Dan Rodricks Commentary and conversation on life in Baltimore, Maryland and the USA

Memo to Trump: The real crisis is within, not at America's borders

The crisis President Donald Trump should be talking about is this one: Life expectancy in the United States is in decline, something not seen in a century — back to World War I and the influenza pandemic that killed an estimated 675,000 Americans and 50 million worldwide.

Immigrants are not to blame.

The continuing epidemic of fatal drug overdoses, most of them related to opioids, is considered the major cause of the decline, according to the Centers for Disease Control and Prevention.

Fentanyl, most of it imported from China, is a threat to American life — not poor Guatemalans at our southwestern border. If anything represents a national emergency it is the drug epidemic — not illegal immigration.

The numbers on overdoses are beyond alarming and render Trump’s obsession with border security ridiculous.

In 2017, there were 70,237 overdose deaths (from drugs and alcohol, but mostly drugs) across the nation — 2,282 of them here in Maryland, an all-time high for the state.

Final numbers for 2018 could be worse, if Maryland is any indication of national trends. Through the first half of last year, the state recorded 1,185 opioid-related overdose deaths. At that pace, the final tally for the year would surpass the 2,009 opioid-related deaths that the Maryland Department of Health recorded in 2017.

Baltimore was the epicenter of the epidemic, with 761 deaths in 2017, the most of any jurisdiction, and it’s likely headed for that distinction again.

Thousands of long-time addicts have been joined in the city by newcomers to the drug scene who became hooked on painkillers and spend hours and days looking for powerful opioids, particularly fentanyl. Those sirens you hear on city streets represent emergency runs to overdoses as much as they represent runs to shootings.

Between last January and June, the city had 483 overdose deaths, an increase of 88 over the same time period in 2017. At that pace, the city might have ended 2018 with three times as many overdose deaths as homicides. We will know when the state publishes its annual report.

It gets worse.

“The latest CDC data show that the U.S. life expectancy has declined over the past few years,” the director of the agency, Dr. Robert Redfield, said in published remarks in November. “Tragically, this troubling trend is largely driven by deaths from drug overdose and suicide.”

If you add suicides — close to 45,000 in 2016, and a steady increase in nearly every state since 1999, according to the CDC — the national portrait gets even darker. And yet the president wastes time, talk and tweets on immigrants and his foolish wall.

Wait. There’s more: The CDC reported in December that more people died from gunfire in 2017 than in any year since 1968. There were nearly 40,000 deaths from firearms, about 60 percent of them suicides. When you consider all this self-inflicted harm from drugs and guns, you see a deeply troubled nation.

Trump, meanwhile, is fixated on threats posed by outsiders — families seeking asylum in the United States, or those willing to cross the border illegally — when it’s clearly the internal threats that pose a far bigger challenge to a American society.

And, while the numbers I cite have been reported elsewhere, and multiple times, it seems a good part of the nation is reluctant to acknowledge these pathological conditions. The appeal of Trump to his supporters is his offer of a simplistic vision — that somehow he’s making the country great again and safe again, fixing things that were broken. Embracing this delusion is a way of avoiding the bad news about addictions, suicide and gun violence that runs like a toxic river from the rural countryside to the inner city.

Trump once spoke of ending the “American carnage,” and for a minute it seemed like he was going to do something about the trends I’ve described here. Tell you the truth, I’m not sure what he was talking about.

He remains fixated on the wrong problems.

But as much as his supporters might like Trump’s obsession with immigrants, the results of the midterm elections suggested something else: That far more Americans recognize that the country has profound problems — not Trumped-up ones — that require real leadership.

Worth noting, if only to add some sunlight to this dark national portrait: The death toll from drugs would have been a lot worse without the wide availability of naloxone, the overdose reversal medication. In Baltimore, Dr. Leana Wen, the former health commissioner, issued a standing order making naloxone available over-the-counter to city residents. During the last four years, the Baltimore Health Department recorded 3,478 reversals — opioid users brought back from the edge of death — and that number does not include the number of reversals performed by paramedics and police officers. Just consider the number of deaths we might be talking about without naloxone and good people who acted to save lives.

drodricks@baltsun.com

twitter.com/DanRodricks

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