I posted a few days ago on the explosion in use of illegally-diverted prescription painkillers such as oxycodone now occurring in the US and throughout the western world. In my view this is a dramatic development that may signal the advent of a new global drug problem that is, in many ways, analogous to the nicotine century that we have just struggled through with its horrific record of millions of deaths from lung cancer and other tobacco-induced health disorders.
Rather than being driven by poppy farmers in Afghanistan and Myanmar, current global opiate use is increasingly under the control of big pharma who can make billions from this line of business.
The world now has about 10 million heroin addicts. Government controls and restrictions have squeezed the supply of illicit heroin but still a lot is supplied.
A recent Canadian study however suggests that heroin use in 7 major sites has dramatically fallen in recent years – in 5 of the 7 sites it is virtually absent. Most illicit opiates are now coming from the medical system not from illicit markets. Users are consuming painkillers that were originally legally supplied, or illegally imported from countries like Mexico. Alternatively users were consuming medically-prescribed substitutes for illicit opiates. All these sources of supply generate a buck for big pharma.
In recent years in Australia a heroin drought that started in 2002 has triggered major reductions in opiate use and overdose deaths. Is this outcome partly the result of medically-supplied pain-killers that in some cases have been illegally diverted and used to substitute for heroin? Certainly there has been growth in the substitute narcotics markets supplying methadone and buprenorphine. These are heroin ‘cures’ that substitute a medically-provided opiate for an illicit opiate. Moreover the demand for opiate-based painkillers has risen strongly in Australia as it has in the US.
Most of our attention has been driven towards thinking about ‘ice’ amphetamine substitutions for heroin but maybe there is a more straightforward route of substitutions towards medically-supplied opiates.
As I wrote in my earlier post, commercial interests are muscling in on a great market. Pharmos can sell these products to addicted users for a lifetime at government-subsidised costs.
I strongly urge those interested in this area to read the short editorial by Benedikt Fischer and Jurgen Rehm in Addiction. There are ideas here that might guide licit and illicit drug debates for the next 50 years.