“Substantially reducing the doses of pain medication prescribed for patients on long-term opioid therapy is associated with a threefold increase in suicide attempts and a 69 percent increase in overdoses, according to a study published this week in The Journal of the American Medical Association (JAMA). The study reinforces concerns that the “tapering” encouraged by federal guidelines as a response to the “opioid crisis” causes needless suffering among patients, leading to undertreatment of pain, withdrawal symptoms, and emotional distress.”
“Although the CDC’s advice was not legally binding, and although the guidance said doses should be tapered only when medically appropriate, doctors, lawmakers, insurers, and pharmacies interpreted the agency’s warnings about daily doses exceeding 90 MMEs as a hard limit. “These and other widely disseminated recommendations have led to increased opioid tapering among patients prescribed long-term opioid therapy,” Agnoli et al. note.”
“The CDC is mulling revisions to its advice. “A revised CDC Guideline that continues to focus only on opioid prescribing will perpetuate the fallacy that, by restricting access to opioid analgesics, the nation’s overdose and death epidemic will end,” Mukkamala warned in his letter to the CDC. “We saw the consequences of this mindset in the aftermath of the 2016 Guideline. Physicians have reduced opioid prescribing by more than 44 percent since 2012, but the drug overdose epidemic has gotten worse.””
“After years of steadily moving in tandem, two of America’s worst public health trends diverged during the coronavirus pandemic.
Drug overdose deaths jumped 30 percent last year to 92,500, according to newly released federal data, a sudden surge following years of incremental increases once the opioid epidemic took hold. But suicides actually dropped slightly, from 47,500 in 2019 to 44,800 in 2020.
Those two trends have tracked closely over the past decade, so much so that there is an umbrella term in academia that encompasses both of them (among other things): deaths of despair. Much of the recent stagnation in US life expectancy can be explained by these premature deaths, concentrated especially among young men, and scholars have theorized about the economic and social conditions driving those trends.
That was the situation before Covid-19. So what happened during the pandemic?”
“Last year saw 44,834 Americans kill themselves, according to provisional data from the National Center for Health Statistics (NCHS) and the National Vital Statistics System (NVSS). That’s down from 47,511 in 2019, 48,344 in 2018, 47,173 in 2017, and 44,965 in 2016.
We do not know from the data in question whether the number of attempted suicides changed at all last year.”
“The leading U.S. cause of death last year remained heart disease, with 690,882 heart disease deaths last year. This number has been slowly but steadily ticking up over the past five years, from 633,842 heart disease deaths in 2015.
The second leading cause of death remained cancer, with slightly fewer cancer deaths last year than in 2017–2019. The provisional data list 598,932 cancer deaths last year.”
“In other news related to COVID-19 and mortality: New estimates from the Centers for Disease Control and Prevention (CDC) suggest the virus is deadlier than previous estimates let on.
“According to the ‘best estimate’ in the most recent version of the CDC’s COVID-19 Pandemic Planning Scenarios, 9 percent of people 65 or older who are infected by the COVID-19 virus die from the disease,” notes Reason’s Jacob Sullum.”
“People who attempt suicide with a gun die nine times out of 10, whereas other common means (such as cutting and overdose) are much more survivable. That’s why the New York Secure Ammunition and Firearms Enforcement Act of 2013 (New York SAFE Act) directed mental health professionals to report suicidal patients to a state agency, which could subsequently seize any guns they might own, and add their name to a “no buy” database for five years. Even in New York, though, this provision is controversial and has faced repeated court challenges. We shouldn’t expect to see similar legislation proliferating across the country anytime soon.
Instead, suicide prevention activists have been trying to cultivate a culture of community responsibility among gun owners, asking them to reach out to friends in crisis with an offer to store their guns after a divorce, job loss, death in the family or other trauma. The idea of letting your neighbor or your hunting buddy lock your gun up in his safe for a while might be more palatable than handing it over to the sheriff. Suicide prevention groups have partnered with gun shops and shooting ranges, first in New Hampshire and now in 11 other states, to spread the idea through posters and pamphlets.”
“Many states have gradually lowered the bar to obtain a permit to carry a handgun in public places. The trends have been toward fewer hours of classroom instruction (reduced in some cases to zero), eliminating shooting requirements at the range, and lowering fees. Tennessee now offers a gun carry permit course that can be completed entirely online. Other states, such as Kansas, have eliminated licensure altogether. When Texas lowered training standards for its concealed handgun license in 2013 to just four hours of classroom instruction, lawmakers said that there simply wasn’t enough material to justify the 10 hours previously required. Typical curriculum covers operation of a firearm and some guidance about where and when it might be appropriate to use it. Some gun violence prevention advocates would like to see the curriculum expanded to include strategies in de-escalation, risk avoidance, safe storage and first aid.”
Homicide Harvard Injury Control Research Center. Havard T.H.Chan School of Public Health. FIREARMS AND FAMILY VIOLENCE Arthur Kellermann, Sheryl Heron. 1999. Emergency Medicine Clinics of North America. https://www.sciencedirect.com/science/article/abs/pii/S0733862705700924 Firearm possession and violent death: A critical review Wolfgang Stroebe. 2013. Aggression and Violent
“Firearms are only used in a small number of suicide attempts, but are responsible for a majority of suicide deaths.”
“The newest of the papers, authored by John Kaufman, Leslie Salas-Hernández, Kelli Komro, and Melvin Livingston in the Journal of Epidemiology and Community Health, examined monthly data across the US from 1990 to 2015 and estimated that a $1 increase in the minimum wage led to a 3.4 to 5.9 percent decline in suicides among adults with a high school education or less. The authors also estimated that over the 26-year period, a $1 increase in each state’s minimum wage could have prevented 27,550 suicide deaths, or about 1,059 per year.
The paper has created a bit of a stir. But it’s just one of four studies in the past couple of years to find an association between higher minimum wages and lower death rates (specifically suicides).
If these findings hold up in subsequent research, they provide a new, persuasive rationale for raising the minimum wage.”