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The United States has been in the throes of an opioid epidemic for years. Based on long-term trends in mortality and mental health over the past two decades, new research highlights just how devastating the crisis has been. But monitoring and understanding these trends could help policymakers implement effective prevention and treatment programs.

From 2001 to 2016, the number of opioid-related deaths rose from 9,489 to 42,245—representing a 345 percent increase. The prevalence of opioid-related deaths was 0.4 percent of all deaths in 2001, but grew to 1.5 percent in 2016, according to a study published this month in JAMA Network Open.

“There has been a large rise in opioid-related deaths over time, which we expected, but what was most striking was one out of every 65 deaths was related to opioid use. That number is staggering,” says Tara Gomes, the study’s lead author and an epidemiologist at Ontario Drug Policy Research Network (ODPRN).

Back in 2015, two Princeton University economists published a key study showing that life expectancies were beginning to decrease for middle-aged Caucasians. The deaths were often attributed to drugs, , and —the pair dubbed these “deaths of despair.” To probe the phenomenon further, University of Virginia professor Christopher Ruhm examined U.S. mortality rates from 1999 to 2015. He found that increases in drug-related deaths during that period could account for “the entire growth” in mortality rates and years of potential life lost among Caucasians aged 22–56. The findings were published in the American Journal of Preventive Medicine.

“We have this surprising result that whites in their 20s through their 50s are living shorter lives than they were, say, at the turn of the century,” Ruhm says. “If it were not for the role of rising drug deaths, that would not be the case.”

Both papers highlight the impact of the opioid epidemic on adults in their 20s and 30s in particular. By 2016, one out of every five deaths among people aged 24–35 was due to opioids. As important as it is to address opioid use among young people, however, older adults have not been spared from the epidemic, says Andrew Kolodny, co-director of opioid policy research at the Heller School for Social Policy and at Brandeis University, who was not involved with the research. Younger people are less likely to die in general, which makes the increase connected to opioids appear especially dramatic, he says, and opioid deaths among the elderly are often misreported as occurring from other causes.

Parallel Concerns About Mental Health

Another research team explored the concept of “deaths of despair” by investigating whether despair itself had really grown over time. They analyzed a group of 4,600 adults surveyed in 1995 and 1996 and another group surveyed between 2011 and 2014, gauging their psychological well-being and emotions such as , fulfillment, sadness, and hopelessness.

Mental health remained steady or improved slightly for people of high socioeconomic status, but it plunged for people of low socioeconomic status, according to the study, which was published in the journal Proceedings of the National Academy of Sciences.

“The mental health of American adults has deteriorated from the mid 1990s to the early 2010s, which is a period that coincides with increased opioid use and increased deaths of despair—and the problem is particularly notable for people of low socioeconomic status,” says the study’s lead author, Noreen Goldman, a professor of demography and public affairs at Princeton. Importantly, however, while the study noted that both trends have occurred simultaneously, it did not investigate a causal link between the two.

The Challenge Ahead

Tracking the trajectories of opioid-related mortality and mental health is important so that researchers and policymakers know where to focus their efforts, explains David Bradford, a professor of public administration and policy at the University of Virginia. Monitoring trends other than deaths is also necessary so that researchers can learn whether prevention and treatment programs are working. “We really need a system for tracking how many Americans have and how many are getting it each year,” Kolodny says. “That doesn’t exist yet.”

Ramping up these efforts will be critical in the years to come, as there is no evidence that the crisis is nearing a peak. Doctors and dentists have become more cautious about prescribing opioids to patients, so the number of people becoming addicted is beginning to decrease, Kolodny says, but he projects that the death toll will likely continue to mount because so many individuals are already addicted. Furthermore, he points out, when people who are addicted to opioids turn to heroin, the drug may be mixed with a far more deadly opioid, fentanyl. “Among users of illicit opioids, deaths are soaring because we have never had such a dangerous heroin supply as we do with the emergence of .”

With fentanyl permeating the nation’s the drug supply, the disheartening trends researchers are describing may continue into the future. “The last few years,” says Bradford, “have been more alarming, frankly, than the first 10.”