings of chronic stress into getting better grades and into top schools with a soul-numbing, tunnel-vision focus that Yale professor William Deresiewicz writes about in his book “Excellent Sheep.” About a fifth use mood-altering substances to manage feelings or “self-medicate.” SAMSHA’s 2013 survey measures the use of illicit drugs at 21.5% among young adults aged 18 to 25 versus 9.4% for all Americans over 12. Marijuana is the most popular and fastest growing drug. Because the new cultivated marijuana plants have THC levels 10 times higher than plants 20 years ago, mental health professionals are seeing a rash of marijuana induced anxiety and psychoses. (One dear family member now relies on medication to help manage schizophrenic thinking that appears to have been teased out, in part by hash). I’m curious to see whether we’ll get some push back from health providers as states expand legalization of medical marijuana.

Three more teens died from overdoses last week in and about my town. Teachers, students, school social workers, along with parents and friends are grieving here. My husband is losing his keys and threatening to punch out our neighbor. Disassociating feels safer. It’s time to disentangle the causal elements of this damn storm.