The Contemporary American Drug Overdose Epidemic in International Perspective

Will the contemporary American drug overdose epidemic prove a case of American exceptionalism, a cautionary tale, or the US as vanguard nation? In many respects, the American epidemic is distinctive—it is clear from the results of this analysis that the US is experiencing a drug overdose epidemic of unprecedented magnitude, not only judging by its own historical experience, but also compared to other high-income countries. No other country has exhibited anything close to the levels of or increases in drug overdose mortality observed in the US. However, the potential remains for drug over-dose mortality to increase in other countries in the near future. Similar and troubling signs are already discernible in the countries which are closest to the US, namely the Anglophone countries (Australia, Canada, and the United Kingdom), and some of the similarities among this subset of countries have been highlighted in the Discussion.

Furthermore, cross-national convergence of the substances driving drug overdose mortality is already occurring. While the current American epidemic started with prescription opioids, it is now rapidly transitioning to heroin and fentanyl (Jones et al. 2018). European countries may be moving in the opposite direction—much of their drug overdose mortality is driven by heroin, but the use of prescription opioids and synthetic drugs like fentanyl are becoming increasingly common in many high-income countries and constitute a common challenge to be confronted by these countries in the near future (EMCDDA 2017a).

Finally, this paper compared the US to other high-income countries partly because of data quality and availability considerations, but also be-cause access to painkillers is very limited outside these countries (Berterameet al. 2016; INCB 2015). However, this situation may change imminently.  Mundipharma—a network of international companies owned by the same family as Purdue Pharma—is expanding rapidly into Latin America, Asia,the Middle East, and Africa (Ryan, Girion, and Glover 2016). Its efforts to generate demand for painkillers mirror practices used in the US, including sponsoring physician training seminars and campaigns to medicalize and increase public awareness of chronic pain. Mundipharma’s marketing campaigns involve the use of celebrities urging people to stop thinking of pain as a normal part of daily life: “Don’t resign yourself” and “Chronic pain is an illness in and of itself,” say these advertisements (ibid.). Comparisons are being drawn between opioid painkillers and cigarettes; in the latter case, multinational tobacco companies moved aggressively into developing-country markets when they started losing revenue in developed countries,and it proved a highly successful strategy. If OxyContin follows the same route, it will pose a major concern because regulatory structures, healthcare systems, and surveillance systems are much less developed in low-income countries, rendering them more vulnerable to aggressive marketing by pharmaceutical companies, and there is a strong possibility that serious drug overdose epidemics could develop with very little warning in these countries.

The full article can be downloaded below.