The Other Side of the Opioid Crisis
Updated: Mar 3, 2020
By Marilou Cameron
The term “opioid crisis” seems to have been dominating mainstream media, with weekly stories of tragedy being disseminated on social medias, news channels and radios as overdose death tolls continue to rise. Since the 1990s, opioid overdoses have steadily increased, along with addiction rates, with 1.7 million Americans in 2017 alone suffering from a substance abuse disorder in relation to having been prescribed opioids (NIH). Although this crisis is a prominent topic of discussion in our everyday lives, the nature of opioids and their intended use is much less discussed, as well as the other, often unseen side of the crisis: the lack of access to essential opioids in developing countries.
Opioids are an analgesic often prescribed after surgeries or to terminal patients and those who suffer from chronic pain (Martel). They can be categorized into three types: natural, semi-synthetic and synthetic (Martel). Originating from the opium poppy, which contains 20 different opiates, four of these are used in medicine: codeine, morphine, thebaine and papaverine (ARS). Codeine and morphine are the only two opiates that can be used in their original state and are therefore referred to as natural opioids, with their use tracing back to 1500 A.D. (Mogil). In 1668, Merck KGaA was founded in Germany and became the first pharmaceutical company to safely dose morphine and to produce a continuous dose, making morphine a safe medication to use (Mogil). The other two opiates found in the opium poppy, thebaine and papaverine, are used in laboratories to make semi-synthetic opioids (ARS). By transforming these opiates from their natural state into a man-made chemical, scientists are able to create a variety of medications, such as Oxycodone, popularized under the names OxyContin or Percocet, and Hydrocodone, better known as Vicodin (ARS). Heroin is also a semi-synthetic opioid as it is made from boiling the naturally-found opiate morphine with acetic anhydride (ARS). Lastly, synthetic opioids are entirely made in labs with ingredients that do not come from the opium poppy and are meant to mimic the effects of opiates (ARS). Methadone and Fentanyl are both synthetic opioids that have been highly popularized and spoken of when referring to the opioid crisis (Martel).
Although the innovation of these medications has revolutionized the medical world and forever changed pain management techniques, it has also led to harmful repercussions such as opioid misuse, abuse and overdose-related deaths. Canada and the US alone represent roughly 80% of the world’s opioid consumption while their population represents less than 5% of the globe (Martel). This disproportionate usage can be attributed to the intense marketing strategies propagated by pharmaceutical companies in the 1990s, which advertised opioids as “safe” and “less addictive” than other drugs (NIH). These marketing ploys were highly successful at promoting opioid medications, with sales spiking and quadrupling between 1990 and 2010 (Martel). In 2018, there were 5,349 opioid-related hospitalisations throughout Canada, with a 70% majority of cases reported in Ontario and British Columbia (Martel). While the opioid crisis in North America has since led to a crackdown on opioid prescriptions in the hopes of curbing drug misuse, this has in return caused a surge of illegal, clandestine drug use such as heroin or street-made fentanyl (Drug-Free World).
While we have heard about the abuse, misuse and addiction that comes with opioids, there exists a secondary crisis that remains largely unspoken of: the lack of access to opioids in developing countries. The use of opioids varies widely from country to country, and in many poorer nations, it is impossible to access these medications (Martel). For terminally ill patients, painkillers are necessary as it is estimated that 70-90% of advanced cancer patients experience intense pain (Manjiani). Beyond terminal illnesses, chronic pain patients that would benefit from the properties of painkillers are also unable to access these medications (Manjiani). Although developing countries have a dense populous, they only represent 6% of global opioid consumption, which has stagnated, while the consumption in European countries, the US and Canada has continued to grow exponentially (Manjiani). This discrepancy in consumption percentages throughout different countries is partially due to varying cultural norms, the establishment of certain healthcare practices, and the training physicians have received (Manjiani). In countries where palliative care has not been established as a major discipline, opioid use is significantly lower, such is the case in Malaysia despite its highly accessible public health system (Manjiani). For other nations, such as many countries in Latin America, government restrictions on opioids limit the number of patients that qualify for the use of these medications (Manjiani). Even then, services typically cost an exorbitant amount making them reserved for the wealthy and inaccessible to many in dire need (Manjiani).
Many attribute these countries’ apprehensiveness towards extending the availability of medical-grade opioids to the crises that have unfolded in Europe, the US and Canada, creating what is referred to as “opiophobia” (Zezima). It is feared that prescribed opioids would become illegally sold and distributed in these countries, which officials see as a bigger issue than providing pain-relief and adequate care to patients (Zezima). However, with prescribed painkillers, patients would not only be able to mitigate their pain levels, they would also be able to treat themselves at home and not lose hundreds of dollars for extended hospital stays (Zezima).
Although the opioid crisis has devastated the lives of many in developed countries, the medical intent of these drugs is highly beneficial to terminal or chronic pain patients. Many of us may take the access to these medications for granted due to their abundance in our respective sphere, but in the majority of countries with cases where opioids are needed, people are unable to receive the treatment and prescriptions they need.
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“Opioid Overdose Crisis.” National Institute of Drug Abuse, 20 Feb. 2020, www.drugabuse.gov/drugs-abuse/opioids/opioid-overdose-crisis.
Manjiani, Deepak et al. “Availability and utilization of opioids for pain management: global issues.” The Ochsner journal vol. 14, 2 (2014): 208-15.
Martel, Marc. “Pain and the ‘Opioid Crisis’.” Powerpoint presented in lecture at McGill University, Montreal, Quebec, February 4, 2020.
Mogil, Jeffrey. “Pain Treatment and Pain Research.” Powerpoint presented in lecture at McGill University, Montreal, Quebec, January 23, 2020.
Zezima, Katie. “America Has an Opioid Crisis, but People in Poor Countries Can't Access Painkillers.” The Washington Post, WP Company, 13 Oct. 2017, www.washingtonpost.com/national/2017/10/13/america-has-an-opioid-crisis-but-people-in-poor-countries-cant-access-painkillers/.