theeconomist | “PLEASURE is oft a visitant; but pain clings cruelly,” wrote John Keats. Nowadays pain can often be shrugged off: opioids, a class of drugs that includes morphine and other derivatives of the opium poppy, can dramatically ease the agony of broken bones, third-degree burns or terminal cancer. But the mismanagement of these drugs has caused a pain crisis (see article). It has two faces: one in America and a few other rich countries; the other in the developing world.
In America for decades doctors prescribed too many opioids for chronic pain in the mistaken belief that the risks were manageable. Millions of patients became hooked. Nearly 20,000 Americans died from opioid overdoses in 2014. A belated crackdown is now forcing prescription-opioid addicts to endure withdrawal symptoms, buy their fix on the black market or turn to heroin—which gives a similar high (and is now popular among middle-aged Americans with back problems).
In the developing world, by contrast, even horrifying pain is often untreated. More than 7m people die yearly of cancer, HIV, accidents or war wounds with little or no pain relief. Four-fifths of humanity live in countries where opioids are hard to obtain; they use less than a tenth of the world’s morphine, the opioid most widely used for trauma and terminal pain.
Opioids are tricky. Take too much, or mix them with alcohol or sleeping pills, and you may stop breathing. Long-term patients often need more and more. But for much acute pain, and certainly for the terminally ill, they are often the best treatment. And they are cheap: enough morphine to soothe a cancer patient for a month should cost just $2-5.
In poor countries many people think of pain as inevitable, as it has been for most of human existence. So they seldom ask for pain relief, and seldom get it if they do. The drug war declared by America in the 1970s has made matters worse. It led to laws that put keeping drugs out of the wrong hands ahead of getting them into the right ones. The UN says both goals matter. But through the 1980s and 1990s, as the war on drugs raged, it preached about the menace of illegal highs with barely a whisper about the horror of unrelieved pain.