Television news, health policy leaders, and politicians frequently discuss the high toll of deaths from COVID-19, cigarettes, opioids, HIV, firearms, and drug overdose. They focus on the absolute numbers of casualties. For example, 4,000,000 Americans die each year from cigarette smoking, 40,000 die each year from second-hand smoke and related illness.
For firearms, they cite figures like 40,000 firearm deaths last year. Sometimes the data is presented as death rates, such as 20 drug overdose deaths per 100,000 population.
But, for physicians and researchers, it is hard to compare these apples to oranges. It is hard enough to understand these data as an expert, but nearly impossible for a layperson to understand what their risk or their family’s risk is for any of these causes of death.
The numbers are so large on the one hand but, then for some confounding reason it seems that we also have an astonishingly low annual rate. A recent American Journal of Medicine study analyzed official death certificate data and calculated the odds that a typical American child will die from a gunshot or a drug overdose throughout a lifetime .
New Analysis for Firearms and Drug Overdose Deaths
Drug overdoses cause more than 33% of all accidental deaths in the USA. The most recent data reported by the Centers for Disease Control and Prevention suggested that at least 72,000 Americans died from drug overdoses last year, according to the. That is an overall increase of 5 percent from 2018.
Drug overdose deaths remain higher than car accidents, guns, or AIDS. These deaths have dragged down overall life expectancy in the United States. Health experts have concluded that 2020 will be even worse.
Drug deaths have risen an average of 13 percent so far this year over last year, according to mortality data from local and state governments collected by The New York Times . This new analysis leads to the conclusion that the lifetime risk of death from firearms is 1%.
What does this mean? Well, that means that in the USA, approximately 1 out of every 100 children will die from guns. Firearm deaths in the USA are 50 times more common than in the United Kingdom.
How does this compare to drug overdoses? The authors report that the lifetime risk of death in the USA from a drug overdose is 1.5%. So, to make this understandable, we could use the same data and say that this means that in the USA today, 1 out of every 70 children will ultimately die from drugs directly by an overdose.
Drugs of abuse may also cause lapses in concentration, judgment, and skill so that accidents at work or on the road may happen. These are not as easy to count.
So, drug overdoses and death by firearms are real significant preventable risks to our children and longevity. Are all of us at equal risk? No, for the most part, “these risks vary depending on who you are and where you live,”  said Ashwini Sehgal, MD, the new study lead author.
Dr. Sehgal went on the describe the differences in risks by race and gender. “The lifetime risk of firearm death is highest among black boys: 1 out of every 40 will die from a gunshot”. Overdose risk, too, depends on your zip code. “The lifetime risk of overdose death is highest in West Virginia, where 1 out of every 30 children will die from overdoses.”
Health providers can use these data to personalize public health research, promote efforts that might reduce these deaths. The number of overdoses fell 4.1% in 2018 relative to 2017 , enough to cause life expectancy to have resumed its rising trend before the COVID-19 pandemic hit.
However, in 2018, the prescribing rate was still 51.4 prescriptions per 100 persons (more than 168 million total opioid prescriptions). If 8 to 12% of those treated with opioids go on to develop an opioid use disorder, then our medical system is still generating many new addicts.
The opioid epidemic is raging in all parts of society. Still, it has hit low, and less well-educated people harder. Those with only a high school degree are at least 2.5 times more likely to die of an opioid overdose than people with a graduate degree. People who have a lower socioeconomic status are also at higher risk of dying from COVID-19.
Poor health and poverty are related to life expectancy. Poverty also makes death from an opioid overdose 1.4 times more likely . People of lower socioeconomic die more from opioids because of access to synthetics like methamphetamine and fentanyl, cheap but potent drugs, untreated addictions, lack of naloxone for reversal, and deaths of despair .
What Can We Do?
A perfect storm arose from a combination of newly available opioids, new attitudes about the importance of pain management, aggressive marketing, loose and decentralized prescribing practices, and a lack of access to effective treatment. We need to focus on these root causes .
Policies that would address these problems include reducing opioid prescriptions to “opioid naïve” patients. Reducing opioid exposure for wisdom teeth removal, minor aches, and pains, and really most pain syndromes, by increasing the use of non-addictive pain treatments, is catching on and having an impact.
As we have written here before, it is important to expand the universe of those who are carrying Narcan or Naloxone. The more patients with OUDs, their families and friends, and concerned citizens carry Narcan, the more overdose-reversals. Last, we cannot just treat patients without MATs , and we need to reconsider the duration of time that we use and recommend patients with OUDs to take MATs with medications for pain.
COVID-19 has caused several changes in violence, most obviously in the decreased traffic accidents and increase gun violence. As the University of Pennsylvania, recently reported overall trauma contacts declined.
Still, the proportion of critically injured patients requiring the highest-level activation (ALERTS), the rate of gunshot injuries, and penetrating trauma injuries increased . They note that similar escalating gun violence reports are coming in from other trauma centers in many large metropolitan centers across the country—including Chicago, Dallas, Houston, and Philadelphia. New York gun violence has been so alarming that N.Y. Times pleaded to please stop. We need beds .
There are important differences in both overdose and firearm deaths by race, gender, state, and country. It is relevant to understand the problems in a particular community first, and then tailor prevention and intervention.
County unemployment and poverty rates are well known. From there, we can think about drugs, overdoses, and guns. Unemployment is linked to overdoses, gun sales, and violence.
Forty million new unemployment claims have been filed since March. As unemployment has increased, so too have U.S. gun sales. Gun purchases have skyrocketed, with over 2 million reported sales since the COVID-19 outbreak began across the country .
Death by firearms is directly linked with firearm access and subsequent increases in gun violence . All countries with enforced firearm control have seen a decrease in gun violence. Currently, nearly 50,000 people per year die or are injured by firearms in the U.S.
Just owning a gun increases the risk of death by domestic violence for women by 20-fold and the risk of suicide by 3-fold. Contrary to the SARS-Cov-2 pandemic, the current increasing trend for gun ownership will not only have short-term consequences.
Gun deaths may be expected to persist, long after we have a COVID-19 vaccine. Physicians, other than Psychiatrists, might ask patients about the presence of firearms in the home, review safe storage practices, and screen for depression and previous violence.
This new analysis  identifies the lifetime risk of death from firearms at 1%. The authors report that the lifetime risk of death in the USA from drug overdoses is 1.5%. Both are tragedies, and we should be able to do a much better job at lowering the odds that our children die of drugs, overdose, or gun violence. Sadly, poverty and COVID-19 are making both of these life-shortening problems much worse.
1. Ashwini R. Sehgal. Lifetime Risk of Death From Firearm Injuries, Drug Overdoses, and Motor Vehicle Accidents in the United States. The American Journal of Medicine, 2020; DOI: 10.1016/j.amjmed.2020.03.047
4. Hedegaard, H., Miniño, A.M., Warner, M. (2020). Drug Overdose Deaths in the United States, 1998-2018 (NCHS Data Brief No. 356). Retrieved from CDC: https://www.cdc.gov/nchs/data/databriefs/db356-h.pdf
5. Altekruse, S.F., Cosgrove, C.M., Altekruse, W.C., Jenkins, R.A., Blanco, C. (2020). Socioeconomic risk factors for fatal opioid overdoses in the United States: Findings from the Mortality Disparities in American Communities Study (MDAC). PLoS One, 15(1):e0227966.
6. Case, A., Deaton, A. (2015). Rising Morbidity and Mortality in Midlife Among White NonHispanic Americans in the 21st Century. Proceedings of the National Academy of Sciences, 112(49), 15078-15083.
9. Cannon, J. W., Martin, N. D., & Qasim, Z. (2020). Violence Unchecked by Social Distancing. The Journal of emergency medicine, S0736-4679(20)30607-7. Advance online publication. https://doi.org/10.1016/j.jemermed.2020.06.049
10. Kaufman E. The New York Times; 2020 Apr 1. Please, Stop shooting. We need the Beds. https://www.nytimes.com/2020/04/01/opinion/covid-gun-violence-hospitals.html [Internet] Available from: [Google Scholar]
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12. Dutheil, F., Baker, J. S., & Navel, V. (2020). Firearms or SARS-Cov-2: what is the most lethal?. Public health, 183, 44–45. https://doi.org/10.1016/j.puhe.2020.04.033
13. Ashwini R. Sehgal. Lifetime Risk of Death From Firearm Injuries, Drug Overdoses, and Motor Vehicle Accidents in the United States. The American Journal of Medicine, 2020; DOI: 10.1016/j.amjmed.2020.03.047
About the Author:
Mark S. Gold, M.D., Professor, Washington University School of Medicine – Department of Psychiatry, served as Professor, the Donald Dizney Eminent Scholar, Distinguished Professor and Chair of Psychiatry from 1990-2014. He was the first Faculty from the College of Medicine to be selected as a University-wide Distinguished Alumni Professor and served as the 17th University of Florida’s Distinguished Alumni Professor.
Dr. Gold is also a Distinguished Fellow, American Society of Addiction Medicine; Distinguished Life Fellow, the American Psychiatric Association; Distinguished Fellow, American College of Clinical Pharmacology; Clinical Professor of Psychiatry, Tulane University School of Medicine; Professor( Adjunct), Washington University in St Louis, School of Medicine, Department of Psychiatry; National Council, Washington University in St Louis, Institute for Public Health
Learn more about Mark S. Gold, MD
The opinions and views of our guest contributors are shared to provide a broad perspective of addictions. These are not necessarily the views of Addiction Hope, but an effort to offer a discussion of various issues by different concerned individuals.
We at Addiction Hope understand that addictions result from multiple physical, emotional, environmental and genetic factors. If you or a loved one are suffering from an addiction, please know that there is hope for you, and seek immediate professional help.
Published on September 7, 2020. Published on AddictionHope.com
Reviewed by Jacquelyn Ekern, MS, LPC on September 7, 2020