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.
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.