The U.S. is in the middle of a devastating drug overdose crisis, one led by opioid-related deaths. But new research out of the University of Southern California highlights just how historically awful the situation really is. It found that the drug overdose mortality in America has shot clear past any similarly wealthy country—with an annual death rate now almost 30 times higher than countries like Japan and Italy.
USC sociologist Jessica Ho looked at overdose death trends from 18 high-income countries across a 20-year span stretching back to 1994.
Throughout the 1990s, she found, the death rate in the U.S. was soundly in the middle of the pack, while rates in countries such as Finland and Sweden were slightly above the rest. But by 2000—four years after the powerful painkiller OxyContin entered the market—it was already steadily climbing. By 2003, the death rate for U.S. men was the highest among all of the countries; by 2005, the same was true for women. The U.S. hasn’t let go of either top spot ever since.
Her findings were published Thursday in Population and Development Review.
“The United States is experiencing a drug overdose epidemic of unprecedented magnitude, not only judging by its own history but also compared to the experiences of other high‐income countries,” she wrote. “For over a decade now, the U.S. has had the highest drug overdose mortality among its peer countries.”
In 2013 (the last year Ho had data for each country), the drug overdose mortality rate for men in the U.S. was 16.97 deaths per every 100,000 people, after adjusting for age. By contrast, Japan’s rate was 0.60 deaths per 100,000 men, a more than 28-fold difference. On average, the drug overdose mortality in the U.S. was 3.5 times higher than the other countries in 2013. And even when compared to Finland and Sweden, the mortality rate was still 60 percent higher.
Ho’s research isn’t the first to show just how much the crisis is uniquely an American problem. A study last year found that, compared to European countries, the number of organs available for transplants from deceased donors in the U.S. has dramatically climbed in recent years, almost entirely due to more overdose deaths. But Ho says her study is the first to conduct such a sweeping comparison of the U.S. and similar countries.
Her findings also seem to confirm the suspicion that the crisis has been directly responsible for a widening life expectancy gap between the U.S. and other nations. The U.S. has lagged behind in life expectancy for some time now, but the sheer number of overdose deaths, which often happen among the young or middle-aged, has only dragged us down further. In 2013, she estimated, the gap in life expectancy would have been, on average, 9 percent and 34 percent smaller for men and women, respectively, without these added deaths.
“While drug overdose alone does not account for the poor and deteriorating U.S. performance relative to other high‐income countries, it is an important contributor to recent increases in the U.S. life expectancy shortfall,” she wrote.
Amazingly, Ho’s findings could be underselling how much worse off the U.S. really is compared to everyone else, given that the most recent year in the study was 2013. In 2014, 47,000 people died of an overdose in the U.S., but by 2017, that number climbed to over 70,000, with more than 40,000 deaths related to opioids (many deaths may involve more than one drug). This rise has been driven mostly by the availability of synthetic opioids like fentanyl, which are more potent and sometimes even falsely sold on the street as other, safer drugs.
On the other hand, while non-U.S. countries have largely avoided or heavily restricted the use of prescription opioid painkillers, neighboring Canada has experienced its own, smaller version of the crisis. And the pharmaceutical industry as a whole has been trying to expand its territory to poorer countries in Latin America, Africa, and Asia, where access to painkillers has been historically low. The industry—including Purdue Pharma, the makers of OxyContin—has been accused of running the same sort of deceptive campaigns they used in the U.S. to now promote opioid use in these countries.
It’s a strategy, Ho noted, that many public health experts have likened to tobacco companies setting up shop in low-income countries after losing their battle to keep people smoking in the U.S. and elsewhere.
“If OxyContin follows the same route, it will pose a major concern because regulatory structures, health care systems, and surveillance systems are much less developed in low‐income countries, rendering them more vulnerable to aggressive marketing by pharmaceutical companies, and there is a strong possibility that serious drug overdose epidemics could develop with very little warning in these countries,” she warned.