The American Opioid Crisis: A Comparative Economic Viewpoint by Annabelle Williams W'20

Studies estimate that the US opioid epidemic has cost the nation over  $1 billion since 2001. But why is it that the US is by far the nation that is most affected by opioids?

America’s opioid epidemic is not just a public health crisis but a far–reaching economic drain with implications for businesses across borders. Nonetheless, the crisis is a uniquely American problem, according to studies citing the relative frequency of prescribed opioids as well as overdose deaths.

Supervised, or safe, injection sites are a polemic aspect of the opioid crisis debate with business implications. Canada has adopted supervised injection sites as well as enforced big pharma regulations as a way to tackle this issue. In the US, Philadelphia and San Francisco are two cities leading the charge in the opening of these sites, which employ medical professionals to distribute sanitary needles and provide care to drug addicts when they overdose.

Many argue that this practice is tantamount to endorsement of addiction by the government because supervised injection sites require that medical professionals watch addicts shoot up. However, studies as well as real-world data from Canada have shown the efficacy of these sites. Moreover, they take a huge strain off the national economy as well as the job market languishing in American states affected by the crisis. European countries like Portugal, which at its peak in 1999 saw 1% of the population self-reporting addiction, have implemented safe injection sites, in addition to policy solutions. The combination of safe injection sites and other healthcare policy structures have taken the addiction rates down to four times less than the European average.

One interesting element of the American healthcare system is the degree to which companies hire reps to push particular drugs to doctors. This process inextricably links the opioid crisis to North American “big pharma”: the most egregious offender being Purdue Pharma. Purdue only decided to cut their direct–to–doctors sales force in February of 2018, despite the fact that opioids have been a hot–button issue for more than a year now, both politically and economically. This firm has been fundamentally entwined with the rise in opioid overdose and heroin–fentanyl use in the United States.

Then there is the question of marketing. There are only two countries in the world where pills can be advertised on television: the US and New Zealand. And the US privatized healthcare system has fewer non–pharmaceutical options for long–term pain management. This perfect storm of circumstances has allowed for American big pharma, in a way not possible in any other country, to commodify addiction.

Furthermore, pharmaceutical companies, such as those that produce Naloxone, an anti–overdose drug, have even commodified addiction treatment in a way that is effectively unprecedented in the American public health canon. Indeed, The Nation reports have even effectively priced out Philadelphia’s local government from buying the amount of Naloxone its needs to make a dent in cities like Kensington. It follows, then, that there are at least two niche markets booming in large part from the commodification of addiction: Naloxone sales, and morgue services.

This is an example of a public health issue with an economic cost unrivaled by anything except the human toll. The pharmaceutical stranglehold on the American health economy needs to end.