2017: when the US woke up to deaths from despair

Published by UnHerd (26th December, 2019)

In the summer of 2017, I found myself in Dayton, Ohio. This friendly and rather nondescript city is famed worldwide as home of the Wright Brothers and birthplace of aviation. But the reason for my visit was a less welcome distinction: it had the highest rate of drug overdose deaths in a nation wounded by a hideous epidemic ripping through families and communities.

A week before my visit, Donald Trump declared that the drug crisis had descended into a national emergency. As I drove around the streets with an affable cop called Andy Teague, he told me he had never seen a heroin overdose before 2011. During our four hours together, there were 12 overdoses on his patch. In one abandoned house, we found a pile of crystal meth big enough for hundreds of hits that he just swept across the floor since it was not worth his time turning it in.

At the end of our time touring the city, we came across a couple slumped like corpses in their car outside a house used by dealers. Their eyes were closed, their mouths open as they lay back on their seats. The impact of ultra-potent opioids was so instant that one syringe lay between the woman’s legs and another on the jeep’s dashboard. The woman was brought back to life, her partner was less fortunate.

It was an astonishing scene, a disturbing tableau for modern America in the age of Donald Trump. Yet it was also a familiar image for the world’s richest nation as a toxic new tide of opioids, often of turbo-charged strength, coursed their way through society under the reign of their newly installed populist president.

This was the year the US finally woke up to what was happening in its midst. There were 70,200 overdose deaths, a sharp rise on the previous year and more than the toll from guns, car crashes or AIDS at the peak of its epidemic. At least 10 million people were misusing opioids, wasting an estimated $80 billion from the economy.

The awful scale of abuse and addiction raises issues over prohibition, exposing the futility of trying to curb the flow of illicit drugs in a globalised world where chemists in Asia can cook up new drugs for immediate sale across the 50 states of America. The Dayton coroner told me his team would monitor the dark web to determine the products that would soon be found inside bodies in their morgue.

But it sparks other issues too: over the US health system, which leaves so many poorer people without healthcare to tackle problems. Over the rapacious nature of unchecked capitalism, since the epidemic was fostered by a pharmaceutical firm pushing highly-addictive new painkillers and callous doctors signing dozens of daily prescriptions in ‘pill factories’. It has even provoked debate over rich philanthropists who profit from misery then launder their images with donations to major museums.

Yet perhaps the most profound issue exposed by that grim scene in an Ohio suburb is the corrosive sickness that lies at core of some of the world’s richest countries, lurking in dark shadows behind the happy, shiny consumerism of contemporary society.

Dayton is a place that has, like other parts of Middle America, struggled with impact of industrial decline as traditional factories offering secure, well-paid jobs were replaced by more insecure, lower-paid employment. Among the firms closing plants was General Motors, for so long the flag-bearer for corporate America, which once churned out engines and pick-up trucks in the city. Many assembly-line workers ended up flipping burgers, pouring beer or delivering parcels in the gig economy.

Several local officials, even a Right-wing police chief, told me how the opioid crisis was a symbol of decline, people were self-medicating in communities and families that suddenly suffered low wages and high unemployment. These were the sorts of places where life was stable, then suddenly became fraught and uncertain. It felt significant that Montgomery Country — home of Dayton — switched from almost three decades of voting Democrat to backing Donald Trump the year before my visit.

Most of the casualties in this cruel epidemic cutting through America were white, male and middle-aged, with overdoses the biggest killer of Americans under 50. Many were also middle-class. ‘This is not just about an unemployed, homeless person shooting up in an alleyway,’ said Don Patterson, mayor of Kettering, a smart Dayton suburb filled with nice houses, neat lawns and fluttering flags. ‘There are kids in blue blazers, people you meet here in the street.’

Those drug users dying in their thousands perfectly illustrate the decline of the American Dream. They should provoke deep questions over failures inherent in capitalism and Western democracy. Their deaths, all that painful distress, should feed into discussions over the rise of populism and inequality.

It is not, after all, just about drugs. Alcohol-related death rates have also been steadily increasing. And suicide levels started surging in the United States after falling for two decades in line with other wealthy nations. In 2017, the number of people taking their own lives hit a new record of 47,173, a rise of about one-third since the turn of the century. Highest rates were among middle-aged white men.

These people trying to blot out the world and bury their troubles fuelled a sudden, unexpected reversal in rising life expectancy in the United States over recent years.

The British Nobel laureate Sir Angus Deaton and his equally-brilliant wife Anne Case, economists at Princeton University who have tracked this plague of pointless fatalities among middle-aged white people, called them ‘deaths of despair’. They published a paper in 2017 called ‘Mortality and morbidity in the 21st century’. It revealed death rates of white people with no more than a high school diploma had grown to be 30% higher than those of black people — having been 30% lower at the turn of the century.

Next year, the couple is publishing a new book, Deaths of Despair and the Future of Capitalism, looking at how the landscape of Middle America is littered with broken dreams for those without college degrees. ‘Capitalism, which over two centuries lifted countless people out of poverty, is now destroying the lives of blue-collar America,’ says the blurb. It should be widely-read.

The couple are not alone in examining the fatal flaws of capitalism. A study of six decades of mortality published last month in the Journal of the American Medical Association examined how the country spent more than any other nation on healthcare, yet was seeing falling life expectancies due to drug overdoses, liver disease and suicide.

It found that one third of ‘excess deaths’ since 2010— the number of deaths greater than the number of deaths projected by U.S. mortality rates — were in Ohio and three other rustbelt states. Steven Woolf, the lead author from Virginia Commonwealth University, said US death rates were supposed to be falling as in other nations. ‘The fact that that number is climbing, there’s something terribly wrong,’ he told The Washington Post.

But those deaths do not just expose a rupture of America’s underbelly. A report earlier this year by the Institute for Fiscal Studies (IFS) suggests we are seeing something similar on this side of the Atlantic. The IFS analysis showed the same trends emerging among middle-aged British men — and to a lesser extent women — with a rise in deaths of despair over this decade. It warned the widening gap between runaway rich and struggling poor was ‘making a mockery of democracy’.

Also telling is the fact that experts who calculate life expectancy for the pensions industry this year made their biggest cut in forecasts, saying evidence of shortening British lifespans that first emerged around 2010-11 had become ‘a trend as opposed to a blip’.

Can it be coincidence these changes are being seen in two countries with some of the highest levels of inequality among developed nations? And that here in Britain, we have seen this surge in deaths amid austerity, a harsher benefits regime, stagnating incomes and collapsing social care?

Britain, with drug-related deaths at record levels, accounts for almost one-third of all such overdoses in Europe. Scotland, the most severely-afflicted part of the country, has higher drug death rates than the United States.

Two months after my trip to Dayton, I went to Kingston-upon-Hull to investigate a spate of 16 deaths from fentanyl, the painkiller 100 times stronger than morphine that was causing such carnage across the US.  Signs across the East Yorkshire city, struggling with high unemployment, proclaimed it was ‘Capital of Culture’, which it had been awarded that year in a desperate bid to revive its fortunes. Yet as I talked to drug users and those trying to help them, I heard the same sad stories as I had in Ohio: of lives wrecked by addiction, along with complaints of slashed treatment services and grotesquely inadequate mental health care facilities.

One user in his forties told me of his collapse after taking heroin adulterated with fentanyl on a busy shopping street. ‘Next thing I knew I was in an ambulance.’ As we sat on filthy blankets below an iconic Hull mosaic on a shuttered shopfront, I asked if he would ever take fentanyl again. ‘I don’t care about my life – look at it,’ he replied. ‘I don’t want to die but if I do I’m not bothered.’

Such despair should not be seen in isolation. The surging tide of death which we first noticed only three years ago, should feed into wider debate about Brexit, the gig economy, the salaries of corporate titans, the tax system, the breakdown of communities, the spiralling mental health crisis, even that decline of Labour fiefdoms in the north and Midlands we recently observed in the election. ‘Events in this proud fishing community should serve as a wake-up call to complacent authorities,’ I wrote for the Mail on Sunday. It was true then. But it is even truer now.

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