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.
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|disease||MESH||substance use disorder|
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- Opioid-related deaths in Europe: Strategies for a comprehensive approach to address a major public health concern.
- Association between opioid analgesic therapy and initiation of buprenorphine management: An analysis of prescription drug monitoring program data.