What the US and Canada can learn from other countries to combat the opioid crisis

What the US and Canada can learn from other countries to combat the opioid crisis

Publication date: Jan 14, 2020

In a 2018 article for Foreign Affairs, we detailed what set off the North American opioid crisis and what other nations can learn from mistakes the U. S. and Canada made.

Here, we describe the opioid situation in other countries and then reflect on what U. S. and Canadian officials could learn from them.

Key lessons include that flooding the health care system with prescription opioids isn’t necessary to manage the population’s pain, guaranteed health care access may help slow opioid epidemics, and the rules for how opioids are prescribed matter, among others.

Unscrupulous U. S. pharma companies are exporting the opioid epidemic abroad Opioid prescribing in multiple Western countries (e. g. the Netherlands, the United Kingdom, Israel) has risen significantly over the past decade, though not yet to U. S. levels.

Purdue drove early stages of the U. S. opioid crisis by promoting OxyContin in misleading and unethical ways, notably misrepresenting its risk of addiction when used to treat chronic, non-cancer pain.

Likewise, Mundipharma has actively lobbied to open up European countries to greater opioid prescribing, as well as sponsored doctors to promote prescription opioids and deny their high potential for addiction.

Mundipharma has also set up joint ventures with powerful pharmaceutical companies in developing countries with huge populations, such as India and Brazil.

India has substantial undertreated pain; if India’s pharmaceutical companies embrace Western-supplied opioids or produce their own generic morphine primarily for acute or cancer pain, that would not be problematic.

China and India remain obstacles to controlling illicit synthetic opioids Meanwhile, China has historically exerted minimal control over producers of illicit fentanyl and other synthetic opioids.

Lesson 1: Flooding the health care system with prescription opioids is not needed for population pain management.

Pharmaceutical companies and patient advocacy groups (some of which are industry-funded) argue that the near-quadrupling of opioid prescribing that began in the mid-1990s was a necessary response to an extraordinary level of pain in the population.

Neither is there any evidence that the explosion of opioid prescribing that began in the mid-1990s reduced population pain in the U. S. Meanwhile France, the developed country which population pain surveys indicate is most similar to the United States, consumes barely one-fifth the prescription opioids on a per capita basis.

In parts of North America, this now presents a high risk of being exposed to extremely deadly synthetic opioids, such as fentanyl, which dealers increasingly use to adulterate heroin and counterfeit opioid pills in those regions.

Markets in more regions might embrace synthetic opioids, amplifying death rates, because fentanyl costs wholesale drug dealers only about 1% as much per morphine-equivalent dose as does heroin.

Concepts Keywords
Addiction Fentanyl
Africa Oxycodone
Alberta Purdue Pharma
Appalachia Sackler family
Black Market Morphinans
Brazil Euphoriants
British Columbia Opioids
Buprenorphine Drugs
Canada Psychoactive drugs
Canadian RTT
Cancer Pain Chemical
Care System Insurance employment
China Population pain management
Cocaine Opioids kinds pain
Counterfeit Pharmaceutical industry
Crack Cocaine Epidemic
Delhi
Developed Countries
Developed Country
Developing Countries
Drug Policy
Economic Growth
England
Epidemic
Equivalent Dose
Estonia
Fentanyl
Finland
Fizzle
France
Germany
Globe
Gram
Heroin
India
Insurance
Iraq
Israel
Italy
Kolkata
Latin America
Lebanon
Lobbying
Methamphetamine
Middle East
Morphine
Mumbai
Myanmar
Narendra Modi
Netherlands
Nigeria
North America
Opioid
Opioid Epidemic
Opioid Overdose
Opioids
Orthodontic
OxyContin
Pain
Pain Management
Painkillers
Patient Advocacy
Pharma
Pharmaceutical
Pharmaceutical Companies
Pharmaceutical Industry
Pharmacy
Physical Therapy
Poland
Poor Law
Poppy
Purdue
Purdue Pharma
Quixotic
RAND
Ratchet
Regulatory Capture
Sting Operations
Tramadol
United Canada
United Kingdom
United States

Semantics

Type Source Name
drug DRUGBANK Morphine
drug DRUGBANK Cocaine
drug DRUGBANK Tramadol
drug DRUGBANK Fentanyl
drug DRUGBANK Diamorphine
drug DRUGBANK Metamfetamine
drug DRUGBANK Flavin adenine dinucleotide
disease MESH employment
disease MESH substance use disorder
disease MESH community
disease MESH death
drug DRUGBANK Buprenorphine
disease MESH suffering
disease MESH cancer
disease MESH growth
disease MESH multiple

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