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The number of opioid prescriptions has decreased in the past few years, after more than a decade of explosive growth. This reflects new practice guidelines underscoring opioids’ generally poor effectiveness at reducing chronic pain, increased monitoring of prescribers by government and health-care organizations, and widespread horror within and without medicine over the epidemic of opioid-related deaths.
Although reducing the number of prescriptions will decrease the number of people who become addicted to opioids, too many prescribing restrictions could deny opioids to patients who need and benefit from them. How can we know if and when prescribing controls have gone overboard and the population has insufficient access to prescription opioids? In short, how will we know if the effort to restrict opioids has gone too far?
United Nations data provide one important benchmark against which to judge how much more or less opioid consumption might be appropriate for a given country. And what it finds about the United States is jaw-dropping: Even when the list is restricted to the top 25 heaviest consuming countries, the United States outpaces them all in opioid use.
For example, Americans are prescribed about six times as many opioids per capita as are citizens of Portugal and France, even though those countries offer far easier access to health care. The largest disparity noted in the U.N. report concerns hydrocodone: Americans consume more than 99 percent of the world’s supply of this opioid.