With an epidemic of opioid abuse, the generation that never wanted to grow old is dying ahead of its time.
Middle-aged white people are not usually anyone's idea of a vulnerable population, even in an era that aims for diversity. Having been history's conquerors and kings, they remain symbols of the establishment, its presidents and chief executives, comfortable, and still powerful.
But in the fall of 2015, two Princeton University economists dropped a bombshell on that assumption. Angus Deaton, who had just won a Nobel Prize in economics, and Anne Case reported in the Proceedings of the National Academy of Sciences that the death rates of middle-aged whites in the U.S. had jumped sharply. For the first time in decades, the life expectancy of white men and women between the ages of 45 and 54 had plummeted—a trend not seen in any other rich country.
Between 1999 and 2013, the study found mortality rates of every other age and ethnic group in the U.S. fell by a steady clip of about two per cent per year. But among middle-aged whites, the mortality rate had risen by half a per cent per year. If it had continued to decline at the same rate as it had before 1998, an estimated 488,500 lives would have been saved. Or, as Deaton told the Washington Post, "Half a million people are dead who should not be dead."
The news hit like a sucker punch. Life expectancy is considered the yardstick of humanity's well-being, the sacred gauge of social progress. So what did it say when, despite advances in health care and nutrition, tens of thousands of white middle-aged Americans had died years before their time? And what did it say when the cause of these premature deaths was not cancer or heart disease, or any of the common killers we know, but rather those we didn't realize we knew so well—drug poisonings, suicides, alcohol-related liver diseases. "Deaths of despair," the researchers called them.
In essence, the study concluded that a quiet epidemic of substance abuse and hopelessness is plaguing America's baby boomers, that the generation that never wanted to grow old is indeed dying younger—and in far greater numbers—than anyone predicted.
"Those currently in mid-life may be a 'lost generation,'" Deaton and Case wrote, noting that "if the epidemic is brought under control, its survivors may have a healthy old age." But, they warned, addictions are hard to treat.
A perfect storm
It may be tempting to blame all this distress on the recent recession. But the spike in mid-life mortality predates the 2008 financial crisis by a decade. Still, baby boomers are a sandwiched generation, financially pinned between the extra costs of caring for elderly parents and putting kids through university—often, while retirement shrinks their incomes.
"Many of the baby-boom generation are the first to find, in mid-life, that they will not be better off than were their parents," Case and Deaton wrote, especially among those with only a high school education.
While people with the least education had the highest death rates, the study did find drug poisonings and suicides increasing among middle-aged whites of all education levels—a trend that doesn't stop at the border. Overdoses and suicides among baby boomers have also been rising in Canada.
In 2011, more middle-aged Canadian men—1,366—died by suicide than by motor vehicle accidents, homicide and HIV combined, according to the Canadian Association for Suicide Prevention. Meanwhile, a recent study from the Canadian Institutes of Health Information and the Canadian Centre on Substance Abuse reports that opioid poisonings are putting 13 people a day in hospital—a jump of more than 30 per cent between 2007–08 and 2014–15—and most of them are age 65 and older.
The Province of Ontario has tracked 2,383 opioid-related deaths between 2006-2010. But without a national system to track drug-related fatalities (different provinces use different methods), there's no concrete numbers available and no way to know if all this is also bringing down life expectancy for middle-aged Canadians.
"At this point, there is no measureable impact on life expectancy," says Dr. Benedikt Fischer, a senior scientist at the Centre for Addiction and Mental Health in Toronto. But, Fischer adds, "this doesn't mean there is no impact and with rising opioid death rates, this impact will increase."
What is clear is that North America's baby boomers have found themselves in a perfect storm of self-destruction. For starters, boomers happened to reach the age of aches and pains just as highly addictive prescription opioid painkillers went mass market in the 1990s.
And many not only became dependent on these dangerous meds to treat bad backs or cranky knees, but the angst aging can bring.
"They're losing their jobs, either because they are being phased out or they are retiring but, with that, they are losing … prestige, social status and the sense of identity and self-esteem that comes with that," says Dennis Long, executive director of Breakaway Addiction Services in Toronto. "There's only so much golf you can play, and then it gets a bit thin."
At the same time, as aging takes its physical toll "stuff starts to break down … and with all this comes an existential pain. The idea of a mid- or late mid-life crisis is not a myth. People look around and say, 'I wanted to do so much more in my life. I thought I'd do so much more.'"
In response, many have made their youthful drug habits a crutch in middle age—and beyond.
At Breakaway, where Long, 68, has worked for more than 25 years, it used to be that the community of drug users was well known to staff and to each other. But now there's a growing number of newcomers: middle-class, middle-aged professionals, still working or recently retired. "I don't think it's a blip. I think we've crossed over a certain line with opiate use, and it's trending in the wrong direction."
The 2012 U.S. National Survey on Drug Use and Health estimates that by 2020, close to six million adults over age 50 will need drug or alcohol rehab, nearly double the number of over-50s seeking treatment in 2002. In New York City, that future has already arrived: a recent New York University study found people over age 50 accounted for close to 50 per cent of people in opioid rehab in 2012, up from 7.8 per cent in 1996.
The growing demand has already heralded the rise of boomer-tailored treatment programs. Online, one South Florida facility, even makes its Rehab for Boomers pitch in a groovy '60s-styled ad that reads: "When one considers the permissive attitudes toward drug use that arose during the coming of age of most baby boomers, it's no surprise that many of them find the need to check into drug and alcohol rehab even in their later years."
The big difference, says Long, is that baby boomers "grew up in the '60s, when drug use was common and not very scary." But today, those harmless highs of youth have run smack into North America's deadly opioid crisis, a public health disaster of such epic proportions that it's been dubbed "the worst man-made epidemic in modern medical history."
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