Exporting addiction

Asia should view the US opioid crisis as a cautionary tale

Sally Tyler

Trade and industry, Social policy, Health | Asia, Southeast Asia

7 September 2017

If leaders in Asia really want to conduct a ‘war on drugs’, perhaps they should look at Big Pharma, Sally Tyler writes.

Methamphetamine, whether called shabu in the Philippines or yaba in Thailand, has long eclipsed heroin as the most abused illicit drug in Southeast Asia, despite the region’s proximity to the Golden Triangle. Ironically, though the US is half a world away from opium’s fertile crescent, Americans consume more drugs derived from opium than any other nation. Opioid overdoses are now the most common type of accidental death in the US, accounting for more fatalities than gun homicides and car crashes combined.

Supply-side intervention led by law enforcement has been the hallmark of anti-drug abuse efforts on both continents, and, despite highly-publicised periodic drug busts, has done little to stem the tide of illicit drugs.

When the US launched its so-called war on drugs in the 1980s in response to the scourge of crack cocaine, criminal justice and sentencing policies were adjusted to incarcerate more people for longer times. Now, 16 per cent of all federal and state prisoners are locked up for drug use, possession or sale, down from a high of 22 per cent in 2000.

More on this: Behind Jokowi and Duterte’s “war on drugs”

More than half of all prisoners in Indonesia, Malaysia, Myanmar, the Philippines and Thailand are jailed for drug related crimes, and many nations in the region require compulsory detention for drug addicts. Such compulsory detention centres have come under scrutiny for human rights abuses, and for lacking scientifically-based rehabilitation therapies.

But more attention is now being paid to evidence-based efforts to lessen demand. In the US, the newly-formed Commission on Combating Drug Addiction and the Opioid Crisis recently released a report calling for enhanced access to Medication-Assisted Treatment (MAT), the most promising modality for opioid abuse treatment.

Plans are also moving forward to build a rehabilitation centre in every one of the Philippines’ 81 provinces, though this will surely not meet the demand of the 700,000 individuals who have “voluntarily” turned themselves in to authorities in the nation’s controversial war against drugs.

Fortunately, data about methods most effective in helping addicts to avoid relapse are shaping the arguments of advocates on both continents calling for more access to therapeutic treatment.

More on this: Why ASEAN’s drug-free dream is failing

Not that you would know this from the words of leaders like Trump and Duterte, whose Wild West talk simplifies the drug abuse epidemic into a matinee showdown between good guys and bad guys. The Philippine president’s rhetoric about the nature of addiction has been far from constructive. In response to criticism in 2016 that his war on drugs involved human rights violations, he said, “Are they humans? What is your definition of a human being?”

And in announcing the recent report of his commission on the opioid crisis, Trump made no mention of specific recommendations, though he twice uttered the platitude that if people “don’t start abusing drugs, they will never have a problem.”

If only it were that easy. Perhaps, he should have first read the commission’s report. It highlights that four out of every five new heroin users in the US started with prescription opioid use.

US states have passed legislation attempting to halt the rapid transformation from patient to addict by creating prescription drug databases which can be monitored by law enforcement to scrutinise, and potentially stop, over-prescribers of opioids. The efforts are working, as prescriptions for Oxycontin (a brand name for oxycodone) have declined by 40 per cent since 2010. But even as reforms are taking hold in the US, Big Pharma is strategising ways to keep global sales strong. Following the “playbook of big tobacco” manufacturers, the drug companies’ solution to enhanced scrutiny back home involves global expansion, particularly in Asia’s developing nations.

More on this: Make drugs a health issue

Mundipharma, a subsidiary of Purdue Pharmaceutical, the maker of Oxycontin, first began operations in Asia in 2011, as US sales began to drop. With regional offices in Singapore, the firm’s promotional materials downplay the risk of opioid addiction. Instead, flashy marketing campaigns have featured glamorous celebrities who tell viewers not to resign themselves to chronic pain.

The message that the affluent do not have to suffer with chronic pain is aimed directly at those poised for social mobility. Market analysts project that rapidly modernising countries will spend more than US $20 billion on pain medicines by 2020.

Members of the US Congress have written to the World Health Organization’s Director General to warn of Mundipharma’s “deceptive and dangerous practices” in promoting Oxycontin sales abroad.  They argue that the international health community has a “rare opportunity to see the future,” and urge the WHO to reign in Purdue and Mundipharma “while there is still time.”

Such efforts must include tighter scrutiny of trade deals to ensure that pharmaceutical companies are not simply greasing a pipeline to supply addictive use of opioids in foreign markets. Public health officials in Asia must also launch education campaigns aimed at both physicians and patients warning of the danger of inappropriate opioid use. A long-term reliance on prescription painkillers is one aspect of the Western lifestyle which should not be categorised as export-grade under any scenario.

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