Issue Category: Substance Misuse and Mental Health

Trust for America’s Health and Well Being Trust Launch National Resilience Strategy Blueprint to Raise Awareness of and Offer Solutions for Drug, Alcohol and Suicide Crises

(Washington, DC and Oakland, Calif., July 2) – A new web-based blueprint designed to help communities deal with the drug, alcohol and suicide crises launched today.

In November of 2017, Trust for America’s Health (TFAH) and Well Being Trust (WBT) released Pain in the Nation: The Drug, Alcohol and Suicide Crises and the Need for a National Resilience Strategy. The report detailed the growing number of “despair deaths” – deaths due to drug and alcohol misuse and suicide – and more than 60 evidence-based programs proven to help fight contributing factors and save lives.

This companion piece, the Pain in the Nation: National Resilience Strategy website, will help policy-makers and community leaders access critical data and prevention-oriented programs and policies – including promotion of responsible opioid prescribing practices, enforcement of underage drinking laws, and anti-bullying and social-emotional learning programs in schools, among others. The website also provides state level data on how the drug, alcohol and suicide crises are impacting lives across the country and includes case studies describing community and school-based prevention programs that work.

“The numbers of these deaths are staggering and tragic. They are also preventable,” says John Auerbach, president and CEO of Trust for America’s Health.  “As a nation, we need to apply what we know about prevention to address the root causes of this epidemic of substance abuse and suicide. The time to act is now.”

According to the Trust for America’s Health and the Well Being Trust, a National Resilience Strategy must be comprehensive and focused at both the crisis intervention level and on early identification of and action on the causes of poor mental and physical health. The Pain in the Nation: National Resilience Strategy website provides a high-level roadmap for communities to tackle these difficult issues.

“To better support the conditions that can prevent these deaths of despair, we must intervene at the source and look at the issue through a more comprehensive systems lens,” says  Benjamin F. Miller, Psy.D., Chief Strategy Officer, Well Being Trust. “While closing the treatment gap is important, we’ll never get there if we don’t also focus on closing the prevention gap – by increasing attention on adverse childhood experiences, chronic stress, food deserts and all the additional health inequities across geographies and demographics.”

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Trust for America’s Health is a non-profit, non-partisan organization that promotes optimal health for every person and community and makes the prevention of illness and injury a national priority. Twitter: @HealthyAmerica1

Well Being Trust is a national foundation dedicated to advancing the mental, social and spiritual health of the nation. Created to include participation from organizations across sectors and perspectives, Well Being Trust is committed to innovating and addressing the most critical mental health challenges facing America, and to transforming individual and community wellness. http://wellbeingtrust.org/. Twitter: @WellBeingTrust

New “Pain in the Nation” Issue Brief Focuses on How Healthcare Systems Can Help Address and Prevent Deaths of Despair

Washington, D.C., May 17, 2018 –Trust for America’s Health (TFAH) and Well Being Trust (WBT) released Pain in the Nation: Healthcare Systems Brief, which focuses on how healthcare systems can help address the deaths of despair due to drug and alcohol misuse and suicide.

According to the brief, hospital stays for mental health and/or substance use were the only categories of hospitalizations that increased from 2005 to 2014.  Between 2009 and 2014, opioid-related inpatient stays increased 64 percent while emergency department visits doubled—placing hospitals and health systems on the front lines in providing and/or linking patients to behavioral health services and integrating mental health services across systems.

To address these issues, the brief recommends healthcare systems apply a careful systems approach that focuses on preventive interventions, clinical care and behavioral health services—building a “whole health” approach with integrated and linked programs.

The brief follows the release of the national report and projections: Pain in the Nation: The Drug, Alcohol and Suicide Epidemics and the Need for a National Resilience Strategy, which found that, in 2016, 142,000 Americans—one every four minutes—died from the diseases of despair and two additional briefs focused on the education sector and an updated data analysis finding that—while drug overdoses were still highest among Whites in 2016—there were disproportionately large increases in drug deaths among racial/ethnic minority groups.

“Healthcare systems are often in a unique place to bring about clinical change that can impact countless individuals seeking care,” said Benjamin F. Miller, PsyD, Chief Strategy Officer, Well Being Trust. “We need better integration within healthcare so that people seeking help for mental health and addiction can have their needs met in a more seamless and timely fashion. Trying harder is not going to be enough – we need systems level change.”

The Pain in the Nation: Healthcare Systems Brief provides extensive recommendations that will enhance behavioral health services:

Better care integration and coordination—Many providers have never been trained in suicide prevention and lack the confidence to effectively deal with suicide. And, while behavioral health services have long operated in their own silo apart from the traditional medical care systems, systems and providers should continue to shift towards an integrated or “whole health” mentality to ensure coordinated medical and behavioral healthcare services and systems.

Boosting medication-assisted treatment—Enhancing behavioral health services requires ensuring providers are employing up-to-date treatments that have been proven clinically effective, notably medication-assisted treatment (MAT)—the use of FDA-approved medications in combination with therapy to treat substance use disorders. In addition to being clinically effective, MAT also makes fiscal sense. A 2015 study found that treatment of opioid dependence with methadone and buprenorphine was associated with $153 to $223 lower total healthcare expenditures per month than behavioral health treatment without MAT.

Improve pain treatment and management practices—Evidenced-based strategies should be used to better address pain. Healthcare providers have a responsibility to ensure they are working with their patients on increasing overall functionality and quality of life in ways that do not leave their patients vulnerable to substance misuse. Healthcare systems should develop practices that require physicians to treat pain responsibly, including:  guidelines on appropriate opioid prescribing; training healthcare providers to identify early signs of opioid use disorders; and strengthening prescription drug monitoring programs (PDMP) and other tools to detect misuse.

Foster community partnerships—Prevention efforts are most effective when multiple sectors in a community work together to support prevention and identify at-risk community members to ensure they receive the support and services they need. For example, the Massachusetts General Hospital (MGH) Center for Community Health Improvement created four coalitions focused on take-back programs, naloxone distribution, connections to treatment through recovery coaches, and screening all patients for substance misuse. In one neighborhood, Emergency Medical Services responses for heroin overdoses decreased 62 percent over a seven-year period.

Screening for substance misuse, suicide and mental health issues—Healthcare systems should coordinate with schools and other community partners to implement screening and provide access to treatment for individuals identified as at-risk for substance misuse, suicide or other mental health concerns. Systems also play a role in supporting evidence-based primary prevention efforts in their community—including social-emotional learning programs.

Reduce access to lethal suicide means—Healthcare systems can encourage providers to counsel patients to safely store both firearms and medications. One method, the Counseling on Access to Lethal Means (CALM) at Children’s Hospital Colorado, found that parents of children being treated for suicide risk who were educated about safe storage of medications and guns made significant changes in their behavior. Additionally, take back programs can help prevent drug misuse.

Ensuring people have better access to behavioral health providers—A successful behavioral healthcare system requires sufficient providers. Currently, 55 percent of U.S. counties do not have any practicing behavioral health workers and 77 percent report unmet behavioral health needs. While it is incredibly difficult to close this gap, the nation should focus on innovative interventions—including telehealth—to ensure people have better access to the health providers they need to be well.

“By prioritizing prevention, working together and improving behavioral health services, healthcare systems can help mitigate the devastating crises of drug overdoses, alcohol-related fatalities and suicides,” said John Auerbach, president and CEO of TFAH.  “Healthcare systems can and should advocate for the policies and resources necessary—both within and beyond the clinical setting—to reduce alcohol, drug and suicide deaths among their patients.”

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Trust for America‘s Health is a non-profit, non-partisan organization dedicated to saving lives by protecting the health of every community and working to make disease prevention a national priority.  Twitter: @HealthyAmerica1

Well Being Trust is a national foundation dedicated to advancing the mental, social, and spiritual health of the nation. Created to include participation from organizations across sectors and perspectives, Well Being Trust is committed to innovating and addressing the most critical mental health challenges facing America, and to transforming individual and community wellness. www.wellbeingtrust.org. Twitter: @WellBeingTrust

Pain in the Nation

New Report: «state»’s Drug, Alcohol and Suicide Death Rate Could Increase «inc_percent» in Next Decade; «state» Would have «rank_25_upper» Rate in Country

Study Highlights Solutions, Calls for National Resilience Strategy

Washington, D.C., November 21, 2017 – «state»’s drug, alcohol and suicide death rate could increase by «inc_percent» in the next 10 years, according to a new report, Pain in the Nation: The Drug, Alcohol and Suicide Epidemics and the Need for a National Resilience Strategy, released today by the Trust for America’s Health (TFAH) and Well Being Trust (WBT).

«state»’s rate could rise to «rate_25» per 100,000 people from these three causes by 2025 – which would be the «rank_25_lower» – compared to the state’s current rate of «rate_15» per 100,000 (as of 2015), which is the «rank_15_lower».

Nationally, deaths from drugs, alcohol and suicide could account for 1.6 million fatalities over the coming decade (2016 to 2025). This would represent a 60 percent increase compared to the past decade, if recent trends hold, based on an analysis conducted by the Berkeley Research Group (BRG) for this report. From 2006 to 2015, there were 1 million deaths from these three causes.

  • Nationally, in 2015, there were 127,500 deaths from drugs, alcohol and suicide. The epidemics currently are responsible for 350 deaths per day, 14 per hour and one every four minutes.
  • According to the report’s projections, this could reach 192,000 per year by 2025 (39.7 deaths per 100,000 in 2015 compared to 55.9 per 100,000 in 2025).
  • At a state level, in 2005, 21 states and Washington, D.C. had death rates from these three causes above 30 per 100,000, and only six states had death rates above 40 per 100,000.
  • As of 2015, 48 states and Washington, D.C. had rates above 30 per 100,000, 30 were above 40 per 100,000 and five states had rates above 60 per 100,000, including New Mexico which had the highest rate of 77.4 per 100,000.
  • By 2025, 26 states could reach 60 deaths per 100,000 – and two states (New Mexico and West Virginia) could reach rates of 100 deaths per 100,000.

The study found, however, that these numbers may be conservative, especially with the rapid rise of heroin, fentanyl and carfentanil use. If the nation continues along recent trajectories, death rates would actually double to 2 million by 2025.

“These numbers are staggering, tragic – and preventable,” said John Auerbach, president and CEO of TFAH. “There is a serious crisis across the nation and solutions must go way beyond reducing the supply of opioids, other drugs and alcohol. Greater steps – that promote prevention, resiliency and opportunity – must be taken to address the underlying issues of pain, hopelessness and despair.

Current Nationwide Trends

  • Drug overdose deaths tripled between 2000 and 2015 (with a total of 52,400 deaths in 2015), with rural community opioid-related death rates increasing seven-fold. Provisional data shows drug overdoses could exceed 64,000 in 2016, with fentanyl deaths alone accounting for 21,000 of these deaths (and fentanyl-related deaths doubling between 2015 and 2016).«state»’s drug overdose death rate was «deaths_drug» per 100,000 in 2015, which ranked «rank_drug».
  • Alcohol-induced deaths increased 37 percent between 2000 and 2015, reaching a 35-year high at 33,200 deaths in 2015. This excludes alcohol-attributable deaths related to injury and violence.«state»’s alcohol-induced death rate was «deaths_alcohol» per 100,000 in 2015, which ranked «rank_alcohol».
  • Suicide deaths increased by 28 percent between 2000 and 2015 to more than 44,000 deaths (as of 2015). Rural suicide rates are 40 percent higher than in metro areas.«state»’s suicide death rate was «deaths_suicide» per 100,000 in 2015, which ranked «rank_suicide».
  • As of 2015, more than 43 million Americans experienced a mental health issue, more than 20 million had a substance use disorder and more than 8 million experienced both – and these numbers are likely to be underestimates due to stigma and lack of available treatment; and
  • Only around one in 10 people with substance use disorders receive recommended treatment.

Report Calls for a National Resilience Strategy

“We’re facing a generational crisis. And it calls for bigger and bolder action. Simply creating new programs to address one piece of the problem is insufficient – we need more robust and systematic change. The good news is: we know a lot about what works and can make a difference,” said Benjamin F. Miller, PsyD, Chief Policy Officer, Well Being Trust. “This report highlights the need for investments that take a whole-person approach to wellbeing – encompassing the physical, mental, emotional and spiritual aspects of wellbeing – to truly address the drivers of pain, ultimately saving lives.”

Pain in the Nation calls for the creation of a National Resilience Strategy that takes a comprehensive approach by focusing on prevention, early identification of issues and effective treatment. The report highlights more than 60 research-based policies, practices and programs to reduce substance misuse and suicide and improve well-being.

Example State Policies and Rates: The report features more than 60 policies – the following are some example policies where state activity can be tracked «state» National Trends
A “Y” means the state has a particular policy
State Law Requires Prescribers to Query the Prescription Drug Monitoring Program (PDMP) Before Submitting an Opioid Prescription (as of 2017)

«policy_pdmp»

37 States
State Law Allows Laypersons to Possess Naloxone Without a Prescription (as of 2017)

«policy_possession»

14 States + D.C.
State Has a Good Samaritan Law Protecting People from Reporting/Experiencing an Overdose from Liability (as of 2017)

«policy_samaritan»

40 States + D.C.
State Has a Law Supporting Sterile Syringe Access Programs (as of 2016)

«policy_syringe»

24 States + D.C.
State Has a Commercial Host Liability Law (also known as dram shop laws, which hold a seller responsible for providing alcohol to minors or intoxicated individuals, laws vary in terms of levels and types of allowed liability) (as of 2016)

«policy_commercial_host»

37 States + D.C.
State Has a Comprehensive Anti-Bullying Laws (all states have some form of law, American Academy of Pediatrics reviewed laws for comprehensiveness) (as of July 2017)

«policy_anti_bullying»

22 States
State Requires Annual Suicide Prevention Training for School Personnel (as of 2016)

«policy_suicide_prevention»

9 States
Number of Physicians in the State Certified to Provide Buprenorphine (Medication-Assisted) Treatment to 100 or more patients (as of October 2017)

«policy_buprenorphine»

1,297 Physicians Nationwide
Children Confirmed as Victims of Maltreatment by Child Welfare Services – Rate Per 1,000 Children. (as of 2015)

«policy_maltreatment_rate»

9 per 1,000
State Has an Earned Income Tax Credit (which supports better outcomes for low-income families, including boosting millions of families out of poverty) (as of 2016)

«policy_eitc»

26 States + D.C.

Some key recommendations from the report include to:

  • Improve Pain Management and Treatment by helping people heal physically, mentally and emotionally. Approaches must acknowledge that there are different types of pain and experts from mental health, medical care and other disciplines must develop team-based solutions that focus on proactively addressing pain before it gets worse.
  • Stem the Opioid Crisis with a full-scale approach – including promoting responsible opioid prescribing practices (such as provider education and best practices for Prescription Drug Monitoring Programs); public education about misuse and safe disposal of unused drugs; “hotspot” intervention strategies; anti-trafficking to stop the flow of heroin, fentanyl and other illicit drugs; and expanding the use and availability of rescue drugs, sterile syringes and diversion programs.
  • Address the Impact of the Opioid Epidemic on Children – and the Need for a Multi-Generational Response that includes substance use disorder treatment for parents and wrap-around services for children and families, including grandparents and other relatives who help care for children, and expand support for the foster care system.Model programs for families struggling with opioid and other substance misuse disorders have been twice as effective in helping mothers achieve sobriety, reduced state custody placement of children by half and had a return on investment of $2.22 for every $1 spent on child welfare programs.
  • Lower Excessive Alcohol Use through evidence-based policies, such as by increasing pricing, limiting hours and density of alcohol sales, enforcing underage drinking laws and holding sellers and hosts liable for serving minors.For example, a 10 percent increase in the price of alcoholic beverages is shown to reduce consumption by 7.7 percent.
  • Prevent Suicides by expanding crisis intervention services; anti-bullying and social-emotional learning in schools; and support systems for Veterans; and better integrating mental health into primary care.For instance, the Zero Suicide model program has shown 80 percent reductions in suicides.
  • Expand and Modernize Mental Health and Substance Use Disorder Treatment Services – Toward a Goal of Focusing on the “Whole Health” of Individuals by prioritizing innovative integrated delivery models for rural and underserved urban areas and expanding the provider workforce, including those who can deliver medication-assisted treatment.Some effective substance use treatment programs have a return of $3.77 per $1 invested.
  • Prioritize Prevention, Reduce Risk Factors and Promote Resilience in Children, Families and Communities by limiting trauma and adverse experiences, which have the biggest long-term impact on later substance misuse, and promoting better mental health.For instance, nurse family home visiting programs have a return of $5.70 for every $1 invested, and early childhood education programs have a $4 to $12 return for every $1 invested.
  • Reboot Substance Misuse Prevention and Mental Health in Schools by scaling up evidence-based life- and coping-skills programs and inclusive school environments and increasing the availability of mental health and other services.Top school substance misuse prevention programs have a $3.80 to $34 return for every $1 invested; social-emotional learning programs have an $11 for $1 return; and school violence prevention (including suicide) programs have a $15 to $81 for $1 return.

The report was supported by grants from WBT and the Robert Wood Johnson Foundation (RWJF). Data analysis and projections were provided by the Berkeley Research Group. The full report is available on TFAH’s website at www.healthyamericans.org.

2015 STATE-BY-STATE DRUG, ALCOHOL AND SUICIDE DEATH RATES AND 2025 PROJECTIONS

Based on an analysis of new state-by-state data from the Centers for Disease Control and Prevention’s Wide-ranging ONline Data for Epidemiologic Research (CDC WONDER), current (2015) and projected (2025) rates of deaths per 100,000 people from drugs, alcohol and suicide from highest to lowest were:

Note: 1 = Highest rate, 51 = lowest.

2025 PROJECTIONS, STATE-BY-STATE DRUG, ALCOHOL AND SUICIDE DEATH RATES

1. New Mexico (105.7); 2. West Virginia (99.6); 3. Wyoming (88.8); 4. New Hampshire (88.1); 5. Alaska (84.4); 6. Kentucky (81.3); 7. Rhode Island (79.7); 8. Arizona (75.8); 9. Montana (75.6); 10. Nevada (75.0); 11. Ohio (74.6); 12. Oregon (72.8); 13. Maine (71.5); 14. (tie) Oklahoma (70.0) and Utah (70.0); (tie) 16. Colorado (67.8) and Tennessee (67.8); 18. Pennsylvania (67.7); 19. Massachusetts (66.6); 20. Michigan (65.9); 21. Vermont (65.8); 22. Idaho (63.4); 23. Washington (63.3); 24. Connecticut (61.2); 25. Indiana (61.0); 26. Delaware (60.4); 27. Florida (59.6); 28. (tie) Louisiana (58.5) and Missouri (58.5); 30. South Dakota (57.4); 31. Wisconsin (55.5); 32. South Carolina (55.4); 33. Arkansas (54.2); 34. North Carolina (53.1); 35. (tie) District of Columbia (52.2) and Maryland (52.2); 37. Alabama (51.9); 38. Kansas (49); 39. California (48.9); 40. North Dakota (47.4); 41. Minnesota (47.3); 42. Iowa (46); 43. Virginia (44.9); 44. Georgia (44.6); 45. (tie) Illinois (44.4) and 45. New Jersey (44.4); 47. (tie) Hawaii (43.3) and New York (43.3); 49. Mississippi (42.8); 50. Texas (38.9); 51. Nebraska (37.7).

2015 STATE-BY-STATE DRUG, ALCOHOL AND SUICIDE DEATH RATES

1. New Mexico (77.4); 2. West Virginia (67.4); 3. Wyoming (66.4); 4. Alaska (63); 5. New Hampshire (60.6); 6. Montana (56.7); 7. Kentucky (56.1); 8. Arizona (55); 9. Rhode Island (54.5); 10. Oregon (54); 11. Nevada (53.8); 12. Maine (51.1); 13. Ohio (50.8); 14. Oklahoma (50.5); 15. (tie) Colorado (49.7) and Utah (49.7); 17. Vermont (47.6); 18. Tennessee (47.3); 19. Idaho (47.1); 20. Pennsylvania (46.3); 21. Washington (45.9); 22. Michigan (45.8); 23. Massachusetts (44.9); 24. South Dakota (43.8); 25. Indiana (43); 26. Florida (42.9); 27. (tie) Connecticut (41.9) and Delaware (41.9); 29. Missouri (41.7); 30. Louisiana (41.2); 31. Wisconsin (39.9); 32. South Carolina (39.7); 33. Arkansas (39.5); 34. North Carolina (37.7); 35. Alabama (36.8); 36. Kansas (36); 37. (tie) District of Columbia (35.7) and North Dakota (35.7); 39. California (35.4); 40. Maryland (35.1); 41. Minnesota (34.5); 42. Iowa (33.9); 43. Virginia (32.3); 44. Georgia (31.9); 45. Illinois (31.3); 46. Hawaii (31.2); 47. Mississippi (30.9); 48. New Jersey (30.5); 49. New York (30); 50. Texas (28.4); 51. Nebraska (28.2).

Trust for America’s Health is a non-profit, non-partisan organization dedicated to saving lives by protecting the health of every community and working to make disease prevention a national priority. For more information, visit www.healthyamericans.org. Twitter: @HealthyAmerica1

Well Being Trust is a national foundation dedicated to advancing the mental, social, and spiritual health of the nation. Created to include participation from organizations across sectors and perspectives, Well Being Trust is committed to innovating and addressing the most critical mental health challenges facing America, and to transforming individual and community wellness. www.wellbeingtrust.org. Twitter: @WellBeingTrust

Deaths from Alcohol, Drugs and Suicide for People of Color Rise Dramatically, Although Still Below the Rates of White Americans

Deaths from Alcohol, Drugs and Suicide Reach Highest Level Ever Recorded

February 22, 2018

Washington, D.C., February 22, 2018 – According to a new Trust for America’s Health (TFAH) and Well Being Trust (WBT) analysis, there were disproportionately large increases in drug deaths among racial/ethnic minority groups, particularly among Black Americans, who experienced an increase of 39 percent in drug deaths between 2015 and 2016. And, Latinos saw drug death rates increase 24 percent, while the rate for Whites increased 19 percent from 2015-2016.

In addition, alcohol, drug and suicide deaths increased at a record pace in 2016 – by 11 percent – and represent more than 14,000 additional deaths over 2015. Now, for two years in a row, increases in these deaths have been at record highs.

Additional main findings:

  • 142,000 Americans, the highest number ever recorded, died from alcohol-induced fatalities, drug overdoses and suicide – an average of one every four minutes.
  • Deaths from synthetic opioids – including fentanyl and carfentanil – doubled from 2015 to 2016 from 9,600 to 19,400 and was the driving force for the increase in drug deaths (alcohol, other types of drug and suicide deaths also increased but by a much lower amount).
  • The Northeast and Midwest had the largest increase in alcohol, drug and suicide deaths between 2015 and 2016. Six states and Washington, DC saw alcohol, drug and suicide death rates increase by more than 20 percent: Delaware (25 percent); Illinois (21 percent); Maryland (40 percent), New Jersey (22 percent), Ohio (21 percent), Pennsylvania (25 percent) and Washington, D.C. (58 percent).

TFAH and WBT issued projections in the November 2017 Pain in the Nation: The Drug, Alcohol and Suicide Epidemics and the Need for a National Resilience Strategy report, which found that if alcohol, drug and suicide deaths continued on the trajectory of the past decade, they could reach 1.6 million over the next decade.  However, the substantial rise in deaths in 2016 puts the country past the “worst case scenario” projection trajectory. If deaths continue to grow at rates similar to those from 2015 to 2016, deaths could top more than 2 million from 2016-2025.

“These data should be a signal to every person – from our friends, family and neighbors to policy makers—that we have a crisis in our country with drugs, alcohol and suicide. These crises scream for action—this is a nightmare scenario—and our communities are suffering,” said Benjamin F. Miller, PsyD, Chief Strategy Officer, Well Being Trust. “We must recognize that it is beyond time to act. These data shouldn’t just be a talking point, these are lives—we need immediate, cross cutting systemic action.”

Trend Analysis

The new Pain in the Nation Update Brief features extensive trend analysis of synthetic opioids, alcohol, total drug, and suicide deaths.

  • Deaths from synthetic opioids surpassed, for the first time, the numbers of deaths related to heroin and common prescription opioids like morphine and codeine;
  • Latinos (24 percent increase), 15-34 year-olds (29 percent) and those living in the Northeast (32 percent) and Metro areas (22 percent) had relatively large increases in drug death rates between 2015 and 2016;
  • Opioid deaths that did not involve synthetic opioids dropped 3 percent – from 23,500 in 2015 to 22,800 in 2016;
  • Over the past decade (2007-2016), the alcohol death rate increased 40 percent; and
  • Suicide rates among Blacks and Latinos in 2016 escalated more than other demographic groups (10 and 9 percent increases, respectively). Suicide rates among those 45 years and older actually declined by 1 percent (while suicide among those under 45, increased by 4 percent).

“For each of these deaths, many more Americans are affected, either directly or through family and friends,” said John Auerbach, president and CEO of TFAH.  “These new data demand policymakers rethink what communities are affected and what multi-sector strategies are needed to address these three epidemics. We must ensure that funding, programmatic efforts and policies are directed to all the people and communities in need. The solution is a comprehensive National Resilience Strategy to combat the deaths from despair.”

State Analysis

  • Forty-four states and Washington, D.C. saw increasing rates of alcohol, drug and suicide deaths from 2015 to 2016. States with the highest alcohol, drug and suicide death rates in 2016 were: West Virginia (80.3 per 100,000), New Mexico (76.8 per 100,000), and Alaska (67.1 per 100,000)
  • Forty-one states had increasing alcohol death rates between 2015 and 2016—states with the highest alcohol death rates in 2016 were: New Mexico (32.1 per 100,000), Alaska (24.7 per 100,000), and Wyoming (23.7 per 100,000).
  • Forty-six states plus Washington, D.C. had growing rates of drug deaths between 2015 and 2016—states with the highest drug death rates in 2016 were: West Virginia (49.8 per 100,000), District of Columbia (40.5 per 100,000), and Ohio (38.5 per 100,000).
  • Twenty-six states plus Washington, D.C. had increasing suicide rates from 2015 to 2016 and 23 states had declining rates—states with the highest suicide death rates in 2016 were: Alaska (26.0 per 100,000), Montana (25.6 per 100,000), and Wyoming (24.6 per 100,000.).

National Resilience Strategy

TFAH’s and WBT’s 2017 Pain in the Nation report called for the creation of a National Resilience Strategy that takes a comprehensive approach by focusing on prevention, early identification of issues and effective treatment. These new data reinforce the need for additional focus and funding at the national, state and local levels to address the underlying causes of long-term increases in alcohol, drug and suicide deaths. TFAH and WBT recommend:

  • Improving Pain Management and Treatment;
  • Rebooting Substance Misuse Prevention and Mental Health in Schools;
  • Addressing the Impact of the Opioid Epidemic on Children – and the Need for a Multi-Generational Response
  • Expanding and Modernizing Mental Health and Substance Use Disorder Treatment Services – Toward a Goal of Focusing on the “Whole Health” of Individuals; and
  • Prioritizing Prevention, Reducing Risk Factors and Promoting Resilience in Children, Families and Communities.

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Trust for America‘s Health is a non-profit, non-partisan organization dedicated to saving lives by protecting the health of every community and working to make disease prevention a national priority.   Twitter: @HealthyAmerica1

Well Being Trust is a national foundation dedicated to advancing the mental, social, and spiritual health of the nation. Created to include participation from organizations across sectors and perspectives, Well Being Trust is committed to innovating and addressing the most critical mental health challenges facing America, and to transforming individual and community wellness. www.wellbeingtrust.org. Twitter: @WellBeingTrust

Substance Misuse and Mental Health

Over one million Americans struggle with a substance misuse disorder.  Alarmingly, we are experiencing a set of epidemics, as more than one million people have died in the past decade from drug overdoses, alcohol misuse and suicide. If these trends continue, drugs, alcohol and suicide could take the lives of an estimated 1.6 million Americans in the next 10 years.

Many factors contribute to drug and alcohol misuse and suicide, including family and social relationships, social and emotional development, childhood trauma, lack of economic opportunity and the cycle of poverty. There is an urgent need to invest in evidence-based, multisector programs and interventions that help people at crisis points and that address the root causes of these deaths.

New Data Shows Drug Overdoses Increased in 40 States and Washington, D.C.

Opioids Put Death Rates on Worst Case Scenario Track for the Nation

December 21, 2017

Washington, D.C., December 21, 2017 – In 2016, 63,632 Americans died from drug overdoses, an increase of 21 percent over 2015, according to data released by the Centers for Disease Control and Prevention (CDC) today.  This represents a 50 percent increase over five years and 225 percent increase since 1999.

Trust for America’s Health’s analysis of the data found that:

  • Overdose rates increased in 40 states and Washington, D.C. between 2015 and 2016.
  • Seventeen states had increases of 25 percent or more. The largest increases were in Washington, D.C. (109 percent), Maryland (59 percent) and Florida (46 percent). Rates decreased in nine states.
  • The highest 2016 drug death rates were in West Virginia (52.0 per 100,000 deaths), Ohio (39.1 per 100,000 deaths) and New Hampshire (39.0 per 100,000 deaths).
  • In 2016, 24 states and Washington, D.C. had rates above 20 per 100,000 deaths.  In 2005, no state had a rate above 20 per 100,000 deaths and only five states had rates above 15 per 100,000 deaths.

Around two-thirds of these deaths were opioid-related.  The increase was largely driven by the continued escalation of deaths from fentanyl and other synthetic opioids –topping 19,410 in 2016, up from 9,580 in 2015 and 5,540 in 2014. This is an increase of more than 70 percent for a third year in a row – highlighting the evolving nature of the opioid epidemic, expanding to include more lethal, illicit drugs.  Heroin-related deaths totaled around 15,500 and there were 14,500 prescription painkiller deaths. Death from all other drugs other than fentanyl and other synthetic opioids only rose by 3 percent.

The rapid rise in drug deaths is putting the country on a “worst case” scenario track – where these deaths could reach 163,000 per year by 2025 if recent trends hold, based on projections in a recently released TFAH and Well Being Trust (WBT) report Pain in the Nation: The Drug, Alcohol and Suicide Epidemics and the Need for a National Resilience Strategy.  The report calls for a comprehensive, multi-prong approach to respond to the “despair deaths” of drugs, alcohol and suicide – from immediate harm reduction to a long-term strategy to bolster the nation’s resilience.

“The escalating growth of opioid deaths is downright frightening – and it’s getting worse,” said John Auerbach, president and CEO of TFAH. “Every community has been impacted by this crisis and it’s getting lots of headlines, yet we’re not making the investments or taking the actions needed at anywhere near the level needed to turn the tide.”

“These are not simply numbers – these are actual lives. Seeing the loss of life at this dramatic rate calls for more immediate action,” said Benjamin F. Miller, PsyD, Chief Policy Officer, Well Being Trust.  “Our fractured approach to a multi-systemic issue isn’t enough and it isn’t working. We collectively need to take a more comprehensive and systemic approach, beginning with prevention through recovery and treatment, to double down on investing in systems change for real results.”

Additional TFAH Analysis

  • Certain demographics had particularly high rates of drug overdoses in 2016, including: men (26.2 per 100,000) and 35 to 44-year-olds (35.0 per 100,000).
  • Synthetic opioids including fentanyl had the largest increase in the number of deaths between 2015 and 2016 (103 percent increase); heroin and natural and semisynthetic opioids (including most commonly prescribed opioid medications) also increased by 19 percent and 14 percent respectively.
  • Synthetic opioid death rates have been increasing dramatically in the past few years. In 2013, deaths were at 1.0 per 100,000; in 2014, 1.8 per 100,000; in 2015, 3.1 per 100,000; and in 2016, they reached 6.2 per 100,000. This a six-fold increase in three years.

Drug Overdose Deaths, by State

State

2015 Drug Overdose Rate

Deaths per 100,000

2016 Drug Overdose Rate

Deaths per 100,000

2016 Rates, Highest to Lowest

Percent change, 2015-2016

2025 Worst Case Scenario Projections

Deaths per 100,000

Alabama

15.7

16.2

35

3%

45.5

Alaska

16.0

16.8

32

5%

46.9

Arizona

19.0

20.3

25

7%

54.0

Arkansas

13.8

14.0

38

1%

38.9

California

11.3

11.2

45

-1%

35.0

Colorado

15.4

16.6

34

8%

44.6

Connecticut

22.1

27.4

12

24%

62.8

Delaware

22.0

30.8

9

40%

60.0

D.C.

18.6

38.8

4

109%

52.7

Florida

16.2

23.7

17

46%

45.4

Georgia

12.7

13.3

39

5%

36.6

Hawaii

11.3

12.8

40

13%

33.4

Idaho

14.2

15.2

36

7%

36.9

Illinois

14.1

18.9

28

34%

39.7

Indiana

19.5

24.0

16

23%

54.0

Iowa

10.3

10.6

47

3%

29.0

Kansas

11.8

11.1

46

-6%

32.7

Kentucky

29.9

33.5

6

12%

82.1

Louisiana

19.0

21.8

22

15%

52.6

Maine

21.2

28.7

11

35%

57.0

Maryland

20.9

33.2

7

59%

59.9

Massachusetts

25.7

33.0

8

28%

74.3

Michigan

20.4

24.4

15

20%

63.7

Minnesota

10.6

12.5

41

18%

32.4

Mississippi

12.3

12.1

42

-2%

33.6

Missouri

17.9

23.6

18

32%

49.2

Montana

13.8

11.7

44

-15%

40.1

Nebraska

6.9

6.4

51

-7%

20.0

Nevada

20.4

21.7

23

6%

59.4

New Hampshire

34.3

39.0

3

14%

88.7

New Jersey

16.3

23.2

19

42%

45.9

New Mexico

25.3

25.2

13

0%

67.5

New York

13.6

18.0

30

32%

41.5

North Carolina

15.8

19.7

26

25%

44.4

North Dakota

8.6

10.6

48

23%

23.4

Ohio

29.9

39.1

2

31%

80.3

Oklahoma

19.0

21.5

24

13%

52.4

Oregon

12.0

11.9

43

-1%

41.2

Pennsylvania

26.3

37.9

5

44%

71.9

Rhode Island

28.2

30.8

10

9%

82.1

South Carolina

15.7

18.1

29

15%

44.2

South Dakota

8.4

8.4

50

0%

22.9

Tennessee

22.2

24.6

14

11%

63.9

Texas

9.4

10.1

49

7%

27.1

Utah

23.4

22.3

20

-5%

60.7

Vermont

16.7

22.2

21

33%

48.3

Virginia

12.4

16.7

33

35%

34.8

Washington

14.7

14.5

37

-1%

45.2

West Virginia

41.5

52.0

1

25%

110.9

Wisconsin

15.5

19.3

27

25%

42.2

Wyoming

16.4

17.6

31

7%

46.1
Source: National Vital Statistics System, CDC; TFAH, WBT Projections from Pain in the Nation: The Drug, Alcohol and Suicide Crises and the Need for a National Resilience Strategy. 

Notes: The CDC’s National Vital Statistics System data has a separate category for methadone and does not include it in the fentanyl/synthetic opioid category. The state death rates from CDC are age-adjusted. See CDC’s reports Drug Overdose Deaths in the United States, 1999–2016 and Drug Overdose Deaths in the United States, 1999–2015 for additional data and analysis.

Recommendations from Pain in the Nation: The Drug, Alcohol and Suicide Epidemics and the Need for a National Resilience Strategy

Pain in the Nation calls for the creation of a National Resilience Strategy that takes a comprehensive approach by focusing on prevention, early identification of issues and effective treatment. The report highlights more than 60 research-based policies, practices and programs, including:

  • Improve Pain Management and Treatment by helping people heal physically, mentally and emotionally. Approaches must acknowledge that there are different types of pain and experts from mental health, medical care and other disciplines must develop team-based solutions that focus on proactively addressing pain before it gets worse.
  • Stem the Opioid Crisis with a full-scale approach – including promoting responsible opioid prescribing practices (such as provider education and best practices for Prescription Drug Monitoring Programs); public education about misuse and safe disposal of unused drugs; “hotspot” intervention strategies; anti-trafficking to stop the flow of heroin, fentanyl and other illicit drugs; and expanding the use and availability of rescue drugs, sterile syringes and diversion programs.
  • Address the Impact of the Opioid Epidemic on Children – and the Need for a Multi-Generational Response that includes substance use disorder treatment for parents and wrap-around services for children and families, including grandparents and other relatives who help care for children, and expand support for the foster care system. Model programs have been twice as effective in helping mothers achieve sobriety, reduced state custody placement of children by half and had a return on investment of $2.22 for every $1 spent on child welfare programs.
  • Expand and Modernize Mental Health and Substance Use Disorder Treatment Services – Toward a Goal of Focusing on the “Whole Health” of Individuals by prioritizing innovative integrated delivery models for rural and underserved urban areas and expanding the provider workforce, including those who can deliver medication-assisted treatment. Some effective substance use treatment programs have a return of $3.77 per $1 invested.
  • Prioritize Prevention, Reduce Risk Factors and Promote Resilience in Children, Families and Communities by limiting trauma and adverse experiences, which have the biggest long-term impact on later substance misuse, and promoting better mental health. For instance, nurse family home visiting programs have a return of $5.70 for every $1 invested, and early childhood education programs have a $4 to $12 return for every $1 invested.
  • Reboot Substance Misuse Prevention and Mental Health in Schools by scaling up evidence-based life- and coping-skills programs and inclusive school environments and increasing the availability of mental health and other services.

Top school substance misuse prevention programs have a $3.80 to $34 return for every $1 invested; social-emotional learning programs have an $11 for $1 return; and school violence prevention (including suicide) programs have a $15 to $81 for $1 return.

The Pain in the Nation report was supported by grants from WBT and the Robert Wood Johnson Foundation (RWJF).  Data analysis and projections were provided by the Berkeley Research Group.

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Trust for America’s Health is a non-profit, non-partisan organization dedicated to saving lives by protecting the health of every community and working to make disease prevention a national priority.  Twitter: @HealthyAmerica1

Mental Health is Vital to Preparedness and Response

By Dr. Octavio N. Martinez, Jr., MD, MPH, MBA, FAPA, Executive Director, the Hogg Foundation for Mental Health at The University of Texas at Austin

This story was published in Ready or Not: Protecting the Public’s Health from Diseases, Disasters and Bioterrorism.

The health effects from a public health emergency go way beyond the physical, taking an enormous mental toll in the immediate aftermath and the years following—and often can harm our children the most.

We must do more to know how to ensure mental health and physical health go hand-in-hand in response planning and efforts. We must also do a far better job of increasing our mental health workforce and ensuring and increasing access to mental health services both during and after an emergency.

Using Data to Plan for Maintaining Access to Mental Health Services

To prepare for any type of emergency, communities must be aware of vulnerable populations—typically children, the elderly and those who have an underlying medical condition or are mentally ill. We have gotten better at identifying where groups of these populations live.

And, we should also be able to access databases to predict what portion of a certain population might have substance use disorders, for example—and then understand what kind of continued treatment and medication are needed and where they might best be distributed.

Paired with this, we should be able to identify geographically which communities will have the hardest time bouncing back from an emergency and will need more resources.

While some neighborhoods might have good infrastructure and better access to transportation and physical and mental health services, others will struggle. The neighborhoods that will struggle should be identified in advance and plans created to help them. And, we can create plans based on any number of scenarios: fires, floods, wind damage, loss of power, etc. If you combine all the knowledge and data together, you can then coordinate resources and everyone has a chance to be healthy.

Long-term Strategies to Improve Responses to Emergencies

We also must acknowledge that human connections are incredibly important. In-between disasters, preparedness work should focus on strengthening families and communities so they are resilient enough to weather an emergency.

For example, after Hurricane Katrina, New Orleans developed community leaders specifically focused on mental wellness, resilience and recovery. The gains in improved access to care and lessened stigma were noticeable—and these should help ensure responders and communities can work together to forge a better response during the next emergency.

While this is by no means a quick fix, taking a long-term approach to emergency preparedness and community health will pay dividends in improved health of the entire population. We should bring this research to other cities and communities that will likely face similar events.

Additionally, psychological effects can take years to manifest and get under control—especially if there isn’t access to mental health services. We learned from Hurricanes Katrina and Sandy that PTSD and suicidal ideation increased dramatically after these events. However, if we were able to step in earlier and connect individuals with mental health professionals, it’s likely these issues and potentially other health issues (substance use disorders, increased anxiety, depression, etc.) could have been prevented or lessened.

Further, while we are getting better at recognizing that mental health is a key component to physical health, the workforce in this area is inadequate—and we’ve known this for a while, especially as the opioid epidemic has continued. By increasing our workforce and ensure they have the right skill sets; we could help tackle the opioid epidemic and better prepare our communities to bounce back from a disaster.

Additional Research is Needed

The devil is often in the details and coordination among the various federal, state and local agencies, organizations and others must be improved. To do so, the nation has to prioritize funding into research and assessments post emergencies—so we can truly understand how these events affect the mental health and stability of a community at a population level.

While the National Institutes of Health has a Disaster Research Response Project, it needs to better include measures on mental health and substance use disorders. We must take each disaster as a learning opportunity that can prepare us for the next one and enable us to save more lives. Increasing research would also help build a network of behavioral health disaster experts.

First Responders

Our first responders and volunteers must be trained to identify and assist people who exhibit psychiatric symptoms, i.e., in “psychological first aid.” And, going beyond this training, we know that mental health must be better integrated with the traditional health services.

Responders and volunteers must also be cared for—they are at risk for suffering secondary psychiatric distress themselves. We need better ways to monitor them during but also after the crisis to ensure they are receiving the appropriate interventions and care.

Part of the solution is increased mental health providers, which would serve many roles: keeping our first responders in good shape, filling gaps in mental health services and, by increasing access to care, hopefully preventing someone from developing a serious and chronic mental health illness.

Quite simply, if we intentionally make mental health part of our preparedness and response systems it will have untold benefits for communities before, during and after an emergency—we will build resiliency and improve well-being.