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egastfriend comments on Increasing Access to Pain Relief in Developing Countries - An EA Perspective - Effective Altruism Forum

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Comment author: egastfriend 07 February 2017 02:48:54AM *  3 points [-]

Great analysis! Very fair and balanced.

As you point out, increasing the prescriptions of opioids in the US lead to an enormous disaster -- drug overdoses now kill more Americans each year than car crashes. The regulatory environment in the US isn't great, but it's decades ahead of what most developing countries have. The fact that the US still hasn't figured out a sensible policy to managing prescription opioids makes me very skeptical that developing countries could pull it off safely.

E.g., look at these two articles. This one points out that there are already deceptive marketing practices around opioids happening in China: https://www.bloomberg.com/news/articles/2016-12-18/china-s-oxycontin-boom-is-a-goldmine-for-this-drugmaker And this one looks at the aggressive expansion of painkillers into developing countries: http://www.scmp.com/news/world/article/2057240/big-push-opioid-epidemic-killing-oxycontins-us-market-so-makers-target

Rather than trying to expand access, the better strategy may be to advise developing countries on drug control policies to be able to better monitor opioid misuse and handle the inevitable increased availability of drugs.

Note: I'm working on a tech startup that helps people who overuse substances.

Comment author: Lee_Sharkey 07 February 2017 09:08:36AM *  2 points [-]

Thanks for those links. It's troubling to hear about some of the promotional techniques described, though I can't say it's surprising.

While US regulations have been developed decades before their equivalents in many developing countries, it's not necessarily a mark of quality. In the article I refer to less desirable idiosyncrasies of the US health system (i.e. aspects of the consumer-based model; pain as a fifth vital sign), which have exacerbated the crisis there and will not necessarily exist in some developing countries. Yet, while I hesitate to paint all developing countries with the same skeptical brush when it comes to developing adequate regulations, I agree with you more than I disagree. I say that a small amount of adverse outcomes are almost inevitable, and it's really difficult to judge where the positives outweigh the negatives.

I still think expanding access should be part of the strategy. The approach promoted by WHO, UNODC, INCB, is to aim for a 'balanced in policies on controlled substances'. The trouble is that countries are all too keen to control the downsides of using narcotic drugs at the expense of the upsides. So I think that what you're suggesting may already be the approach being taken, but the emphasis needs to compensate for states' existing imbalance.

And what you're doing sounds interesting! Feel free to post links