There is a story in this weekend’s New York Times about a growing movement among insurers and health-care system administrators to discourage doctors from prescribing so many opiate pain-killers to patients who don’t clearly need them. This is indeed a big problem. These opioids are powerful, dangerous, and extremely addictive. Twenty or thirty years ago, they were very rarely used outside of extreme suffering, typically among patients with terminal diseases. Now, thanks to aggressive marketing by big pharma, these pills are often dispensed like candy. I am amazed at how often, after even the most routine procedure (like getting a cavity filled), doctors will offer to write me up a prescription for Percocet or Vicodin or whatever.
Don’t you ever just want to shout… Suck it Up, America! And as for doctors, geez, do they really have to be told these drugs are dangerous? Don’t they already know?
But the real reason the article caught my attention was this paragraph:
Medical professionals have long been on high alert about powerful painkillers like OxyContin because of their widespread abuse by teenagers and others for recreational purposes.
My question: Why single out teenagers? In fact, kids in their teens and twenties are not the biggest-abusing age bracket for opioids. Not even close. Rather, the biggest abusers today are in midlife. The media needs to wake up to some basic generational shifts here. Accustomed to associating deadly drug use with youthful rebellion, journalists (even at the NYT!) are slow to recognize that drugs today are a much deadlier threat to the peers of Rush Limbaugh than to the peers of Lady Gaga.
It just so happens that we wrote a recent piece in Social Intelligence exploring this issue. It looks at the bad breaking trend in fatal drug overdoses—and it compares and contrasts it with a good breaking trend… in motor vehicle accidents. Here goes.
In recent years, the steady decline in traffic fatalities (now to a record low) has been a genuine good news story. Going back at least fifty years, motor-vehicle traffic accidents had long been America’s leading cause of death by injury—so the big drop is welcome. Yet according to a new report by the CDC, this is actually a good news/bad news story. Between 1980 and 2008, at the same time that the traffic fatality rate decreased by nearly half, from 22.9 to 12.5 deaths per 100,000, the fatality rate from “poisonings” almost tripled, from 4.8 to 13.5. This growth in “poisoning” deaths has been entirely driven by the growth in drug overdoses, which now constitutes roughly 9 out of every 10 “poisoning” fatalities.
Bottom line: As of 2008, drugs—not cars—are America’s leading cause of accidental death.
Let’s look at the good news first. The CDC summarizes the broad range of positive trends that have helped to make driving safer. These include improvements in the safety of vehicles (air bags, auto-body “crumple zones”), improvements in roadways (better lighting and signage), increased use of seatbelts, stricter laws on child safety seats, reductions in speed, and a concerted law-enforcement effort to catch intoxicated drivers and keep them off the road. The rising use of child restraints in particular has been a great success. Researchers found that child safety seats have reduced the risk of fatal injury by 71 percent for infants (younger than 1-year-old) and by 54 percent for toddlers (ages 1-4). Between 1975 and 2008, according to one estimate, almost 9,000 Millennial and Homelander lives were saved by child restraints.
The dramatic decline in teenage traffic deaths is also very good news. Between 1980 and 2006, the motor vehicle death rates for teens (ages 15-19) declined from 42 to only 23 deaths per 100,000. Interestingly, the traffic death rate for teens today is down to the death rate for Americans of all ages back in 1980. One big reason for this decline is the spread of graduated drivers licensing (GDL) programs, which restrict (and often effectively delay) the teen use of cars. According to the CDC, these GDL programs are associated with reductions of 38 to 40 percent, respectively, in fatalities and injuries resulting from accidents involving 16-year-olds. It also helps that the share of teens who consume alcohol is falling. Today, the teen share of DUI arrests is only about half of what it was thirty years ago.
To be sure, teens and cars remain a dangerous mix: Auto accidents are still the leading cause of death among teens, and account for more than one in every three teen deaths. Yet the trend over time has been very favorable.
This youth trend, btw, reflects not just how kids are growing more risk-averse in general—but more specifically how they no longer enjoy the association between driving and risk. This has big implications for auto marketers. Where Boomers and Gen-Xers once saw their first chance at the wheel of a car as an exhilarating ticket to freedom and independence, Millennials see it as something you do under the watchful eye of parents and family. The iconic muscle car is no longer an effective youth attractor. In fact, most Millennials actually take some pride in how carefully they drive. It may make sense to design messages that appeal to that care and pride.
Now let’s turn to the bad news—the shocking rise in deaths by poisoning. Again, this increase in “poisoning” has been driven entirely by the misuse of drugs. (Indeed, poisoning deaths not caused by drugs have actually been declining.) And among drugs, most of the growth has been in one category: opioid analgesics. The brand names of these drugs (such as OxyContin, Percocet, Avinza, Darvon, Vicodin, and Demerol) have become familiar to many Americans, as have the names of celebrities (from Heath Ledger to Michael Jackson) whose lives they have claimed.
Back in the 1980s, opioid addictions and deaths were relatively rare. By 1999, opioids were responsible for 30 percent of all deaths where the identity of the drug could be determined. By 2008, that share had risen to 54 percent. By all accounts, this scourge has been enabled by the increasingly casual distribution of prescription opioids by doctors, typically for pain relief. Medical use can then lead to addiction, and addiction to death. The magnitude of this human tragedy vastly exceeds the 15,000 Americans actually died from an opioid overdose in 2008. The CDC estimates that for every one prescription painkiller death, there are 10 admissions for addiction treatment, 32 emergency visits to the hospital, and 130 people who are chronically addicted.
Which generation has suffered most from opioid addition and death? Given lurid media accounts of youths who host “pharm” or “cocktail” parties (in which teens randomly mix prescription pills in a party bowl), one might suppose that it’s Millennials. Wrong. It’s Boomers. The overdose fatality rate for Americans ages 45-64 is now the highest and fastest-rising of all age brackets. Gen Xers are in second place. Millennials are last. Though overdose death rates have been rising over the last decade for the young as well as the old, the young started from a much lower level. Today’s 50-year-old is now over three times more likely to die of a drug overdose than today’s 20-year-old.
The good news/bad news story from the CDC thus reveals a generational subtext. Consider the good news on traffic fatalities. It wouldn’t have happened without a range of policies—from child safety seats to graduated licenses—that reflect America’s collective determination to protect Millennials and Homelanders, both as drivers and passengers. As for the bad news on drug overdose fatalities, here the important generational driver is Boomers (plus older Gen Xers) moving into their late 40s, 50s, and 60s. Throughout their lives, these cohorts have pushed up personal risk-taking in every age bracket they have passed through. When they were young, teens did more dangerous things with drugs than older people ever imagined. Now that they’re older, they’ve taken the danger with them.