The deadlier drug crises that we don’t consider public health emergencies

German Lopez · Friday, October 27, 2017, 2:39 pm

Alcohol and tobacco kill far more people than opioids. Should they be considered an “epidemic”?

In 2016, this drug was linked to more deaths than guns, car crashes, or even HIV/AIDS at its peak. Actually, it was associated with more deaths than guns and car crashes combined.

I’m not talking about opioids. I’m talking about alcohol.

According to the Centers for Disease Control and Prevention (CDC), alcohol is linked to 88,000 deaths each year — more than all the 64,000 drug overdose deaths in 2016. That includes all potential alcohol deaths: liver cirrhosis, poisonings, crimes related to alcohol, driving while intoxicated, and so on. But it’s a very high death rate — making alcohol the third leading cause of preventable death in the US.

What’s worse, the 88,000 number may, at this point, be an underestimate. The figure comes from an analysis of deaths between 2006 and 2010. But since then, we’ve seen some signs that alcohol deaths may have gone up: Between 2010 and 2015, the number of alcohol-induced deaths (those that involve direct health complications from alcohol, like liver cirrhosis) rose from nearly 26,000 to more than 33,000.

Alcohol isn’t even the deadliest drug in the US. That would be tobacco, which is linked to, depending on the estimate, 480,000 to 540,000 deaths each year — regardless, the leading preventable cause of death in America. (This figure is likely a bit too high, since it’s based on mortality data from 2005 to 2009, and smoking rates have dropped since then. Still, it’s an extremely high death toll.)

Yet all of these deaths didn’t inspire President Donald Trump or the presidents before him to formally declare a public health emergency over tobacco or alcohol, as Trump finally did for opioids on Thursday. We don’t often call alcohol or tobacco “epidemics,” even as we regularly use that same language for opioids that are linked to a fraction of the deaths from alcohol or tobacco.

Maybe we should. We have a lot of evidence that we could do much more to combat alcohol and tobacco deaths. But we haven’t.

We’ve become desensitized to legal drug deaths

Part of the reason there are far more deaths from alcohol and tobacco than other drugs is because alcohol and tobacco are legal for recreational purposes and, therefore, far more accessible. If you were to look at deaths per user, several other drugs — such as the dangerous synthetic opioid fentanyl — would very likely pull ahead.

But that’s not a reason to ignore the problems alcohol and tobacco pose. They still lead to tens of thousands of people needlessly dying in the case of alcohol and hundreds of thousands dying when it comes to tobacco.

Yet we have become desensitized to these drugs. When I’ve asked drug policy experts about this, they have attributed it to the fact that alcohol and tobacco — and the deaths they cause — have just been with us for a long time. That’s made the deaths feel routine.

That’s not to say that policymakers have done nothing about either. Anti-tobacco campaigns, particularly since the 1990s, have done a lot to reduce smoking rates. (About 16.8 percent of adults reported smoking recently in 2014, down from 42.4 percent in 1965.) Similarly, the push to take drunk driving seriously in the 1980s helped reduce both alcohol-related deaths and car crashes.

Read more
https://www.vox.com/policy-and-politics/2017/10/27/16557550/alcohol-tobacco-opioids-epidemic-emergency