A recent review of research published in the journal “World Psychiatry” highlights that prescription drug abuse is already a worrisome trend in a number of middle-income or developed countries — particularly among young people. While each study included in the review uses slightly different methodologies for each country, they all underscore that populations outside the United States are at major risk of surging painkiller abuse.
The review looked at survey data from young people in Canada, Australia and Europe, and found nonmedical prescription drug use among teenagers and people in their 20s that is comparable to the United States. It also found high prescription abuse among high school and college students in the Middle East — specifically, Beirut and Saudi Arabia — and in China, where a survey conducted in southwest China found that one in 10 students have tried prescription drugs nonmedically at least once in their lives.
None of this is to say that opioid abuse elsewhere in the world is comparable to that found in the United States — we’re still the reigning champion in that regard, with more than 11 percent of the U.S. population using prescription drugs nonmedically. But’s it’s the devastating impact that these drugs have had on our country that makes these trends extra troubling. Today, overdoses account for more deaths than car accidents or gun violence.
Doctors in the United States began prescribing opioids — powerful narcotics that include pill-form painkillers such as methadone, oxycodone and hydrocodone — to treat pain at unprecedented rates in the 1990s. The medical community adopted the practice more commonly despite long-standing fears that the drugs would lead to addiction, mostly as a result of promises from pharmaceutical companies that their products were safe treatments for pain. Over the past few decades, drug companies flooded parts of the country with the drugs, especially in places where patients were highly vulnerable to addiction.
We know all too well how that ended: Despite no change in the amount of pain reported in the United States, abuse of prescription painkillers and heroin has exploded. Over the past few decades, experts estimate that Americans consumed the vast majority of the global opioid supply — including about 81 percent of oxycodone and almost 100 percent of hydrocodone. And by 2015, deaths due to opioid overdoses surged to about 62 a day, according to the Centers for Disease Control and Prevention.
But as the prescription opioid market in the United States begins to shrink, pharmaceutical companies are reportedly looking elsewhere to sell their products, according to an in-depth investigation by the Los Angeles Times. What’s more, these companies are offering the same false promise of safely ending pain. Embedded in these marketing campaigns are the same calls made to American doctors to let go of their “opiophobia” — or their fear of prescribing potentially addictive pain pills.
“Once pharmaceuticals start targeting other countries and make people feel like opioids are safe, we might see a spike [in opioid abuse],” said Silvia Martins, an epidemiologist at Columbia University and author of the World Psychology paper. “It worked here. Why wouldn’t it work elsewhere?”
The opioid epidemic in the United States shows that it is possible to drastically change the cultural norms in medical communities that are reluctant to treat pain with powerful opioids. It’s also an easy way for doctors to make patients feel like they’re solving their problems — especially if they give them a bottle of pain medication that could last months on end. We often forget that for a lot of people, opioids are a solution — however heavy-handed — to chronic pain. For that reason, the lure of strong opioid medication is particularly troubling in places outside the United States where doctors might not have much training on addiction.
“(Physicians in other countries) need to be very aware of where their information is coming from,” said Scott Novak, an epidemiologist at RTI International who studies drug abuse internationally. “For many doctors, the number one source of information on drugs is pharmacy representatives, but you really need to do your homework.”
Hopefully, the tragedy of opioids in America will help stem the tide in other countries. The lesson should be loud and clear: Powerful painkillers should not be our first line of defense in treating pain. And when we do have to resort to the drugs, they should be heavily regulated.