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The Spiraling Opioid Epidemic in America

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US Opioid Epidemic Spiral in America

The Spiraling Opioid Epidemic in America

Over the last 20 years, the ongoing U.S. opioid crisis has claimed tens of thousands of lives. In fact, opioid overdose deaths accounted for nearly 70% of all drug overdose deaths in 2018.

Although the damage of the opioid epidemic is well documented, what people might not know is that it has escalated in three distinct waves.

We pull the latest statistics from the UN World Drug Report 2020 to uncover the scope of the opioid crisis in the U.S., and how national drug-related death rates compare to other countries.

Three Waves of the Opioid Crisis

According to the CDC, the opioid epidemic can be traced back to the 1990s, when opioids started being over-prescribed for pain relief purposes.

  • 1990s – Wave 1
    Over-prescription of opioids for pain relief, including natural opioids, semi-synthetic opioids, and methadone. Addiction risks were widely downplayed.
  • 2010 – Wave 2
    Heroin-related overdose deaths on the rise.
  • 2013 – Wave 3
    Synthetic opioid-related deaths on the rise, particularly fentanyl and tramadol.

Here’s how that breaks down in terms of opioid-related overdose deaths over the years. Note that by the year 2018, 67% of overdose deaths involved synthetic opioids such as fentanyl.

YearAny opioidsHeroinPharmaceutical opioidsSynthetic opioids
19998,0501,9603,533730
20008,4071,8423,903782
20019,4961,7794,935957
200211,9202,0896,7741,295
200312,9402,0807,8391,400
200413,7561,8789,0761,664
200514,9182,00910,2341,742
200617,5452,08812,4232,707
200718,5162,39913,6762,213
200819,5823,04114,0432,306
200920,4223,27814,4312,946
201021,0893,03615,5203,007
201122,7844,39716,1112,666
201223,1665,92515,0722,628
201325,0528,25713,9373,105
201428,64710,57415,5595,544
201533,09112,98916,0289,580
201642,24915,46917,86019,413
201747,60015,48217,68928,466
201846,80214,99615,57531,335

Overdose deaths from synthetic opioids such as fentanyl and tramadol shot up by over 4,000% between 1999-2018. This can be attributed to two things: their relative potency, and the minute quantities of each that qualify as a lethal dose.

As per the medical and legal standard, opioids are often compared to morphine. To that end, heroin is 2-5x stronger—while fentanyl is 50-100x more potent. Put another way, roughly a dime-size or 10-12mg of heroin is considered a lethal dose, compared to only 1-2mg of fentanyl.

What’s worse, fentanyl is typically mixed with other types of drugs such as heroin or cocaine to increase their effects, which is how it ends up unintentionally ingested. Between 2008-2017, drug-use disorders as a whole claimed the most healthy lives due to poor health or early deaths—measured in disability-adjusted life years (DALYs)—followed in close second by opioid use disorders.

The Death Toll of U.S. Drug Overdoses

It’s undeniable that the opioid epidemic in America has caused significant harm to communities. But how does the U.S. drug crisis compare to the same issue in other countries?

The UN Drug Report further puts these numbers into perspective by comparing drug-related deaths per million population. Note that the source also compiled the total deaths across years for selected countries.

Country (Latest Year)Latest Years of EstimateTotal DeathsRate per 1M (Aged 15-64)
🇺🇸 U.S.201867,367314.5
🇦🇺 Australia2016-20173,240202.6
🇸🇻 El Salvador2018765184.5
🇨🇦 Canada 20184,460179.8
🇺🇾 Uruguay2016264119.4
🇮🇸 Iceland2012-201623105.2
🇸🇪 Sweden201757592.9
🇳🇿 New Zealand201626988.6
🇫🇮 Finland201728983.9
🇬🇧 UK20173,54783

With 314.5 deaths per million, the U.S. by far had the highest proportion of drug-related deaths per million people in 2018. It also had the highest overall number at 67.4K deaths.

Elephant in the Room?

Another drug rearing its head on the streets is carfentanil. Formerly developed as ‘elephant tranquilizer’, this synthetic opioid is similar in appearance to other illicit drugs such as heroin, making it indistinguishable when mixed in. However, there’s one big problem—carfentanil is 100x more potent than fentanyl itself.

In response to the continued crisis, an additional $35.7 billion was requested for counter-drug funding efforts in the FY2021 Budget. This amount is expected to go towards prevention and treatment efforts ($18.6 billion) and law enforcement efforts ($17.1 billion) both domestically and internationally.

But will these efforts properly combat the crisis, or are we already in the midst of a fourth wave of the opioid epidemic?

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Markets

Ranked: The Best and Worst Pension Plans, by Country

As the global population ages, pension reform is more important than ever. Here’s a breakdown of how key countries rank in terms of pension plans.

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Ranked: Countries with the Best and Worst Pension Plans

The global population is aging—by 2050, one in six people will be over the age of 65.

As our aging population nears retirement and gets closer to cashing in their pensions, countries need to ensure their pension systems can withstand the extra strain.

This graphic uses data from the Melbourne Mercer Global Pension Index (MMGPI) to showcase which countries are best equipped to support their older citizens, and which ones aren’t.

The Breakdown

Each country’s pension system has been shaped by its own economic and historical context. This makes it difficult to draw precise comparisons between countries—yet there are certain universal elements that typically lead to adequate and stable support for older citizens.

MMGPI organized these universal elements into three sub-indexes:

  • Adequacy: The base-level of income, as well as the design of a region’s private pension system.
  • Sustainability: The state pension age, the level of advanced funding from government, and the level of government debt.
  • Integrity: Regulations and governance put in place to protect plan members.

These three measures were used to rank the pension system of 37 different countries, representing over 63% of the world’s population.

Here’s how each country ranked:

CountryOverall ValueAdequacySustainabilityIntegrity
Argentina39.543.131.944.4
Australia75.370.373.585.7
Austria53.968.222.974.4
Brazil55.971.827.769.8
Canada69.27061.878.2
Chile68.759.471.779.2
China48.760.536.746.5
Colombia58.461.44670.8
Denmark80.377.58282.2
Finland73.673.260.792.3
France60.279.14156.8
Germany66.178.344.976.4
Hong Kong61.954.554.586.9
India45.839.944.956.3
Indonesia52.246.747.667.5
Ireland67.381.544.676.3
Italy52.267.41974.5
Japan48.354.632.260.8
Korea49.847.552.649.6
Malaysia60.650.560.576.9
Mexico45.337.557.141.3
Netherlands8178.578.388.9
New Zealand70.170.961.580.7
Norway71.271.656.890.6
Peru58.56052.464.7
Philippines43.73955.534.7
Poland57.462.545.366
Saudi Arabia57.159.650.562.2
Singapore70.873.859.781.4
South Africa52.642.34678.4
Spain54.77026.969.1
Sweden72.367.57280.2
Switzerland66.757.665.483
Thailand39.435.838.846.1
Turkey42.242.627.162.8
UK64.46055.384
U.S.60.658.862.960.4

The Importance of Sustainability

While all three sub-indexes are important to consider when ranking a country’s pension system, sustainability is particularly significant in the modern context. This is because our global population is increasingly skewing older, meaning an influx of people will soon be cashing in their retirement funds. As a consequence, countries need to ensure their pension systems are sustainable over the long-term.

There are several factors that affect a pension system’s sustainability, including a region’s private pension system, the state pension age, and the balance between workers and retirees.

The country with the most sustainable pension system is Denmark. Not only does the country have a strong basic pension plan—it also has a mandatory occupational scheme, which means employers are obligated by law to provide pension plans for their employees.

Adequacy versus Sustainability

Several countries scored high on adequacy but ranked low when it came to sustainability. Here’s a comparison of both measures, and how each country scored:

Ireland took first place for adequacy, but scored relatively low on the sustainability front at 27th place. This can be partly explained by Ireland’s low level of occupational coverage. The country also has a rapidly aging population, which skews the ratio of workers to retirees. By 2050, Ireland’s worker to retiree ratio is estimated to go from 5:1 to 2:1.

Similar to Ireland, Spain ranks high in adequacy but places extremely low in sustainability.

There are several possible explanations for this—while occupational pension schemes exist, they are optional and participation is low. Spain also has a low fertility rate, which means their worker-to-retiree ratio is expected to decrease.

Steps Towards a Better System

All countries have room for improvement—even the highest-ranking ones. Some general recommendations from MMGPI on how to build a better pension system include:

  • Increasing the age of retirement: Helps maintain a more balanced worker-to-retiree ratio.
  • Enforcing mandatory occupational schemes: Makes employers obligated to provide pension plans for their employees.
  • Limiting access to benefits: Prevents people from dipping into their savings preemptively, thus preserving funds until retirement.
  • Establishing strong pension assets to fund future liabilities: Ideally, these assets are more than 100% of a country’s GDP.
  • Pension systems across the globe are under an increasing amount of pressure. It’s time for countries to take a hard look at their pension systems to make sure they’re ready to support their aging population.

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Animated Map: The History of U.S. Counties

This video highlights the history of American counties, and how their boundaries have changed over the last 300 years.

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Animated Video: The History of U.S Counties

Did you know that there are 3,142 different counties in the U.S. today?

Going as far back as the 1600s, English settlers arriving in the New World envisioned counties as a means of accessible government—a county seat was meant to be within a day’s buggy ride for every citizen.

While the role of counties in local government has remained significant in modern times, their boundaries have changed drastically over the years.

This animated map by Alexander Varlamov visualizes the history of U.S. county borders, and how these jurisdictions have evolved over time.

County Equivalents

Before diving in, it’s important to note a few county-equivalents that function similarly but go by different names:

  • Boroughs/Census areas: Alaska is made up of 19 boroughs, but the majority of its landmass is not included in them. Rather, it’s officially labeled by the Alaskan government as the unorganized borough.
  • Parishes: Instead of counties, Louisiana uses the term parishes because of its French and Catholic heritage.
  • Independent cities: These are cities that operate outside their surrounding county’s jurisdiction. There are 41 independent cities in the U.S. and 38 of them are in Virginia.

Over 300 Years of Growth

The number of counties in the U.S. has increased dramatically since the early days of American history. Here’s a look at their growth since 1790:

YearNumber of Counties and Parishes
1790292
18501621
18702247
19002713
19203041

The first county was established in 1634, over 100 years before the first Census was taken (and long before America gained independence). It was created in James City, Virginia—an interesting location, considering Virginia now has the highest concentration of independent cities.

Why does Virginia have so many independent cities? The state’s separation of counties and cities dates back to the early 1700s. With a rural population and low productivity, it was difficult to establish town centers. After several attempts, the General Assembly gave up. Independent cities were established instead.

Short-lived Counties

Counties as a political organization have been around for hundreds of years, but some individual counties haven’t lasted long.

For instance, Bullfrog County in Nevada was established in 1987 and dissolved just two years later. During its brief existence, it had no population and no infrastructure—and its primary purpose was simply to prevent Yucca Mountain from becoming a nuclear waste dump.

While Bullfrog County has since been dissolved, the controversy around the nuclear waste site is ongoing as of 2020.

Continual Change

The latest official county, Broomfield Country, was established in Colorado in 2001.

Although it’s been decades since the last county was created, there have been continual boundary changes and status updates—sometimes for political reasons. For instance, the Supreme Court recently ruled that half of Oklahoma is within a Native American reservation. While this doesn’t necessarily change ownership, it does affect jurisdiction and county authority.

Though the lines on the map are more or less static now, the invisible lines of county jurisdiction will continue to change and evolve over time.

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