death of despair

Death of Despair, 1



trend decade demographic
corner outreach cosmopolitan
brisk struggle establishment
of late funeral in the sense that
abuse recovery wear multiple has
opioid overdoes ambulance
blame hooked prevalence
guilt suicide tremendous
pour innocent took his own life
cancer lifelong blow his head off
tube share (3) feeding tube
profit poison disturbing
heroin steadily life expectancy
lack reversal pay attention
rate paper (2) Nobel Prize
error benefit patient (2)
inject leave off degree (3)
end up finding hammer (2)
injury unleash time and again
liver specialize substance abuse
horrid dramatic commit suicide
fired temper lose my temper
pain longevity hang/hung/hung
FDA approved aggressively
repeat advances side affects
earn case (3) medication
pill sudden premature
label as well emergency
snort despair intentional
void priority seek/sought/sought
brain major (2) take down
crave supply pick up (4)
curb high (2) crackdown
source coroner filling the void
versus area (3) no matter
crisis addicted preventable
crash secluded painkiller






Now a look at a demographic trend that is surprising the experts. Despite decades of advancements in healthcare, diet and safety, middle-aged White Americans are living shorter — not longer — lives.


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Maysville Kentucky in the northeast corner of the state just a short bridge away from Ohio.

Despite some merchants’ best efforts at cosmopolitan outreach, the downtown is struggling.

But at one local establishment, business is brisk and growing.

David Lawrence manages the Knockson Brothers Funeral Home. He’s also the county coroner. He’s been seeing a lot of dead White males of late —especially ages forty-five to fifty-four.

David Lawrence, Mason County, Kentucky Coroner: “A lot of it due to alcohol or drug abuse.”

Craig Denim wears multiple hats too. A fifth-generation Kentucky family physician, he’s also medical director for the fire department’s emergency service.

Craig Denim: “In the past two years, we’ve had a 300% increase in the drug overdose ambulance runs. And the prevalence of opioid addictions in this area continues to increase.”

Becky Manning’s son got hooked on drugs. Fortunately, he’s still alive. But she blames the drugs in part for her husband’s suicide.

Becky Manning: “He just carried this tremendous guilt for everything, for our son doing drugs. Then he started getting depressed. And then my husband took his own life.”

Journalist: “How did he do it?”

Becky Manning: “He blew his head off. I came home to that.”

Best friend Marcy Conners’ husband also killed himself.

Marcy Conner: “He developed alcoholism very young in life.”

An addiction he shared with lifelong friends.

Marcy Conner: “One died with a heart attack. Drug use, alcohol use all through his life. Another one died of cancer; drank up to the very end. And my husband actually had a G-tube, a feeding tube in, and poured alcohol down his feeding tube — until he died. Alcohol poisoning.”

These cases fit a disturbing national pattern: though the US life expectancy has been going up steadily over the last century, there has now been a sudden and dramatic reversal — for just one demographic.

Anne Case, Princeton University: “White non-Hispanics in America, middle-aged are dying in large numbers.”

Angus Deaton, Princeton University: “It’s certainly a surprise to me.”

Economists Anne Case and Angus Deaton, who are married, published their finding after Deaton won the 2015 Nobel Prize in economics.

Their paper show that starting in 1999, the death rate of middle-aged, White Americans has been going up, instead of down.

Angus Deaton, Princeton University: “We though it must have made an error. I mean the whole world is getting better; this middle-aged group benefitted most, at least since 1970, from the advances in the treatment of heart disease, from people quitting smoking.

All of those things, and then suddenly this trend of going down, reversed. It seemed like it had to be wrong, but it wasn’t wrong.”

The big increase was in what Case calls, “death of despair”: alcohol-related liver disease … suicide … drug overdose.

Anne Case, Princeton University: “People kill themselves slowly, with alcohol or drugs, or quickly with a gun. For people aged fifty to fifty-five, for example, those rates went from forty per hundred thousand to eighty per hundred thousand since the turn of the century.

And it’s people with a high school degree or less who are killing themselves in these ways in large numbers. That’s the group that’s getting hammered.

Ellen Kumler: “And now the CDC is paying more attention to that age group and demographic.”

Ellen Kumler, a public health doctor from Mason County, Kentucky, says the latest data from the Centre of Disease Control picks up where the Deaton’s study leaves off.

Dr. Ellen Kumler, Mason County, Kentucky Health Department: “When we look at the suicide rate, when we look at unintentional injuries, a lot possibly related to substance abuse, as well as liver disease.

The rates of those issues have actually increased.”

Marcy Conners is a nurse specializing in substance abuse, who has experienced deaths of despair time and again, in her own family.

Marcy Conner: “I had a brother that committed suicide also.”

And two cousins, one of them a nurse.

Marcy Conner: “And he started to tell me that his depression medication wasn’t working well. And pain medication wasn’t working as well.

He lost his temper at work one night . . . and got fired.

They found him hanging in his garage.

Journalist: “And the other cousin?”

Marcy Conner: “She overdosed.”

And why so much drug use and abuse?

Ann Case and Angus Keaton found something else in their study:

Anne Case: “Since at least the mid-1990s, people’s reports of pain, of synaptic pain, of neck pain, of lower pain, year-on-year have increased.

The mid-nineties was also when the opioid painkiller oxycontin was approved by the FDA, and began to be marketed aggressively by doctors.

Oxycontin Promotional Video: “They do not have serious medical side effects. And these drugs, I repeat, are our best, strong medication, should be used much more than they are for patients with pain.”

Within five years, the drug’s maker, Purdue Pharma, was earning a billion dollars a year in profits on oxycontin, which soon rose to three billion.

As for the lack of serious side-effects, well it did have one.

Angus Deaton: “It’s basically heroin in a pill, with the FDA label on it. So people get addicted to this.”

Elizabeth Easton: “I started on oxycotin in high school.”

Elizabeth Easton is now in recovery.

Elizabeth Easton: “It unleashed something horrid in me. I went from one pill to taking them, to snorting them to injecting them. It was just really, really horrid.”

Journalist: “Because you gotta have it?

Elizabeth Easton: “You have to. It’s the only thing that makes you feel “normal”. And it’s the furthest thing from “normal”.

Becky Manning: “It controls your life. You’re a different person.”

That’s what Becky Manning saw in her son.

Becky Manning: “Seeking and finding his next high was his only priority, no matter who he took down with him.”

Marcy Conner: “The brain is telling you I got to have it again; I need more. So what’s where you end up with that craving. The craving ends up with the seeking supply.”

And though lawsuits and government crackdown have helped curb the supply of oxycotin, cheap heroin is more than filling the void.

Dr. William Craig Denham, Family Practitioner: “If you can’t get your pain pills that you were abusing, you’re going to find the source somewhere, so people are going to turn to street drug heroin, which is more dangerous, in the sense that you’re taking something made in someone’s garage versus something made in a factory.”

Chris Ruhm, Economist, University of Virginia: “In many areas, it’s cheaper to get high on heroin than it would be to get drunk. This is a major health crisis. Drug crisis have become the biggest preventable, premature deaths. So for example, there are more drug poisoning deaths than car-crash deaths.

And that’s quite recent.

And says Dr. Denham: “I’m seeing just as many middle-aged women as I am middle-aged men.”

Bucking a century-long improvement in White longevity.

David Lawrence, Mason County, Kentucky Coroner: “People without jobs, just kind of keeping to themselves, secluded from others.”


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1. The economy of Maysville, Kentucky is booming. Business is brisk. True or false?

2. Like the rest of the world, is their life expectancy increasing? Is it older residents who are dying earlier?

3. The main causes of death among many middle-aged people is cancer, cardiovascular (heart) disease and stroke. Is this right or wrong?

4. Were the two women very frank and open or reticent about talking about their family tragedies?

5. Who are most likely to die from drug overdoses, alcoholism and suicide? What socio-economic group is most vulnerable?

6. What may be a major cause of these deaths?

7. Is there a link between prescription medication and illegal substances (narcotics)?

A. Are there similar problems where you live?

B. Have things been changing over the years?

C. Are there any demographic trends? Why does this affect certain groups more?

D. What are the causes of the health crisis in parts of the US?

E. What will happen in the future?

F. Is there a solution or cure to this epidemic?

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