�Bruce Einhorn and Hui Li

Pill Patterns

Un-linked International Narcotics Control Board reported in February. Almost all of the world’s opioids are consumed in North America, Europe, Australia, and New Zealand. The U.S., facing an epidemic of prescription painkiller abuse, consumed 43,879 defined daily doses (a standard unit for measuring drug consumption) of opiates per million people in 2011-13, while China consumed just 91.

The Chinese total was more than triple that of a decade earlier, a sign that attitudes are changing. For companies that make painkillers, China is a potential prize. The global opioids market was $34.9 billion in 2015, according to a report by Persistence Market Research, a consultant and researcher, and demand will grow 3.2 percent annually from 2015 to 2021. Chinese will use 76.86 million grams of narcotic drugs this year, according to the INCB, a fraction of the 1.36 billion grams Americans will take. When it comes to treating pain, “China has made progress, but it’s still significantly behind,” says Dr. James Cleary, a professor at the University of Wisconsin School of Medicine and Public Health, where he is director of the Pain & Policy Studies Group.

The government in China knows it needs to allow doctors to prescribe more painkilling drugs to patients, especially those with cancer. China accounts for 22 percent of new cancer cases worldwide, and total cancer deaths in the country increased 74 percent from 2006 to 2015. “As people’s quality of life improves, they won’t just suffer through the pain,” says Dr. Huang Bing, a pain specialist at Jiaxing City First Hospital in Zhejiang province. “They naturally want to buy better service and painfree health care.”

The strict controls stem in part from a serious social problem. “I think it has to do with the fact that there are many drug abusers in China, and some of these people may try to obtain these injectable narcotic painkillers,” says Dr. Ni Jiaxiang, director of the pain center at Beijing’s Xuanwu Hospital. China had more than 3.2 million registered drug addicts in 2015, according to the official Xinhua news agency, and more than 14 million Chinese have abused narcotics at some point. The state-run media frequently publish stories about the abuse of heroin, crystal meth, and ketamine, a veterinary medicine that’s used recreationally.

So, while the government is encouraging local drug companies to do more research and development on opioids, says Zhenjiang Yue, chief executive officer of Aoxing Pharmaceutical, the official approach to prescription painkillers “is still very restrictive.” Aoxing last year received a license to make tilidine opioid tablets, a painkiller widely used in Germany.

In China, outpatients are allowed prescriptions for no more than seven days’ worth of regular narcotics. Cancer patients can get prescriptions for up to 15 days but must first receive a document from a qualifying hospital certifying that they need treatment using narcotics. To keep track of the drugs, doctors who administer injectable opioids must return the empty drug vials. “Once, we accidentally broke a used bottle, and the doctor, the hospital manager, and I each had to write a self-criticism,” says Ni.

Experts in the state-controlled media have been writing educational articles about the need for opium-derived drugs in pain treatment. In September, China’s National Health and Family Planning Commission called for an increased focus on pain management. Chinese doctors are getting the message “loud and clear that cancer pain has to be adequately controlled,” says Dr. Frieda Law, a consultant at Shantou University Medical College.

The Chinese may be doing the right thing in proceeding cautiously. Pain is a serious issue, but so is addiction to these potentially life-destroying drugs. More Americans die from opioid overdoses than traffic accidents, President Obama said in a March 29 summit on prescription drug abuse. “You see an enormous ongoing spike in the number of people who are using opioids in ways that are unhealthy,” he said, “and you’re seeing a significant rise in the number of people who are being killed.”

Facing growing opposition from American politicians to the overprescription of opioids in the U.S., drugmakers hope changing attitudes elsewhere about pain will fuel growth in underserved countries such as China. That wish may be coming true. Oxycontin maker Mundipharma had about $100 million in China sales last year, a 45 percent increase over 2014. At a growth rate like that, China will soon have a lot more opioids—and perhaps more problems, too.

The U.S. used opioids at more than 14 times the

global average

U.S. 43,879 Germany 23,352 Canada 22,941 U.K. 5,227 Worldwide

3,027 Brazil 342

China

91

India

11

Up from 29 in 2001

2003 Opioid use is starting to increase rapidly in China, but it’s far more prevalent in other parts of the world. Here are the daily consumption rates* of opioid analgesics in some of the world’s largest economies, adjusted for population, from 2011 to 2013. The bottom line Global opioid sales are $34.9 billion a year, but if China loosens its restrictions, the market will grow much more.

Edited by Christopher Power Bloomberg.com

The modern amateur athlete loves data. Marathoners and triathletes devour information about their workouts, gleaning stats from sophisticated gadgets strapped to their wrists, chests, and bikes.

Richard Schwabacher wants to give them more, by going deeper inside the body. He runs Quest Diagnostics’ Sports and Human Performance unit, the medical testing giant’s effort to take a product directly to consumers. Not just any consumers, but endurance athletes willing to spend a lot of money to enhance their performance.

Take the Ironman, the popular triathlon, which asks participants to swim 2.4 miles, bike 112 miles, and then run a marathon (26.2 miles). A 2015 survey for Ironman operator World Triathlon found the average annual household income of its participants was $247,000; the median for the U. S. in 2013 was $51,939. More than half a million people in the U. S. run marathons each year.

Training for and participating in an Ironman isn’t for the frugal, Schwabacher says, noting that it can run up to $15,000 a year if you buy a bike and wet suit and figure in the cost of pool time, travel and lodging, assorted gear, and massages. “If you’re going to spend that much money on your sport, isn’t it worth spending a couple hundred dollars to make sure the food you’re eating is right?” he asks.

Quest is in the early stages of bringing a diagnostic tool called Blueprint for Athletes to those free-spenders. It’s recruited what it calls ambassadors—a couple dozen hard-core weekend warriors who regularly win or place in triathlons and ultramarathons—to test the product. It’s also rolled Blueprint out to consumers in endurance athlete havens including Houston, Denver, and Quest’s home base in northern New Jersey.

Blueprint was born in part from an effort with the New York Giants football team, for which Quest became a sponsor in 2013. Late that year, Quest’s chief executive officer, Steve