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.
