The most underreported story of 2020.

Death Measure: COVID-19 v. Opioids

The ongoing drug overdose epidemic (mainly driven by opioids) has as big if not bigger impact on the USA than COVID-19 deaths as calculated in Years of Life Lost (YLL), a measure of premature mortality.

Photo by Diana Polekhina on Unsplash

My focus here is on the impact of excess deaths caused by these two different epidemics as calculated in Years of Life Lost (YLL).

https://www.pastemagazine.com/travel/the-bucket-list-8-catacombs-for-cryptic-travel/

I apologize in advance for the brutal rationalist nature of this article. I do not seek to make light of anyone’s death, but I seek a common metric of measurement for death to highlight the most under-reported story of 2020.

I will present four different measures of death (cost, death-count, average life expectancy, and YLL).

METRIC OF MEASUREMENT 1: Death costs, for better or worse — one metric of measurement is dollars

Dying is expensive. A recent study in July 2017 by Eric French and others pulled the numbers apart for us to use. In the United States, the last year of someone’s life costs about $80,000 per death according to Health Affairs in a 2017 study and the cost is likely higher now.

As for COVID-19, the estimated medical costs are:

  • Medically-Attended — $9,763 (cost of treating pneumonia without complications)
  • Hospitalization — $13,767 (cost of treating pneumonia with complications or comorbidity)
  • Ventilator — $61,168 (cost of treating pneumonia with ventilator)
State transitions in the COVID-19 disease model

As for an Opioid overdose death, the estimated medical costs are $18,511 per overdose-related ER visit according to the Ameican Journal of Managed Care (AJMC) in the July 20, 2019, The Economic Burden of the Opioid Epidemic on States: The Case of Medicaid, July 30, 2019.

COMPARISON: According to this metric, the cost of a COVID-19 death is higher than the cost of an overdose death ($61,168 v. $18,511).

METRIC OF MEASUREMENT 2: number of deaths

WHAT WE KNOW, THE BIGGEST REPORTED STORY, COVID-19: We have all seen the reports of > 500,000 deaths attributed to COVID-19 within a year of it reaching our shores. As of March 18, 2021, the estimate was 550, 956. This number adds weight to the seriousness of both the epidemic and the economic impact of our efforts to mitigate it.

Contrasted with COVID-19, 81,000+ drug overdose deaths that occurred in the United States in the 12 months ending in May 2020 (lasted reliable estimate), is small. Still, it is the highest number of overdose deaths ever recorded in a 12-month period, according to recent provisional data from the Centers for Disease Control and Prevention (CDC) representing a “21% jump, making it the deadliest year for U.S. overdoses.”

COMPARISON: Again, by this metric, COVID-19 deaths of 550,956 in a year exceed those of overdose deaths (81,000+ in a year). However, the deaths from overdoses are accelerating and those from COVID-19 decreasing (thanks more to the new vaccines than lockdowns).

Photo by Markus Winkler on Unsplash

As is common in our statically illiterate nation, these headline numbers do not reflect the underlying economic/social impact on our country of the excess deaths caused by these two ongoing epidemics (differentiated from the full impact of the COVID-19 epidemic that includes our attempts to control it via lockdowns).

METRIC OF MEASUREMENT 3: Average life expectancy (Ohio v. the USA)

The average age of death for Ohio residents in 2019 was 73.16 years, according to the Ohio Alliance for Innovation in Population Health report. That may not seem like a large shift, but it’s notable because life expectancies have been increasing in the U.S. for the past century, Alliance research lead Orman Hall said. U.S. residents had a life expectancy of 78.7 years in 2018, according to data from the National Center for Health Statistics.

Ohio’s average life-expectancy compared to the USA average evidences increasing ‘deaths of despair.’

COMPARISON: 78.7- 73.16 = 5,54 years difference in average life expectancy between USA and Ohio.

METRIC OF MEASUREMENT 4: Years of Life Lost (YLL)

A more useful metric of measurement allowing us to compare/contrast these two ongoing epidemics is to measure them in Years of Life Lost (YLL), a measure of premature mortality as an alternative to death rates.

Extrapolating from a global study published in Nature: “Globally, 44.9% of the total YLL can be attributed to the deaths of individuals between 55 and 75 years old, 30.2% to younger than 55, and 25% to those older than 75. That is, the average figure of 16 YLL includes the years lost from individuals close to the end of their expected lives, but the majority of those years are from individuals with significant remaining life expectancy…[with] the majority of deaths are occurring at ages above 75….”

Given that “those dying from COVID-19 may be an at-risk population whose remaining life expectancy is shorter than the average person’s remaining life expectancy” Nature AND the world totals estimates YLL based on an age of COVID-19 death at 75 instead of Ohio’s 80, a COVID-19 death in Ohio has an estimated average of approximately half that of the world average, i.e., 5 YLL.

This estimate is based on current Ohio data and a Harvard Study from June 2020 that’s Objective: To examine variation in age-specific mortality rates by racial/ethnicity and calculate its impact using Years of Potential Life Lost (YPLL)….Accounting for age distribution and population size differences between racial/ethnic groups, the age-standardized YPLL rate was 6.7 (95% CI 6.7, 6.8) for NHB, 5.4 (95% CI 5.3, 5.4) for Hispanics, 4.0 (95% CI 3.9, 4.0) for NHAIAN, and 2.6 (95% CI 2.6, 2.7) for NHAPI times higher compared with NHW…. ** Age-standardized rate ratios relative to NHW were 3.6 (95% CI 3.5, 3.7).

[I AM NOT A STATISTICIAN, THIS IS AN ESTIMATE — WHY THIS NEEDS TO BE STUDIED BY THE EXPERTS]

The Overdose Ohio numbers in Years of Life Lost (YLL)

I could not find national measures worth citing, therefore, I have focused on Ohio as one state that has reliable YLL numbers for Opioids/Overdose deaths.

According to a Journal of Addiction Medicine (JAM) report on Ohio overdose deaths, the average Years of Life Lost (YLL) per individual was 39.8 years.

The JAM used a multistep procedure to reach this estimate. First, the total number of Ohioans who died of any cause (n = 119,574) was multiplied by the average lifespan in the state for that year (72.91 years). Second, the total number of 2016 opioid overdose decedents (n = 3411) was multiplied by the average age of death (39.8 years) to determine the total number of years lived by opioid overdose decedents (136,304 years).

This estimate is substantiated by the CDC. Loss of life because of opioid overdose is associated with personal and societal costs, which are compounded by the relatively young age of decedents (Inocencio et al., 2013). With death rates highest among 25- to 54-year-olds for prescription opioid overdose and 25- to 44-year-olds for heroin overdose, individuals succumbing to opioid poisoning are often deprived of many years of work, family, and community life (Centers for Disease Control, 2017).

The COVID-19 Ohio Numbers

As of March 16, 2021, the Ohio Department of Health recorded 17,992 deaths from COVID-19 with a median age of 80 (79% of COVID-19 deaths were of people 70+) with 6,903 of the deaths occurring in Long-term care facilities.

This difference in life expectancy is driven by ‘deaths of despair,’ not COVID-19 deaths.

COMPARISON: Based on the estimated deaths from these two epidemics and the YLL estimates, the ‘cost’ in YLL for the USA is:

  • COVID-19: 550,956 X 5 = 2,754,780 YLL
  • Overdoes: 81,000 X 40 = 3,240,000 YLL

Opioid-overdose deaths (and other ‘deaths of dispair’) are ignored at our nation’s peril

In this light, the ongoing drug overdose epidemic’s impact (mainly driven by opioids) is as big if not bigger than deaths from COVID-19 (differentiated from the full impact of the COVID-19 epidemic that includes our attempts to control it via lockdowns).

While COVID-19 has caused more deaths in the past year than overdoses, the impact of the overdoses has reduced the average life expectancy in the USA (Ohio’s 73.16/78.7-= 5,54 years difference). Further, in the metric of measurement -YLL, the impact may actually be larger than that of COVID-19.

The USA has no vaccines for overdoses.

Synthetic opioids (primarily fentanyl) are the primary driver of the increases in overdose deaths, increasing 38.4 percent from the 12-month period leading up to June 2019 compared with the 12-month period leading up to May 2020. CDC December 17, 2020 Press Release

For example, the WaPo reported, “Overall, drug overdose deaths jumped by 18 percent from the previous year, with increases recorded in 46 states[June 2019-May 2020].”

The media must wake up to this underreported story and the growing ‘deaths of despair in the USA.

Take care of your mental health (resources recommended by CDC)

You may experience increased stress during this pandemic. Fear and anxiety can be overwhelming and cause strong emotions just as despair can too.

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Find a health care provider or treatment for substance use disorder and mental health

Father, attorney, essayist, thinker, and active manager who found the courage to create through the chrysalis of San Quentin prison.

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