Opioid Crisis in the US: How Does It Compare to the Rest of the World?

If by this point in time you have not been made aware of the opioid epidemic destroying American communities, hamstringing necessary funding meant for healthcare, and leading the overdose-rate globally, then we would be surprised. If this is news to you then put your seatbelt on, as the road we are going to take you down is not a pretty one.

A Speck of History

The U.S. is currently facing a drug crisis unlike any other it has faced before. What the cocaine boom of the 80s and the heroin dump of the 90s had in common was that both were caused by illicit drugs. Neither heroin nor cocaine has ever been an FDA approved drug, nor have either been regulated. Today, the crisis we currently face begins with a regulated, commonly prescribed, and legal drug; the opioid.

Opioids are relatives to opiates. Both originate from the papaver somniferum, more commonly known as the opium poppy. The opium poppy is the grandfather of pain medication, with the earliest records of the flower appearing in Sumerian text date near 4,000 BC. Many moons later, a widely known pain relief drug named morphine was derived from that specific flower in the 1800s.

Regarded as a breakthrough medication, it was made available to the public and used heavily in the wars that occurred in the 19th century, with the American Civil War being the event which required the most morphine. Being that morphine predates heroin and was the first extraction of the alkaloid in the opium poppy, or in other words highly concentrated opium, it also had the most efficacy. It mitigated pain, caused drowsiness and released endorphins which gave the users a pleasant ‘high.’

Unfortunately, it took less than a decade for the world to learn that as much of a benefactor morphine was to the progress of medicine, it was equally as harmful to humanity. Returning to the American Civil War, it is said that once England lost, some 400,000 soldiers were left with the ‘war sickness.’ In other words: addiction.

What followed was heroin, which happened to be a drug created as a response to the ‘morphine epidemic’ that riddled America after the Civil War. Marketed as a ‘non-addictive alternative for morphine addicts,’ it hit US markets towards the end of the 18th century and was nearly available to everyone. Heroin, as we know, proved not to be a solution for morphine addiction but in fact a stronger addiction altogether. Enter the drug that would be the leading cause of overdoses for many years to follow.

Fast forward another century and then some and we land here, where opioids are now the primary pain relief medication. Opioids are synthetic, lab-made pain relief drugs derived from the same alkaloid found in heroin and morphine, but they scale from moderate potency to certain molecular structures that take not more than a few micrograms to stop a healthy person’s respiratory system.

Drugs like Vicodin, Percocet, and Fentanyl are all part of the opioid family. If you have ever undergone surgery, no matter what the severity, you have probably been prescribed some form of an opioid.  

The Problem in America

The opioid epidemic can be broken traced back to two problems; Big Pharma and the nature of opioids. Despite the progress and advances the world has made in medicine, when it comes to painkillers their base molecular structure is not too different than the addictive drugs which came before it. There is a simple and monumental point to be made here: the opioids (painkillers) commonly prescribed in medicine remain to be highly addictive.

The other problem boils down to the massive marketing campaigns spearheaded by pharmaceutical companies. With aspirations to place opioids like Vicodin and Percocet into the back pocket of every healthcare professional, these companies advocated the use of these painkillers as long-term solutions for pain management. Today, evidence proves that the long-term use of opioids is far more detrimental than beneficial to the user’s health. This evidence was available to them at the time, but they used incentive-based programs to motivate doctors to overprescribe opioids.

This is what happened: in the 1990’s, once the medical industry began to treat chronic pain as a medication-requiring disease, painkillers became the answer. With little regard to long-term effects (a trend often noted in medicine), prescriptions were passed out like candy on Halloween. From 1999 to 2015 the prescription rate in the U.S. alone quadrupled.

We repeated the past. Morphine was distributed to soldiers in the American Civil War which spurred the morphine epidemic. Opioids were distributed to the American public from the 90s to now, and big surprise: it served as a genesis of the opioid epidemic.

From the doctor’s office, the streets, to the affluent parent’s upstairs bathroom cabinet, opioids were one of the most prolific medications to disrupt the market. But with such vehement proliferation come consequences and those ugly truths are now dancing in front of us.

In 1999, around 17~ thousand Americans died from drug overdose, with heroin being the most common killer. In 2015, 52,000 Americans died at tragic hands of an overdose. 37,000 of those deaths were opioid exclusive or opioid-related. The prolific rise of opioids within the American market caused other factors to scale at the same rate. Sadly, this means it gave birth to more addicts and overdoses.

Nowadays overdose from opioids is the leading cause of death for Americans under 50 years old. That’s more than disease, car crashes, and more than the AIDS crisis of the 80s. Let that resonate. In a bit more than a decade, we have allowed a ‘medicine’ to infiltrate our society that is now the leading cause of death for an age group that should be healthy and thriving.

This is certainly a nationwide epidemic and at this point in time, our futile efforts to regulate opioid distribution have done little to correct the problem. Once an addiction such as the one we’re facing evolves, market demand will call for market supply, and drug traffickers have heard the siren and continue to deliver. Counterfeit pills, Chinese-synthesized fentanyl, and mass-batches of heroin continue to infiltrate our drug market and contribute to the rising addiction and overdose rates. There is no other way to put it: this is a crisis currently out of our control.

How Does the US Opioid Epidemic Compare to the Rest of the World?

Herein lies another startling fact about the American opioid epidemic: we currently consume about 90% of the world’s opioid supply. When taking into account that America contributes to around 4.4% of the global population, then it is reasonable to say there is something adamantly wrong here.

One might think that America is a microcosm to the way in which the distribution of painkillers affects a certain territory. While overdose spikes and drug addiction continue to rise globally, the only other country which has taken the brunt force of the opioid cancer is Canada. This, unfortunately, is not a fact which protects the healthcare system of other countries.

First—beyond the startling wealth shared in America, which allows for more people(s) to purchase opioids—we have vast accessibility. The healthcare system in this country is a topic that sparks much controversy but to deny its vastness and availability (to those with money) is to live in denial. Not all countries have the same infrastructure and many handle the problem of pain in other ways than throwing prescription canisters in a patient’s face.

While we struggle to right the issue we’re facing within our borders, it is paramount that other countries look to us as an example of what not to do. Due to mass-awareness brought to the opioid epidemic, the government is now regulating the way in which doctors prescribe medication. The flexibility for unscrupulous doctors to benefit off Big Pharma incentives is ending and the way in which we’re administering pain medication is finally, at last, beginning to shift.

Unfortunately, these regulations have hardly made an impact. Addiction is a disease as any other and once it surfaces, aiding those suffering is not as simple as disciplining the legal source of their medication. Nowadays many former opioid-addicts turn to the streets once they can no longer doctor hop, or if their prescriptions become too costly, turn either to counterfeit pills or cheap bags of heroin to satisfy their cravings.

While some communities have begun to work autonomously at righting the opioid problem, we are expecting to see a continued rise in both usage and overdoses by the end of the year. This is particularly the fault of fentanyl, a powerful opioid that’s 50 times stronger than morphine and being mass-replicated then dumped into our drug market.

The regulations set about by the government do have a major consequence, however, and unfortunately it has little to do with fixing our problem or us as a nation in general. Being that these regulations aim to change the prerogative of practicing doctors, our medical industry’s demand for opioids lessens.

This is beneficial for us as a country, as it means less opioids are being distributed, but this is a huge red flag for Big Pharma. Seeing as Australia, Europe, Canada, and the Middle East have experienced a substantial rise in opioid abuse and overdoses (although nothing in comparison to the US), pharmaceutical companies will strive to disrupt other markets and extend their influence elsewhere.

We’ve seen the type of influence they can have on a culture and people and we can only hope that other countries learn from the situation we’re currently facing. It’s imperative that as we shoehorn more regulations within the medical industry in aims to tackle the ‘legal’ side of the problem, also considered the source, that the result will be less influence for these companies.

In which case it is developed countries that will be their first targets, with countries on the rise a close second. We all know the power, wealth, and infrastructure that is America, yet we have proven nearly powerless in tackling this issue. What will happen when opioids disrupt countries that do not have the resources to provide help for the addicts? What will happen when Big Pharma decides to cheapen their products in hopes to poach lower-income countries into using their ‘impeccable solution’ for pain management?

Sadly, this is not a problem of the future. Already companies are launching marketing campaigns promoting opioids and simultaneously discrediting American ‘opiophobia,’ advocating only the best and non-addictive attributes of the drug they’re trying to sell.

We can only hope that this problem remains our own. If any positive can be taken from our current epidemic, it’s that we serve as a model example of what not to do when it comes to opioids. Handing out prescriptions should be the last resort when it comes to managing pain, and extremely regulated. The patients in need should be vetted for prior addiction and closely monitored if prescribed a powerful painkiller. Pills are not the only way to treat pain and we can only hope that the rest of the world adopts this mantra.

What is Being Done to Correct the Problem?

The US Government is currently trying to develop multiple programs to help addicts suffering from their addiction to opioids. Last year, Congress approved a $1 billion dollar grant to be allotted across the nation with means to aid the fight against opioids. Trump followed up this year by declaring that he would be distributing more money and creating infrastructure to combat the problem.

While we have seen little success with these installments, at least the problem is now under the spotlight. Leaders across the nation are rallying together to try and explore different methodologies in righting the problem, and leaders across the world are taking note of the mistakes we’ve made. Awareness is essential in the ending of an epidemic, but now it’s time to take serious action in both prevention for potential drug users and treatment for struggling addicts.

We do not want this epidemic to become a pandemic, so as we continue to battle on the frontline, we hope other countries do not repeat our mistakes.

Sources:

Ory, Marcia. “What the US Can Learn From Other Countries in Dealing With Pain and the Opioid Crisis.” The Conversation. 21 June 2018. 11 Mar. 2019. http://theconversation.com/what-the-us-can-learn-from-other-countries-in-dealing-with-pain-and-the-opioid-crisis-97491

Harrison, Tracy. “TreatingPain Responsibly in the Midst of an Opioid Epidemic” Mayo Clinic. 11 Mar. 2019. https://www.mayoclinic.org/medical-professionals/trauma/news/treating-pain-responsibly-in-the-midst-of-an-opioid-epidemic/mqc-20438006

Reevell, Philip. “US Opioid Epidemic: ‘This is Bigger Than This Town’”. BBC. 8 Nov. 2018. 11 Mar. 2019. https://www.bbc.com/news/world-us-canada-46036629