On despair – The Economist:

‘Most economic theories come and go with little fanfare. Every once in a while, however, one catches fire. In 2015 Anne Case and Angus Deaton, two Princeton University economists, published a landmark study showing that from the late 1990s the mortality rate of white middle-aged Americans had started to rise after decades of decline—owing to a surge in alcohol-related deaths, fatal drug overdoses and suicides. This “deaths-from-despair” mortality rate has not slowed since: in 2022 more than 200,000 people died from alcohol, drugs or suicide, equivalent to a Boeing 747 falling out of the sky every day with no survivors. Yet even as America’s deaths-of-despair epidemic has intensified, its causes have grown harder to identify.’

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‘Many economists, however, were not convinced. Some criticised the researchers’ methodology. By adjusting for inflation using the consumer-price index rather than the personal-consumption-expenditures index, for example, the duo overestimated the decline in white working-class wages. By comparing people with and without college degrees, they obscured the fact that much of the increase in mortality was concentrated in high-school dropouts, a small and shrinking segment of the population. Finally, some researchers thought that the survey data on which the economists relied to illustrate growing mental distress was inadequate to explain the rising death toll.
Others argued that the deaths-of-despair phenomenon was better explained by supply-side factors. In 2010 Purdue Pharma, a drug company, reformulated OxyContin, its signature prescription opioid. The new “abuse-deterrent” version, unlike the original one, could not be crushed and snorted to deliver an immediate high. This prompted some addicts to switch to heroin, leading to more overdoses. When fentanyl, a synthetic opioid, entered widespread use from the early 2010s, deaths were highest in places with the greatest access to the drug. A recent working paper shows that between 2008 and 2020 states with more imports—fentanyl is often smuggled from abroad, hidden with legitimate shipments—suffered from more fentanyl overdoses.’

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‘A decade ago the mortality rate from alcohol, drugs and suicide was nearly one-fifth higher in conservative counties than in liberal ones. Today, deaths from despair are now as prevalent in Democratic parts of the country as in Republican ones. And because left-leaning counties tend to be bigger than conservative ones, they record 10,000 more deaths of despair per year than right-leaning ones.
Indeed, the despair that Ms Case and Mr Deaton wrote about can now be found among nearly every demographic group. Black Americans are more likely to die from drug overdoses than whites. Young people are taking their own lives at ever-higher rates. Perhaps most overlooked are Native Americans, for whom the deaths-of-despair mortality rate is at least one-and-a-half times that of white Americans, and rising. Our data show that such deaths are more than three times as common in the 35 counties where Native Americans make up the largest share of the population than they are in the rest of the country.’

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‘In 2010 suicides barely outpaced overdoses, and alcohol deaths lagged just behind. That justified thinking about the three causes of death together. Today, however, there are more deaths from overdoses than from the other two causes combined (see chart).
This now looks more like a medical crisis than a social one. And if the lethality of new drugs is even partly to blame, America is in trouble: dealers have started lacing fentanyl with “tranq”, a horse sedative that causes flesh wounds, and nitazenes, a Chinese-made opioid more than 40 times as potent as fentanyl. Such cocktails will kill even more people, even more quickly.’

Read the article here.

States with more imports have more fentanyl, and therefore more deaths of despair, which might not be deaths of despair actually.

If it’s a medical crisis than we should conclude that people are looking for a high, the risk of dying is ignored or part of the consideration.

Income and education are less important than was thought apparently. But it’s still not wise to be a high school dropout, or a native American for that matter.

Determinism will make a comeback; it might already have done so.

A Dutch psychiatrist told me recently: ‘People are entitled to self-destruction.’

I answered: ‘Yes, of course, but not your own children.’