By Jeanna Smialek Bloomberg

Ryan Johnson was 22 when he succumbed to a heroin addiction that had intensified as the Erie, Pennsylvania, high school graduate grew disillusioned with his future. His mother found him in his room with his head slumped and lips blue.

It was June 28, 2014, the day of his sister’s master’s-degree graduation party.

“He just saw his life as not what he wanted it to be, and he didn’t know how to get it there,” said Sue Johnson, who lay next to her son’s corpse for an hour. He had dropped out of a two-year culinary program and was working part-time, low-wage jobs. He often compared himself with his peers in college and his athletic, academic older sister.

The fates of the less-educated and those who graduate from universities diverge in dire ways. Middle-aged white Americans without four-year degrees are at increasing risk of dying, a well-documented trend driven not only by drug use but also by alcoholism, suicide, and slowing progress against heart disease and cancer. Outcomes may worsen further as millennials-Johnson’s generation-grow older.

“America is not a great place for people with only a high school degree, and I don’t think that’s going to get better anytime soon,” said Angus Deaton, a Nobel Prize-winning Princeton University economist.

It’s too soon to tell whether millennials will die at higher rates in middle age than today’s 45- to 54-year-olds, said Anne Case, a Princeton economist who identified the “deaths of despair” trend with Deaton, her spouse and co-author. But in stories like Johnson’s, there are reasons to worry.

Case and Deaton have a theory for why mortality has risen for less-educated whites. For all the debate over whether college is worthwhile, high school graduates who go straight into the workforce have higher unemployment, weaker wage growth, and less chance of marrying than their predecessors and educated peers. Community supports have broken down, and as disadvantage snowballs, premature deaths rise.

Those problems could intensify for the next generation that reaches middle age. Many millennials, born after 1980, joined the workforce during the Great Recession, so they faced low starting salaries and tough job prospects. And they’re saddled with student debt. Still, almost two-thirds lack a bachelor’s degree, which in today’s economy is a near-prerequisite for jobs that provide higher wages and benefits.

Meanwhile, marriage is happening later and less often. Religious affiliation and union membership have declined, so when life doesn’t work out well for millennials, they’re on their own.

While blacks and Hispanics without college degrees are also falling behind economically and socially, middle-age mortality has worsened for whites in particular over the past 20 years-a fact some attribute partly to social context.

“For whites, their reference group is previous generations of whites,” said Shannon Monnat, a Penn State University professor who studies the opioid epidemic in rural America. “When they look back on their parents and grandparents, it feels like their generation is doing worse.”

Such decline runs deep in Erie, where Johnson attended school and worked a string of part-time restaurant jobs. Nestled against the gray-green waters of one of America’s Great Lakes, the town has been declining since the 1970s. Its population dropped below 100,000 in 2014 for the first time since 1920.

Formerly grand red-brick factories have broken windows and vine-covered exteriors. The local General Electric Co. plant, which makes locomotives for export, has shed almost half its workforce in recent years-1,500 jobs were cut last year, and 950 were moved to Texas in 2013. While service industries including health care show signs of life, high-paying jobs that require only a high school education are increasingly limited.

“A lot of that leads to despair, to hopelessness,” said Scott Slawson, a longtime GE welder and union local president. “It’s a scary path we’re on.”

Erie’s suicide rates have risen, with 48 last year, up from 29 a year on average for the past half-century, according to county coroner Lyell Cook. There were 95 drug deaths in surrounding Erie County last year, up from a historically normal 40, and 35 drug deaths in 2017 as of mid-March, with another 12 likely overdoses awaiting toxicology reports.

The opioid crisis, born of heavy prescribing of addictive pills and compounded by readily available street heroin, has added fuel to the fire for people already facing a tough labor market.

“It stems from depression,” said Jack Martin, a 63-year-old funeral director who’s dealt with many overdose deaths. That’s especially true for younger victims. “When they look down the road: Am I going to get married? Am I going to be successful? Am I going to have enough money?”

Just 71.3 percent of 25- to 34-year-olds who graduated high school but didn’t go on to college were employed in 2016, versus 85.2 percent of college graduates.

Signs of distress are already showing up. Today’s 20- to 34-year-olds are killing themselves at higher rates than people of similar age in 2000. Alcohol-induced deaths have been rising across age groups, and the rate doubled for 25- to 34-year-olds from 1999 to 2015, based on Monnat’s analysis of Centers for Disease Control and Prevention data.

Nationally, 25- to 34-year-olds make up the biggest share of opioid overdoses, and their proportion has been climbing, based on Kaiser Family Foundation data.

Johnson started using opioids in high school after breaking his collarbone, first in football and again while wrestling, and he got hooked on his prescription, his mother thinks. He was a functional addict at first, caring and warm, but things slipped out of control after he graduated and found that his skills-art and cooking, but not academics-meant little in the workforce. After dropping out of culinary school, he went to rehab for the first of three times.

At one point, things were looking up: He was clean and got a full-time job making wood pallets. But his co-workers did drugs, and before long, he was using again.

“That was the thinking there: It’s a stupid job. It doesn’t matter if you’re high to work it,” his mother said.

The cycle ended in June 2014. While she was getting ready for the party for her daughter, who had earned a degree in occupational therapy, Sue Johnson went to wake her son. She couldn’t: He had overdosed.

The next year, Martin, the funeral director, started teaching students at a local high school about opioid abuse. He brings health classes to his funeral home and shows them the white-tiled preparation room and the cold, steel table where he lays out bodies.

“I actually scare the crap out of them,” he said. “But it works.”

He shows them pictures of heroin-dead, explaining that just years before their bodies passed through this sterile room, the deceased had walked high school halls. Among the pictures is a snapshot of Johnson, shaggy-haired and smiling.