Life expectancy for Americans fell for the second straight year in 2021, largely driven by increases in deaths from Covid-19 and drug overdoses, according to new data from the Centers for Disease Control and Prevention.
A baby born in the U.S. in 2021 has a life expectancy of 76.4 years, down from 77 years in 2020 and the lowest level the CDC has recorded since 1996. The age-adjusted death rate for Covid rose by 22.5% between 2020 and 2021, while death rates from unintentional injuries — one-third of which come from overdoses — rose by 12.3%.
Before Covid, life expectancy in the U.S. had gradually increased for decades, said Kenneth Kochanek, a statistician in the CDC’s National Center for Health Statistics (NCHS) and a co-author of the new report. “Then this one disease comes along and just wipes everything out. … I’ve never seen anything with this much of an impact in a short period of time.”
Age-adjusted death rates for drug overdose rose by about 14% from 2020 to 2021. The rates spiked significantly in all groups aged 25 and over. The largest percentage increase, 28%, occurred in adults aged 65 and older.
Broken down by racial demographics, non-Hispanic American Indian or Alaska Native people had the highest drug overdose death rates in both 2020 and 2021. Non-Hispanic Black people had the second-highest rates for both years. Also striking was the 47% increase in overdose death rates among Native Hawaiian or other Pacific Islanders between 2020 and 2021.
One of the major reasons for the overall surge in overdose deaths is the spike in access to fentanyl — which is much more potent, addictive, and cheaper than other opioids — coupled with scarce access to treatment, said Noa Krawczyk, a substance use epidemiologist at NYU Langone’s Center for Opioid Epidemiology and Policy.
On Tuesday, the Drug Enforcement Administration said it had seized over 379 million potentially lethal doses of illegal fentanyl this year alone. Fentanyl is also making it more difficult for people to start addiction treatment because it causes intense withdrawal symptoms for people on buprenorphine — a key drug for treating opioid use disorder.
Fentanyl is also flooding the illicit drug supply, which means that people may use drugs like cocaine without being aware that it’s been laced with fentanyl, said Monica Ruiz, associate professor of prevention and community health at George Washington University. “They don’t worry about needing Narcan because that’s for opioid overdose,” she said, referring to the lifesaving antidote.
While the rate of deaths involving synthetic opioids like fentanyl climbed 22% between 2020 and 2021, the rate of deaths involving heroin declined by 32% in the same period.
Heroin is “being replaced with fentanyl … because that’s all [people] can get,” Shoshana Aronowitz, an assistant professor of family and community health at the University of Pennsylvania School of Nursing, told STAT via email. “As heroin is less potent … we’d be seeing less overdose deaths if more folks were using heroin rather than fentanyl.”
On Dec. 13, federal regulators moved to increase access to addiction treatments, proposing a measure that would make pandemic-era emergency policies that expand access to buprenorphine and another medication, methadone, permanent.
Still, Krawczyk is frustrated that more sweeping governmental action is “moving at a snail’s pace, … despite knowing a lot of strategies that are effective.” Meanwhile, “deaths are continuing to go up.”
She sees prospects for broader change in bills such as the Opioid Treatment Access Act of 2022, which would make methadone more available, and the Mainstreaming Addiction Treatment Act (MAT) of 2021. MAT would rev up buprenorphine’s availability by scrapping special waiver requirements for physicians to dispense the narcotic. Currently these waivers are more prevalent in whiter, less diverse communities. Methadone, which is a much more controlled substance and therefore generally harder to access, is more commonly prescribed in largely Black and brown communities.
That’s just the tip of the iceberg when it comes to disparities affecting overdose deaths.
“I’m talking about everything from families being forced to live in dangerous neighborhoods where drugs are more readily available because economic disparities won’t allow them to move to safer places to inadequate access to culturally sensitive and culturally competent addiction treatment services,” Ruiz told STAT. She also cited the need for trauma-informed mental health care to target the root causes of substance use.
The decades-long U.S. “war on drugs,” which disproportionately targeted Black and brown people, still plagues these communities’ collective memory. Fear of the criminal justice system prevents many people of color from coming forward to seek substance use treatment, said Lori Freeman, chief executive officer for the National Association of County and City Health Officials.
Research also backs up the “Iron Law of Prohibition,” which explains how “our increasingly potent and deadly drug supply is a result of the war on drugs.”
The collective pain and discrimination experienced by marginalized communities also plays a role in addiction. To Freeman, it’s not surprising that American Indians — a group that’s been stigmatized for hundreds of years and whose land and livelihoods were seized by the U.S. government, setting off a chain of disparities — had the highest overdose death rates in the past two years. People who experience this kind of intergenerational trauma may be more likely to turn to addictive substances as a means to ease their suffering, she said.
Across the board, the pandemic has also exacerbated many Americans’ mental health issues, chronic physical pain, and socioeconomic problems, worsening rates of substance use and overdose deaths.
“I feel like we’re at the breaking point, unless we do something,” Freeman said. “This is such a catastrophic loss of life that we’re seeing … across all spans of populations.”
This story has been updated.