Macau Matters | America’s real crisis – opioid overdose deaths

Richard Whitfield

The February 23rd issue of The Economist contains a very sobering article about the opioid crisis currently unfolding in America. This problem can be effectively modeled as a disease epidemic that has already killed several hundred-thousand Americans and is likely to kill another half-million as it runs its course over the next 10 years. I cannot understand why the greedy pharmaceutical companies and prescribing doctors, and the lax government officials, involved in this totally preventable epidemic are not in jail for criminal negligence and crimes against humanity. I pray that the relevant medical officials in Macau and the pan-Pearl River Delta are aware of the problem and are taking strong steps to ensure that a comparable epidemic does not happen here.

The dangers of opioid addiction have long been known and under-played. Morphine injections that were invented during the American Civil War were touted as a life-saving medical breakthrough, but more recent studies suggest that as many as 100,000 veterans from this war were addicted to morphine. Up until the 1990’s medical morphine and heroin usage was very limited, but then Purdue, a private pharmaceutical firm, released OxyContin as a prescription pain relief drug. It releases Oxycodone which is a powerful opioid that is as strong as heroin, and twice as strong as morphine. Other pharmaceutical companies quickly released similar drugs. They claimed, without supporting evidence or drug trials, that these opioids were wonder drugs that could safely relieve chronic pain with less than a 1% chance of the patient becoming addicted.

Opioid sales quadrupled between 1999 and 2011 and the number of overdose deaths exploded while Americans did not report any reductions in chronic pain rates. The problems were evident by 2012, but in 2015 American doctors were still prescribing 4 times the number of opioids that were being prescribed by European doctors. American government drug agencies have still only issued a few regulations to control medical opioid use and still do not seem to accept the severity of the problem.

It is now estimated that 2.1 million Americans are addicted to opioids, but only 20% of them are receiving treatment. These addicts are a broad selection of the population from teenagers to grandparents. Each year 1-4% of them will die from an overdose.

As these addicts have more problems getting doctors to continue their legal, and subsidized, prescriptions they start to buy drugs on the open market. They cannot afford to personally pay the US$50/pill price for OxyContin and similar properly manufactured drugs and quickly turn to the illegal trade in heroin and fentanyl which sell for about US$5/“pill equivalent”. The illegal trade is very problematic because of poor quality control and because fentanyl is about 50 times stronger than heroin. Because of poor quality and strength control it is very easy for addicts to overdose using illegal drugs, which now account for 70% of deaths but nearly all initial addiction is still related to legal prescriptions.

Well proven mathematical epidemic models indicate that there will be around 500,000 opioid overdose deaths in America between 2016 and 2025. This is many more than the cumulative American deaths from HIV, and American service deaths during the entire Vietnam War. It is also substantially more than will die from car accidents or gunshot wounds. It is estimated that this epidemic cost 2.8% of American GDP in 2015.

We really do not want to have a similar problem in Macau.