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The Real Opioid Crisis

© 2018 by Remay Ningano Nymous

The real opioid crisis is the fact that in many places, including China and many African countries, opioid pain relief, including opioid pain relief for people in the last 6 months of life, when they are believed to be dying from a painful terminal illness, is almost non-existent, as is treatment for chronic pain for those who expect to live more than 6 months. Even in Mexico, the southern neighbor of a country, the United States, where opioids are relatively abundant – some say too abundant – even in Mexico legal opioids are consumed at only fraction of rate at which they are consumed by their northern neighbor.

Here is an article from Human Rights Watch, published in 2010, about the Kenyan's governments failure to provide adequate opioids for children dying in pain.

Similar to Kenya, there are opioid shortages in other countries in sub-Saharan Africa.

Today's opioid crisis in China may be something different however. It may be a consequence of China's history of being embarrassed by the opium trade imbalance foisted upon them by the British Empire – when British traders brought opium from their colony in India, into China, encouraged habitual overuse of opium by Chinese poeple, created a demand for opium, and thereby were able to drain China of valuable tea, silks, and porcelain pottery – and the Chinese officials had difficulty getting Britain to stop. The result is that China went to war, and lost territory to Britain. Opium and opioids became a symbol of Chinese embarrassment at the hand of the west, and remains a reminder of this embarrassment today – and this may be why it is viewed today as a great evil. So today in China, opium is viewed as something bad that came from the west, while in the west, opium is viewed as something bad that comes from the east. In other words, bad connotations are the result of history, and culture, propaganda, and politics, and have nothing to do with science, except for the tendency of some scientists to try and help support the culture values, by making claims that sound scientific, claims that come from the scientists, but that cannot truly be supported scientifically.

Where do opioids come from?

Commercial opioids are all derived from a flowering plant called the opium poppy – Papaver somniferum. Even fentanyl, called a "synthetic" opioid, is made using chemicals acquired from the opium poppy. Today laws, and law enforcement, has restricted this poppy's growth. It is grown legally in only a few places, and lots of forceful measures are directed toward curtailing illegal cultivation. Yet it has historically been cultivated in every region of the earth where people have cultivated plants. It is not particularly difficult to grow, and it has been cultivated both for its food value (of its seeds), as well as for its value as a drug. Also, the oil from its seeds has been used in paints and varnishes. It is a wonderfully useful plant. With evidence that it had been cultivated 8000 years ago, it may have been one of the very earliest agricultural products. Historically obtaining opium from the plant has been a very labor intensive activity, but due to modern mechanized devices, obtaining opioid drugs from the plant is no longer labor intensive. And modern agicultural knowledge has enabled an increased yield per acre. Opium, morphine, codeine, oxycodone, hydrocodone, hydromorphone, and fentanyl can all be produced very cheaply. They are available cheaply. However "abuse-deterrant" formulations are not available so cheaply. Those people who use opioids without ever having any intention of abusing them, end up paying for abuse-deterrant formulations, even though these are of no value to them. Well-behaved users are paying the cost of policing the misbehavior of abusers.

Why is there a shortage?

Overwhelmingly, the main reason that people in many countries are suffering from a shortage, and suffering from pain unnecessarily, it that laws and law enforcement are creating a shortage. The governments that supposedly exist to help citizens, are in actuality harming citizens.

I believe that what we need, including in the US, is more legal poppy cultivation and less interference from governments, and I believe this is more important than limiting opioids for those people who are thought to be using them in a way that may harm themselves. In my view, their opioid use, if any, is their responsibility.

Why is it bad to "do that"

In the recent past we saw "scientific" reports about the dangers of masturbation. From around 1900 to 1936, a couple medical textbooks that were widely used in medical schools included sections about the dangers of masturbation. The textbooks listed dozens of diseases that were caused or made worse by masturbation. Then they recommended medical and surgical procedures that could be used to arrest masturbation, and control the diseases – including amputation of the prepuce in males and females, and complete clitorodectomy in females. For many years, these surgical procedures were actually performed, often withouto the victims's consent, in order to try and control masturbation.

There is nothing distinctly different about the bad habit of immoderate opioid use, than any other bad habit. Not much is said about masturbation anymore, not even "excessive" masturbation. Now masturbation is sometimes actively encouraged. But the bad habit of overeating, like the the bad habit of overuse of opioids, has risen in the US, and I believe that overall, overeating may cause more harm. Yet overeaters are generally treated gently, and non-judgementally. I believe this is a good thing. And we don't hear the kind of fear-mongering regarding the availability of, say, lard (which is freely available without a prescription) that we hear regarding the availability of opioids (which are already tightly controlled) and there is no effort to make lard (or coconut oil, or olive oil, or canola oil) illegal, make it available by prescription only, or to have the government interfere in any manner in order to curtail its use. When lard, or olive oil, is used as an ingredient in prepared food, there is no requirement that the food have a warning label about its presence. The only labeling requirement is a small-print label stating that it is there – same as for all the other ingredients. If someone has difficulty controlling their consumption of olive oil, controlling their "olive oil habit," we may want to try and help them – but do we make it difficult for everyone else to get olive oil? Do we make it difficult for the olive oil overuser to get olive oil? No, we do not – and rightly so – and I do not think we should handle opioids any differently.

Culturally, undereating is thought of differently than overeating, with undereaters being treated judgmentally, and harshly. Undereaters sometimes find themselves voluntarily confined to locked mental ward; this is rarely a danger for overeaters.

My personal journey

Despite being in pain since 1967, before 1999 I foolishly avoided taking opioids, having believed the propaganda that it might do more harm than good. After beginning opioid therapy from a specialist in New York, my life was dramatically improved, and I changed my opinion about opioids. I am not saying that opioids are not risky, or that they are not harmful. They most certainly are potentially harmful – as are all drugs. What I am saying is that people should be educated about the benefits and the risks – with scienfitic information, as opposed to cultural norms – and then people should weigh the benefits verses the risks and make their own choices – without government interference.

Her body; her choice

I am all for people being able to solicit the advice of physicians, especially the advice of pain management specialists, in order to help them weigh the benefits verses the risks. Some people are able to research the benefits verses the risks themselves; some people may benefit from professional help with evaluating the benefits verses the risks. And I am all for physicans being able to prescribe opioids to their patients who they believe may benefit. But the decision whether to take them, and the decisions regarding how much to take, should be up to the person who might potentially be taking the opioids. It is her body, her choice. And for those reasons I am for making opioids available without a prescription, and for making them available in every country.