The opioid epidemic is a global problem. And it’s getting worse

The opioid crisis isn’t only an American problem. It’s a global problem that’s getting steadily worse, and according to some experts, is in danger of becoming a global pandemic.

To be clear, the sheer numbers in the U.S. dwarf those of any other country. According to the Centers for Disease Control, about 115 people die every day in this country of an opioid overdose — about 42,000 in 2016. Roughly 40 percent had a prescription for the drug. The White House Council of Economic Advisers estimates that in 2015, the epidemic cost the United States more than $500 billion, or 2.8 percent of GDP.

But it’s not just about Prince. And it’s not just West Virginia.

Consider the following. Iranian media say that over the years, an estimated 4,000 police officers have been killed fighting drug traffickers, some of whom are armed with heavy weapons like anti-aircraft guns. Iran shares a long border with Afghanistan, which grows the vast majority of the world’s opium poppies. Officials say the number of regular drug users in Iran has more than doubled since 2011. About two-thirds of them use opioids.

An estimated 1.5 million Russians are addicted to heroin. One side effect of injecting heroin there is a large and growing HIV problem – an estimated 1 million Russians also carry HIV. Russia, too, gets most of its opioids from Afghanistan because of proximity and the legacy of its long war there.

In Canada’s British Columbia, with 4.6 million people, more than 1,400 died of overdoses last year. Officials say the biggest culprit there is fentanyl, a powerful synthetic opioid that dealers frequently mix in with street drugs.

Other countries, like the United States, are struggling to rein in prescription medications. In Australia, prescription opioids were responsible for more than 70 percent of drug deaths last year. Even China, despite a long, bitter history with opium, is seeing a rapid rise in the number of prescriptions for opioids to treat pain.

Germans use a lot of opioids, as well. Fentanyl is prescribed at rates three times higher than in the U.S., and a prominent doctor warned recently that the country risks a U.S.-like epidemic. Others argue that physicians are careful about watching for signs of addiction, and cite statistics showing far fewer people than in the U.S. The number of prescriptions for opioids is rising in Britain, as well – particularly in poorer communities.

Most public health experts say there is a place for prescription opioids – primarily to ease the pain of cancer and other terminal illnesses. And the stigma attached to opioids means that in some countries they simply aren’t available when they might help lessen such suffering.

But writing in Foreign Affairs recently, three public health experts warned that the U.S. epidemic actually is in danger of going global, creating a “public health disaster of historic proportions.” Afghan cultivation of opium poppies is unabated. Drug companies that promoted broader use of prescription opioids for pain relief in the United States have shifted their focus abroad, they say. Add the rapid increase in the supply of cheap, illegal fentanyl – sometimes just dropped in the mail from China – adds a third dangerous element.

What to do? You couldn’t find any more opposite approaches than those used in Russia and British Columbia.

The Russian approach is cold turkey, starting with a mandated 21-day period in which addicts are given little more than aspirin to ease withdrawal. Success rates are lower than in the West, but Russia regards drug replacement therapies as just another form of addiction, and another way in which the West coddles people who need to be straightened out.

The medical director of British Columbia’s Center for Disease Control says authorities need to put solving addiction on the back burner in order to save lives. So officials have been making plans for a biometric-operated vending machine that dispenses safe opioids.

Dr. Mark Tyndall told the Vancouver City Council that military-grade steel would prevent theft. And then, “we can program exactly to give this much to this person. You put your finger on it; it pops out two pills. It’s on the cloud, and every pill we know about.”

Between those polar opposites, the U.S. public health experts say foreign countries could allow only the government or nonprofits to supply prescription opioids for extended home use. They could ban advertising, and they could restructure penalties for drug companies that break the law — for instance, making the size of fines dependent on how many overdoses occur.

They argue that British Columbia has to do more than focus on health and social services. Not attacking the supply issue “is akin to emptying an overflowing bathtub with a thimble without turning down the tap.”

Dealing with the booming supply of fentanyl and other synthetics will be difficult. In a relationship as complex as that between the U.S. and China, for instance, it will have to take its place alongside other pressing issues. The Obama administration persuaded China to ban four variants of fentanyl, the public health experts said. The Trump administration needs to keep up the pressure.

The alternative, not focusing on the problem, is “sleepwalking toward disaster.”