A new SOA/RGA study shows that after years of rising drug overdose deaths, preliminary 2024 data indicate a potential turning point, with the first sustained decline in more than two decades. The analysis also found that alcohol presents mortality impacts relevant to the insurance industry, and discussions with internal experts highlighted various considerations for insurers.
The numbers that have haunted American mortality statistics for more than two decades are finally bending in the right direction.
Drug overdose deaths skyrocketed from 17,000 in 1999 to nearly 108,000 in 2022, driven largely by the involvement of opioids. These deaths dropped to approximately 105,000 in 2023. At the time of the analysis, provisional data suggests an even more dramatic 27% decline in 2024, marking the first sustained decrease in a crisis that has claimed hundreds of thousands of lives.
For insurers, this shift represents both hope and complexity. While substance-related mortality has declined, there remains an ever-evolving set of drivers and considerations for insurers.
The drug overdose crisis unfolded in phases, each generally more deadly than the last.
While headlines tend to focus on opioids and drug overdose deaths, alcohol may present a more significant threat to the insured population.
The data reveals stark differences in how substances affect various populations. For example, alcohol-induced deaths typically occur at older ages, likely due to chronic conditions such as liver disease, while drug overdose deaths claim younger lives.
The drug overdose crisis affects demographic groups differently. The highest mortality risks are faced by males, unmarried individuals, those with lower education levels, and workers in construction-related occupations. In fact, one alarming finding shows that around 25%-30% of all deaths for those aged 25-39 were attributed to drug overdoses in 2023.
Geographically, Eastern states have seen more improvement than Western states for 2024 drug overdose death rates, with some Eastern regions dropping 36% below pre-pandemic levels, while Oregon, Washington, and Alaska remain 130%-150% above 2019 levels.
These disparities can reflect complex socioeconomic factors, including income inequality, access to healthcare, and treatment availability.
Recent advances in treatment accessibility may be driving the mortality decline. The removal of DEA X-waiver requirements for buprenorphine prescriptions in 2023 expanded access to medication-assisted treatment. Over-the-counter naloxone approvals have made overdose reversal medications widely available, and increased legality of drug checking equipment have further enhanced risk reduction measures.
Emerging treatments such as GLP-1 drugs, originally developed for diabetes and now used to treat obesity, show promise for addiction treatment. These medications are expressed in brain areas influenced by addictive substances and may represent a new frontier in substance use disorder treatment.
RGA's analysis of over 6,900 alcohol- and drug-related claims from 2011 to 2023 reveals patterns that mirror but do not perfectly match general US population trends. Substance-related mortality in the insured population peaked in 2021, with rates increasing 13% annually between 2019 and 2021 followed by an annual 2% decline.
As the industry moves to better align underwriting processes with consumer demands, traditional fluid testing becomes less common. It is important for underwriters to be able to identify potential substance use disorders through less direct indicators.
Red flags include histories of trauma, mental illness, extended sick leave, or accidents. Medical signs such as hypertension, palpitations, gastrointestinal issues, or liver function abnormalities warrant closer scrutiny. Prescription patterns – particularly multiple prescribers, frequent renewals, or extended durations – can signal potential misuse.
The correlation between mental health and substance use disorders is important to understand. One-third of adults with mental illness had a substance use disorder in 2023, and those with mental illness were more likely to use illicit drugs, misuse opioids, and binge alcohol compared to those with no mental illness.
The US leads the world in drug-related mortality, largely due to unique factors including prescription marketing practices, supply chain differences, and limited supervised consumption sites. Comparisons with Canada show similar trends but lower overall mortality rates.
The future remains uncertain. While recent declines offer hope, the contamination of drug supplies with novel substances poses ongoing risks.
The evolving substance use crisis demands a nuanced approach to risk assessment. The focus on drug overdoses must expand to include alcohol’s significant impact, particularly on higher-educated populations which may be more representative of an insured population.
These findings highlight the importance of considering the differences in cause-of-death trends between the general and insured populations when setting mortality improvement assumptions. While substance-related deaths have had a larger impact on general population mortality, the insured population shows similar experience patterns. Nevertheless, it is important for underwriters to be aware of the subtle indicators — medical, social, and behavioral — that could indicate a potential substance use disorder.
The encouraging decline in substance-related mortality offers hope, but insurers must remain vigilant. The crisis has evolved through multiple waves, each bringing new challenges. Success in navigating this landscape requires continuous monitoring, adaptive strategies, and recognition that the battle against substance-related mortality is far from over.
Read the full research paper – which includes additional insights from analyses, medical literature review, and discussions with internal RGA experts – and discover practical considerations to respond to this new data.
