The Washington PostDemocracy Dies in Darkness

Americans take more pain pills — but not because they’re in more pain

Americans consume prescription opioids at a greater rate than any other population in the world, according to research data. Could this outsized level of prescribing be a rational, appropriate response to an unusually high level of pain in the U.S. population? Comparative international research suggests not.

In 2008, an international team of researchers assessed population pain using the same methods in 18 countries. The age standardized prevalence of experiencing chronic pain in the United States was 43 percent. The two countries most similar to the United States in their prevalence of chronic pain were Italy (42.8 percent) and France (47.8 percent). But that is where the parallels among the three nations ends.

United Nations data for 2012-2014 show that standard daily doses of opioids consumed per capita are roughly comparable in Italy (6,246) and France (8,706) but reach a staggering 50,142 in the United States. In other words, despite suffering chronic pain at a similar rate as Italians and the French, Americans consume six to eight  times as many opioid painkillers.

One could argue that France and Italy simply have poor health-care systems that don’t give patients the care they need. But life expectancy at age 65 — a key indicator of health-care system effectiveness — is higher in France and Italy than in the United States.

Another explanation is that U.S. pain levels would be much higher if not for its world-leading opioid consumption. But there is no evidence that pain in the United States is less prevalent than it was before the near quadrupling of opioid prescribing that began in the late 1990s.

The reason that Americans consume so many opioids is therefore not because they suffer  more pain than people in other countries. A more likely explanation is that the United States regulates opioid manufacturers and distributors far less rigorously than do Italy, France and, indeed, virtually all other developed countries. America is an unusually friendly environment for manufacturers to market opioids aggressively and to donate generously to political causes and regulatory bodies. It is those features of American exceptionalism, and not exceptional physical pain, that sparked the worst prescription opioid epidemic in history.

Keith Humphreys is a professor of psychiatry at Stanford University and an affiliated faculty member at Stanford Law School and the Stanford Neurosciences Institute.