Prescriptions for Increasing Life Expectancy

"On the opioid crisis, heightened attention to overprescribing of pain medications, including new prescribing guidelines, has begun to reverse the two-decade-long increase in deaths from opioid prescription drugs. We need to drastically improve management of both pain and addiction. This will require improvements in how medical care, including physical therapy and addiction treatment, is provided and paid for. And law enforcement needs to stanch the inflow of illicit heroin and fentanyl, because lower prices and greater accessibility lead, inevitably, to increased use."
"For those addicted to opioids, easy access to medically-assisted treatment, particularly with buprenorphine and methadone, is important. For everyone else, we need to hit the reset button on opioid prescriptions, which, except for terminal palliative care and no more than three days for acute pain, should rarely be used. These are dangerous medications — a few doses and a patient can be addicted for life, and a few too many pills and a person can die; no other class of medication kills such a high proportion of people who take them. Doctors and their state medical boards should be informed each time a person dies from a prescription they wrote."
Thomas R. Frieden, director of the Centers for Disease Control and Prevention from 2009 to 2017

"Living in the US increasingly looks like a health risk. Average life expectancy here dropped for the second year in a row, according to recent data from the Centers for Disease Control and Prevention. The grim trend stems from a toxic mixture of more drug- and alcohol-related deaths and more heart disease and obesity in many parts of the country. And it puts Americans at a higher risk of early death compared to their counterparts in other wealthy countries."
Julia Belluz, Vox

"In Canada, the average life expectancy was 80 years for males and 84 years for females in 2018. For the United States those numbers were 71 years for males and 81 years for females. Of those considered in this statistic, the life expectancy of female Canadian infants born in 2015 was the longest, at 84 years. Female infants born in America that year had a similarly high life expectancy of 81 years."
Statista.com


”[Society in the U.S. is] very unequal to an extent the whole national performance is affected – it is the only country without universal health insurance."
"The U.S. has the highest child and maternal mortality, homicide rate, and body-mass index of any high-income country."
"The USA is also the only country in the OECD (Organization for Economic Co-operation and Development) without universal health coverage, and has the largest share of unmet health-care needs due to financial costs. Not only does the USA have high and rising health inequalities, but also life expectancy has stagnated or even declined in some population subgroups."
Majid Ezzati, professor, global environmental health, Imperial College London 

"There are some signs which are pointing in the same direction [that life expectancy in Canada may come under threat by factors similar to those causing falling life expectancy in the United States]."
"We find the same [trends], to a much lesser degree, in Canada. Ninety percent of what's happening with deaths of despair in the United States is happening in rural America. You cannot let large parts of a country have a net loss in salary over ten to fifteen years and expect those people to be as happy and as clear as before."
"Our life expectancy [in Canada] is increasing, but it's plateauing."
Juergen Rehm, Centre for Addiction and Mental Health, Toronto

Life expectancy in the United States has begun to decline -- rare in a wealthy country -- with most of the emerging decline seen to be the result of an increase of "deaths of despair" related to drug overdoses, suicide or alcohol abuse. In addition, the increase of those deaths are seen to be heavily weighted in areas with poorer and people living rurally. Mr. Rehm recently wrote a paper, published in the Canadian Medical Association Journal suggesting that the problems plaguing the United States are sliding over into Canada.

Overdose deaths, lethal enough to take the lives of well over 100 American citizens daily have been on a steady increase, amounting in 2017 to a total of 4,000 in Canada, according to the commentary by Mr. Rehm published in the Canadian Medical Association Journal. As deaths from drug overdoses rise, so too are those from alcohol-related diseases such as cirrhosis of the liver. Canadian income inequality may not quite reflect those of the United States, but World Bank figures indicate that income inequality is on the rise in Canada, as well.

A separate paper published in the same journal provides additional support for Mr. Rehm's contention. The average Canadian lifespan remains at 82 years -- representing the 10th-longest in the world, up slightly from 81 years in 2006. A decade ago, Canada's ranking among other nations was several notches higher than it now is. The death rate from mental and substance use disorders increased by 11 percent in Canada from 2006 to 2016, according to the same study.

Canadians' health overall is generally good, reports the Public Health Agency of Canada, while also noting health issues in an aging population are steadily shifting toward disease and disability as people age. With his experience at the teaching and research hospital at Toronto's Centre for Addiction and Mental Health, Mr. Rehm stresses that further decline in life expectancy driven by deaths of despair can be avoided by the simple expedient of making it more difficult to acquire inexpensive alcohol.

The obvious factor of doctors prescribing opioid painkillers too liberally and with too little oversight to patients is yet another partial solution to an intractable and growing problem within society. "While Canada has seen half the prescription opioids in the U.S., we’re still the second-highest-use country in the world", he emphasized. "We should allow those policies that are at least not worsening our gap between the rich and the poor. I’m a statistician, I’m not a member of a political party, I’m not a member of anything. I look at the data. Will I convince everybody? No, but I’ll do my best."

The Public Health Agency of Canada says the average Canadian lifespan is 82 years — still the tenth-longest in the world. But it’s up only slightly from 81 years in 2006. And Canada’s current ranking is two notches lower than it was a decade ago. The same study finds the death rate from mental and substance use disorders increased by 11 per cent from 2006 to 2016.  (Brian B. Bettencourt / Toronto Star)

Epigenetics Fracturing Aboriginal Youth

"Suicide is not a traditional aspect of indigenous culture in Canada."
"This commentary raises the possibility that the effects of tetraethyl lead poisoning during the 1970s and 1980s contributed to the rise in suicides, and continues to contribute to the growing problem through epigenetic modifications."
New research paper on aboriginal youth and suicide

"I think it [1970s/80s gasoline sniffing among aboriginal youth] is a contributing factor [in current-day suicide rates], but I don't think it's the primary one."
"It's not just going to be one thing, there are going to be a lot of interactions between environmental risk factors and the biological ones, too."
Trehani Fonseka, leader, First Nations depression and suicide-prevention program, St.Michael's Hospital, Toronto, study co-author

THE CANADIAN PRESS/Nathan Denette   A cemetery at Attawapiskat First Nation, which declared a state of emergency over suicide attempts last year.

A newly re-discovered letter sent in 1973 from a scientist with Health Canada to colleagues at the hospital in Sioux Lookout alerting them to his finding tests indicated that gas sniffing had become a widespread practise among aboriginal youth, and it led to research findings and theories resulting in a paper recently published in the journal Psychiatry Research. The finding was that gas-sniffing as a source of lead poisoning was responsible for triggering genetic changes in the users.

And those genetic changes passed on through the generations, a process named as epigenetics. The scientists at St. Michael's Hospital and the University of Toronto arrived at a hypothesis that neurological problems surfaced in the original sniffers' descendants making them more susceptible to depression and suicide. That theory is partially supported by the fact that indigenous communities had minimal suicide rates before the mid-1980s while at the present time their rates of suicide rank among the highest in the world.

The lead poisoning leading to genetic alterations, added to impoverished communities breeding in their residents attitudes of hopelessness -- along with family histories of mental illness and addictions, childhood abuse and the unfortunate after-affects of the residential-school era, when aboriginal children were removed from their homes and placed in teaching institutions whose programs steered them to a rejection of their heritage and toward European values -- constitutes a lethal mixture of social dysfunction.

"We're always struggling to find some simple explanation for complex, multi-factorial things. It's a mistake to interpret this (suicide epidemic) as some kind of inevitable consequence", stated Dr. Laqurence Kirmayer, a professor of psychiatry at McGill University who heads a national network on aboriginal mental-health research, and who seems less than impressed with the conclusion reached by this latest research paper, though it makes no effort to attribute epigenetics entirely being the sole fault in the spate of recent suicides.

CP PHOTO/Ted Ostrowski    An unidentified Sheshatshiu Innu youth openly sniffs gas in the community on Friday Nov. 17, 2000.

Yet the effect of the past 30 years of surging suicides among aboriginal youth has transfixed the scientific community through endless discussions with no solution in sight. On a single day at the Attawapiskat reserve in northern Ontario last spring, eleven suicide attempts occurred. While in northern Saskatchewan there were six deaths by suicide among girls from age ten to fourteen, and another six suicides in 2014 in a remote Quebec indigenous community. A staggering loss.

A coroner's enquiry in 2010 stated that young indigenous people commit suicide at five to six times the rate of non-native youth, when it looked into 15 child suicides at the Pikangikum First Nation in Ontario. Thirty years ago the twenty First Nations in northwestern Ontario recorded one or two suicides a year in comparison, according to the coroner's office figures.

Tests in the 1970s showed lead volumes in gas sniffers of up to 85 micrograms per 100 millilitres of blood, when neurological damage is known to begin with levels as low as five micrograms. Dr. Fonseka allows that additional studies to test the hypothesis are required, and if confirmed the very presence of genetic changes linked to lead poisoning that occurred in earlier generations could provide an "early warning", identifying groups at risk of suicide so preventive programs can be designed in response.

"I think I'll never stop sniffing gas. I want the same thing to happen to me that happened to my brother Charles," Angela says. "I want to die the same way my brother died... while sniffing gas."   CBCnews