In about the time it takes to read this article, one American dies from suicide, according to the American Foundation for Suicide Prevention (AFSP). Every year 1.1 million take their own life. Ninety percent of those who die each year from suicide had a diagnosable disorder, although not all of them received treatment. With all the modern advances in medicine and healthcare, who would think that people would be actually dying sooner?
On November 29, 2018, the Centers for Disease Control and Prevention (CDC) released its annual report on American life expectancy. It painted a morbid picture in which Americans are dying younger from drugs and suicide. For the third straight year, the American life expectancy continued to decline in 2017. Americans are dying at an average age of 78.6. By comparison, life expectancy in Europe in 2016 was 81.
Tipping the U.S. life expectancy downward was the momentous rise in the number of deaths caused by drug overdoses. There were 70,237 of them in 2017. The rate of drug overdoses rose by nearly 10 percent from 2016 to 2017, primarily due to the use of fentanyl and related powerful opioids. Suicides also contributed to this decline, rising 3.7% in the past year alone. The United States is currently in the longest period of a declining life expectancy since the late 1910s, when the flu pandemic and World War I combined to kill nearly 1 million Americans.
According to CDC Director, Robert R. Redfield, “The latest CDC data shows that the U.S. life expectancy has declined over the past few years. Tragically, this troubling trend is largely driven by deaths from drug overdose and suicide. Life expectancy gives us a snapshot of the Nation’s overall health and these sobering statistics are a wakeup call that we are losing too many Americans, too early and too often, to conditions that are preventable.”
Chris Quaglino, LCSW, LCDC is an addiction and suicide prevention specialist. Through his time spent as a 24/7/365 crisis mental health counselor and work with Intensive Outpatient Programs, he says teens and persons in the 65-70 age range are most vulnerable to suicide and self-harm. “Males are more likely to complete a suicide attempt,” Quaglino says. “Statistics show that for every female, four males complete a suicide attempt.” According to AFSP, suicide is the 2nd leading cause of death for those under 45 years old.
Substance abuse can be linked to impulsive behavior which sometimes can lead to suicide. Quaglino isn’t surprised by the lowering of the life expectancy rates. He said, “I know the statistics are rising on drug use in general, as well as the suicide rate of young people. Keeping in touch with and having the door open to communication, especially with young people, is key. Both are difficult because it is the young person’s developmental task to become independent and stretch boundaries. It is always good to slow down, make time, and genuinely be curious, interested and concerned. And don’t wait until there is an issue. Make time and check in when things are going well. Whether drugs are involved or not you can’t go wrong by caring. It’s good to have the initial conversation about drugs with your child. If you feel there is an issue, then seek professional help.”
Suicide Prevention and the Importance of Keeping Communication Open
Quaglino says one of the myths surrounding suicide is that those who attempt it are crazy. “That is false. People who attempt to take their lives are not crazy. Most people are under a temporary state of emotional distress.” The key is to recognize the signs and know when to pull in an expert.
“We need to take all signs of suicidal and self-harming behavior seriously,” he says. Quaglino cites some of the behaviors that could prove dangerous:
- Aggressive or disruptive behaviors
- Behavior changes and mood swings
- Changes in eating or sleeping habits
- Threatening to hurt or kill self or talking about wanting to kill self
- Giving away personal items
- A sudden need to make amends
- Making closure type statements
Behaviors that should be looked for and evaluated:
- A loss of interest in work, school, social activities
- Expressing feelings of hopelessness, uncontrollable anxiety, rage, or revenge
- Expressing a lack of purpose and meaning in life, no reason for living
- Loss of loved one, job, pet, home, independence
Additional behaviors that might be apparent and could be warnings of suicidal risk:
- Relationship problems
- Withdrawing from family and friends
- Engaging in reckless or risky behaviors
- Substance Abuse Drugs and alcohol can result in mental highs and lows that exacerbate suicidal thoughts
- Being bullied
- Talking or writing about death, dying, or suicide
- Depression or extreme feelings of loss
- Isolation or withdrawal from normal activities
- Obsession with death or violence often expressed in art, poetry, or writings
Circumstances that should be monitored and very possibly evaluated by a professional:
- A history of trauma or abuse
- Prolonged stress
- Feelings of worthlessness or hopelessness
- Thoughts of suicide
- Planning suicide
- Family member or friend completed suicide
Quaglino says friends, family members, and parents should be aware and alert when they sense their loved one is struggling. Communication is critical and should be ongoing. Take time and notice – be present he says. Rather than a direct confrontation, “Be curious, ask questions about the behavior you observe, don’t come out and say are you thinking about suicide, that will overwhelm and shut off the communication.”
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Signs of Hope in Slight but Steady Opioid Death Rate Reductions
Despite the grim report from the CDC, there have been some hopeful signs in 2018. Preliminary CDC data from December 2017 to April 2018 shows, for the first time in years, that the number of opioid deaths nationwide has begun to dip, with totals for the preceding 12 months falling slightly but steadily during those five months. Opioid prescription rates have also begun to decline. Further, recent survey data released by the Substance Abuse and Mental Health Services Administration (SAMHSA) suggests that fewer Americans tried heroin for the first time in 2017 (down 52%) and more received addiction treatment. The National Survey on Drug Use and Health: 2017; https://www.samhsa.gov/data/sites/default/files/nsduh-ppt-09-2018.pdf. Moreover, the survey found a decrease in the number of new adolescent users of alcohol (ages 12-17) compared to 2015, though there was an increase in new users ages 18-25.
Though it is far too soon to know if these slight improvements are part of a longer trend, there may be some interesting lessons to be learned in places like Dayton, Ohio. Dayton has been an epicenter of opioid abuse and drug overdoses for the last several years. In 2017, Montgomery County, Ohio, home to Dayton, had the state’s highest rate of accidental overdose deaths for the second year in a row, according to data released by the Ohio Department of Health. But in 2018, overdose deaths have plunged. The county had 548 overdose deaths by November 30 last year, but through November 2018 there have been 264 overdose deaths – a drop of 52%. There are several possible explanations for this positive news.
According to Dayton’s Mayor Nan Whaley, she believes what had the biggest impact on overdose deaths was then-Governor John Kasich’s decision to expand Medicaid in 2015, which gave nearly 700,000 low-income adults access to free addiction and mental health treatment. https://www.nytimes.com/2018/11/25/health/opioid-overdose-deaths-dayton.html. As a result, Dayton gained more than a dozen new treatment providers in 2017, which included residential programs and outpatient clinics that dispense drugs like methadone to treat opioid addiction.
Another factor could be the prevalence of naloxone, a life-saving drug also known by the brand name Narcan, which is the medication that reverses opioid overdoses if administered quickly. Dayton has been at the forefront of in making naloxone widely available. In 2017 alone, Montgomery County distributed 3,300 naloxone kits, and expect to distribute more than double that number this year. Various city agencies hold Narcan training sessions at treatment centers and 12-step meetings as well as at local businesses and schools.
Beginning in 2014, Dayton Police Chief Richard Biehl, first directed all his officers to carry naloxone, which was contrary to many of his law enforcement peers in other Ohio communities. “We really jumped on it because we saw it as absolutely consistent with our public mission to save lives,” Chief Biehl said. Chief Biehl turned out to be right. In a recent Stanford University study, it was estimated that wider availability of naloxone could prevent 21,000 deaths over the next decade. https://ajph.aphapublications.org/doi/10.2105/AJPH.2018.304590.
As more powerful fentanyl and its analogues began appearing in Dayton, officers soon learned that these drugs made it harder to revive overdose victims with a standard dose of naloxone. Therefore, the city, with financial support from the state, has begun spending more ($350,000 in 2017) to provide higher doses of naloxone. This has been money well spent. Helen Jones-Kelley, executive director of Alcohol, Drug Addiction and Mental Health Services for Montgomery County told the New York Times, “If nothing else, you get that second chance with them — and in some cases that third or fourth chance,” she said. “It gives people the opportunity to get connected to services, who would not otherwise have had that chance at life.”
Dayton also is looking at other, new ways to address the fentanyl crisis. It secured a federal grant for a pilot program that distributes fentanyl test strips that can check street drugs for the presence of various fentanyl analogues. Very few other cities are sanctioning the test strips at this point. “If it’s about conserving and protecting life,” Chief Biehl said, “it has to be considered as an option.”
Dayton and Montgomery County may also be seeing the results of Ohio’s efforts to fight the opioid crisis through a quick response team approach. In September 2017, the Ohio Attorney General awarded $3 million to 40 agencies to replicate or expand Drug Abuse Response Teams (DARTs) and/or Quick Response Teams (QRTs). Montgomery County’s team is called Getting Recovery Options Working (GROW). These teams include law enforcement officers, drug treatment providers, medics, clergy members and peer recovery specialists who’ve been through recovery and received special training to assist current drug abusers during the recovery process. Following an overdose, the teams immediately visit survivors and offer drug counseling and referrals to drug treatment facilities where the survivors would receive assessment, detoxification, and treatment. The goal of this type of rapid response is to reduce the likelihood of repeated overdoses and increase the support network for survivors and their families. “I just stop and plant a little seed,” said Darcy Shepherd, a peer supporter with GROW and former opioid addict who’s been sober for over five years. “I will pull up to them, ask how they are doing and if they are ready for treatment, and when they are, to give me a call.”
GROW is one example of Dayton’s efforts to try and bridge the gap between the different methods employed by law enforcement and public health representatives to stem the opioid crisis. Established in the fall of 2016, the Community Overdose Action Team (COAT) was organized to allow dozens of local public health and law enforcement organizations share data and strategize on ways to address the opioid/heroin epidemic in Montgomery County. https://www.phdmc.org/coat#news. The Montgomery County Alcohol, Drug Addiction & Mental Health Services and Public Health – Dayton & Montgomery County are the lead agencies on COAT though over 60 community leaders from numerous public and private organizations, including the Dayton Police Department and Montgomery County Sheriff’s Office, are members of the COAT steering committee that help guide their work.
It is too early to definitely state whether what is happening in Dayton in 2018 is an anomaly or the beginning of a downward trend in drug overdoses. Nevertheless, the multi-layered approach to fighting opioid and heroin deaths in that city is an inspirational example of a community using a variety of tools at its disposal to combat this scourge; one that is killing Americans at such an alarming rate that life expectancy rates are falling to unprecedented levels. Hopefully, Dayton’s actions will yield information that will help other cities develop approaches that yield similar success. For every individual struggling with an addiction or suicidal thoughts, strong lines of communication between friends, family, co-workers, and parent-child can lead to a reduction in destructive behaviors and suicide.