Pills a-popping

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.

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. 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.

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 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.