By Tasnim Ahmed, Stanford Global Health Media Fellow

Since 2002, several countries, including the Netherlands, Spain and Israel, have seen a sharp incline in opioid consumption, threatening the possibility of the North American opioid epidemic becoming a pandemic, according to a Stanford-Lancet Commission on the North American Opioid Crisis published this month.

The commission, made up of 17 members, released a report detailing seven domains of policy recommendations to confront the soaring opioid-use disorder and overdose rates in the US and Canada. And while the commission focuses mainly on reforming policies in Northern America, the group recognizes the potential global impact of this epidemic, devoting its seventh domain to preventing opioid crises outside the US and Canada.

Commission Chair and Professor of Psychiatry and Behavioral Sciences at Stanford Keith Humphreys compared the opioid epidemic to the war on smoking.

“Did we win the war on smoking, or did we shift the cost of it to other people less able to defend themselves? We don’t want that to happen with opioids,” said Humphreys, also a Faculty Fellow at the Stanford Center for Innovation in Global Health.

The commission outlines how aggressive campaigns by pharmaceutical companies such as Purdue Pharma to promote OxyContin set the US off on a trajectory for opioid addiction unparalleled by any other country. Oxycontin is the medication thought to have ignited the flame for the modern-day opioid crisis.

In 2020, Purdue Pharma agreed to plead guilty to criminal charges for destructively promoting Oxycontin and relinquish control of their company, which would become a public trust. The Sacklers are still negotiating the final details of the settlements.

However, according to the commission, the court decision does not bar the Sackler family, which owned Purdue Pharma, from continuing its operations abroad through Mundipharma, Purdue Pharma’s international sister company.

Investigative journalists have reported that Mundipharma is now using similar marketing tactics to promote OxyContin in several countries including Brazil, China, Egypt and Mexico. 

Noting this, the commission calls for legal action to ban dangerous marketing practices of opioids not only domestically but also internationally. 

The report states, “The risk of global spread is greater where COVID-19 has ravaged health systems, where pain needs in resource-limited settings go unmet, and where corporations look for new markets, but are left to self-regulate. To manage pain, greed must be managed as well.”

Such oversight should be under the American government’s purview, according to Humphreys. 

The second component of the commission’s international response acknowledges the need for better pain relief and palliative care options in low-income countries, where lack of access to opioids to control pain causes preventable suffering. The commission thus endorses a proposal by the Lancet Commission on Palliative Care and Pain Relief to increase global access to basic palliative care medicines, equipment, and human resources. 

“Low-income countries should not be forced to choose between letting their citizens suffer needlessly or giving in to corporate predation,” the report states.

Humphreys said that the endorsement was made as “a basic matter of human compassion,” adding, “We are worried about people not getting adequate pain relief.”

The commission calls on the World Health Organization (WHO) to coordinate the delivery of generic morphine to hospitals and hospices in low-income nations to prevent control of the market by large pharmaceutical companies. They estimate that implementing this model will cost $1 million USD per year.

“We now have a responsibility to the rest of the world: To not turn a blind eye and watch them suffer as we have suffered,” Humphreys said.