Trade, tariffs and opioid addiction

About a week ago at the G20 meetings in Buenos Aires, over a dinner that featured sirloin steak, caramel-rolled pancakes and glasses of Malbec, U.S. President Donald Trump and Chinese President Xi Jinping reportedly talked trade, tariffs and fentanyl.
The first two have grabbed headlines internationally, but the third has been a silent but far deadlier issue. The synthetic opioid, a component of many painkillers, has been central to America’s opioid epidemic that was responsible for 49,000 of the 72,000 deaths caused by drug overdoses, says the Centers for Disease Control and Prevention (CDC). These drugs bind to pain receptors in the brain and spinal cord, blocking pain, and also stimulate areas of the brain to release dopamine, causing a “high” and making users want to take the drug again. Some opioids like codeine and morphine are made from opium poppy plants, while some like hydrocodone and oxycodone are a combination of natural and synthesised compounds. Fentanyl is a synthesised opioid and can be up to 50 times more powerful than heroin. In the U.S., opioids became increasingly popular in the 1990s as doctors started prescribing them for treatment of non-cancer severe pain based on reassurances from pharmaceutical companies and poorly conducted studies that they were not addictive. The medical community was also reacting to a global environment of under-treatment of cancer and post-operative pain. “Not prescribing opioids for a patient with pain risked being labelled as inhumane, often even to the extent of litigation for the under-treatment of pain,” an article by Mark R. Jones et al in the journal Pain and Therapy says. Mandatory pain management standards for practitioners contributed to the doling out of opioids. The CDC says that between 1999 and 2016, 3,50,000 U.S. residents died from an overdose of prescription and illicit opioid use. There were three waves of deaths — the first in the 1990s caused by prescription opioid misuse; the second, starting in 2010, with an increase in heroin deaths; and the third wave starting in 2013, this time with a significant rise in the use of synthetic opioids, especially based on illicitly manufactured fentanyl. Today, unlike other drug problems, the crisis is manifest across the U.S, though its shape varies slightly across regions and populations. While fentanyl is the basis of the most powerful prescription opioids, the fentanyl on the streets — according to the Drug Enforcement Administration (DEA) — comes from diverted supplies not from hospitals, but from China and Mexico. However, on the positive side, China has added two fentanyl precursors and 25 other fentanyl-like substances to its controlled list, The New York Times reported. While time will tell how this impacts America’s drug problem, any long-term solution is likely to be found closer to home, by focussing on the demand side — better treatment, care and prevention of drug addiction.
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