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THE INTERNATIONAL OPIOID CRISIS by Lainey Newman

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THE INTERNATIONAL OPIOID CRISIS by Lainey Newman THE INTERNATIONAL OPIOID CRISIS By Lainey Newman INTRODUCTION In Lomé, the capital city of Togo in West Africa, a man named Lucien woke up at 10 a.m. in his auto repair shop feeling weak and unable to move. Knowing he couldn’t sacrifice a day on the job, Lucien took several tablets of tramadol to ease his pain. Tramadol is a synthetic opioid-based painkiller. Its use has been spreading The World Health rapidly throughout the Middle East and Africa. Lucien told The Organization Lancet medical journal that his friends told him about “this medicine estimates that 27 that gives you strength.” Little did he know that shortly after he million people began taking the painkillers, he would become mentally and worldwide suffered physically debilitated from them. from opioid use In Togo, tramadol is technically a prescription drug, but the drug disorders in the is pervasive and easily accessible. Lucien and his friends purchase year of 2016. tramadol from street vendors that also sell cigarettes, foods, and Photo: Michigan other medicines. The drug is primarily manufactured in China and Health Blog India. Countries everywhere are experiencing the international opioid epidemic. Opioid drugs can be both used and abused. There are many cases in which opioid drugs are necessary to ameliorate severe pain that individuals experience. However, opioids can also be abused when they are used without medical reason for the purpose of “getting high.” The manifestations of the epidemic vary across regions and nations. In the United States, the opioid epidemic claimed over 130 lives per day in the year 2018. In the US and many European countries, there is an excess of prescriptions of opioid drugs. In some HARVARD MODEL CONGRESS counties in the US, there are over 200 annual opioid prescriptions Opioids – A per 100 people in the county. However, in other nations, such as classification of India and Nigeria, individuals are struggling to access the necessary psychoactive drugs amount of pain medication — in these countries, there is not a large that are derived from enough supply of medicine to provide for those who suffer from opium poppy or chronic pain or other illnesses. synthetic substitutes. Who is to blame in the international opioid epidemic, and who Opioids come in both should bear the responsibility? Some argue that culpability falls on prescription form, drug companies that have encouraged inappropriate prescriptions of such as Percocet or opioid drugs. Others argue that the blame lands on the individuals Oxycodone, or hard who abuse the drugs. Still others argue that the opioid epidemic is drug form, such as the fault of unresponsive and ineffective governments that did not heroin or fentanyl. take appropriate action when the epidemic was starting. Finally, some attribute culpability to doctors for being more interested in compensation from drug companies than the health of their patients. Throughout this briefing, pay close attention to the actors at play, particularly the individuals—from infants to senior citizens—the public, the private sector drug companies, governmental bodies, and international coalitions. Think about what action should be taken, at individual, community, national, and international levels, to reduce the immense consequences of the opioid epidemic. As representatives of the World Health Organization, it is crucial that we ensure that the WHO takes immediate and appropriate action to Opioid-based address this dangerous public health crisis. substances have been around for EXPLANATION OF THE ISSUE thousands of years, but the recent Historical Development epidemic started in Though the modern opioid epidemic is relatively recent, opioids the early 1990s. have existed for thousands of years. In the 4th century B.C.E., civilizations located in the modern-day Middle East used opium poppy for both health-related and recreational purposes. Centuries later, the drug morphine was created by German scientists in the early 19th century. Codeine was discovered not long after, in 1832. In Opioid Use 1874, heroin was produced for the first time. The German drug Disorder – OUD is manufacturing company Bayer synthesized and sold heroin from the the disorder that late 1800s until 1913, when the company realized that the drug was results when someone lethally addictive. becomes addicted to The United States criminalized the non-medical use of opium opioids. Symptoms products in 1914. In the US, the recreational use of opioids is still include intense banned. In other countries, heroin, which is also known as cravings of the drug diamorphine, is regulated with varying severity. In Switzerland, for and withdrawal when example, diamorphine is legally produced in tablet form by a one does not have it company under contract with the government. In the United for a period of time. © HARVARD MODEL CONGRESS 2020 – REDISTRIBUTION OR REPRODUCTION PROHIBITED 2 HARVARD MODEL CONGRESS Kingdom, diamorphine can be prescribed to individuals with opioid use disorder when other forms of treatment have not worked. There have been three primary waves of the opioid epidemic in recent history in the US and some other Western nations. These Diversion – the three waves started in the 1990s. According to many, the first wave process by which occurred simply because doctors began to prescribe more opioid legal drugs—that are drugs to patients. Simultaneously, however, pharmaceutical rightfully prescribed companies (often referred to as “big pharma”) were promoting the to patients—are use of opioid drugs to prescribers, even for patients without chronic transferred to the pain or serious illnesses such as cancer. In places in the US that had black market to be significant amounts of over-prescribing in this first wave, diversion sold to people who of opioids occurred swiftly. abuse them. The second wave occurred after the year 2010. Beginning in the early 2010s, the number of deaths due to opioids began to increase sharply. Starting in 2010, the number of deaths due to drug overdoses in the US surpassed 20,000. The impact of legal prescriptions in this wave is great. Approximately four out of five individuals with opioid use disorder originally became addicted to prescription drugs. However, because of the high cost of prescription drugs on the black market, many people switch to heroin or opioid- based non-prescription drugs when they become desperate for a continued supply of opioids. Lastly, in the mid-2010s, around the year 2013, the third wave of the modern opioid epidemic began. This wave has been characterized by the introduction of the drug fentanyl. Fentanyl is similar to morphine but much more potent. The National Institute on Drug Abuse warns that fentanyl is 50-100 times more powerful than morphine. It was introduced to the drug market as a way for drug dealers to “cut” heroin, to substitute some fentanyl into their heroin product and maximize their profits because of fentanyl’s high potency and lower costs. However, the equivalent of a few individual pieces of salt in fentanyl is enough to kill someone. Even breathing it The “other” opioid in can be lethal. Thus, when dealers substitute fentanyl for heroin, it crisis refers to the is easy to mistakenly use an excess of the substance. This mistake can deficient supply of be deadly to the drug user. necessary pain Scope of the Problem medication in some countries with poor There are many different aspects of the opioid epidemic. In each country that is affected, there is both a domestic side of the issue and health systems. a foreign affairs side. The domestic issues are related to how to deal with the epidemic from both the public health and public safety perspectives. The international issues that result from the epidemic are related to the chain of production to distribution of drugs. International relations are affected because of these considerations— depending on the legality and the varying degrees of legal authority in various countries, the sequence of drug production to © HARVARD MODEL CONGRESS 2020 – REDISTRIBUTION OR REPRODUCTION PROHIBITED 3 HARVARD MODEL CONGRESS consumption is complicated, as the drugs move from country to country. Amount of Opioid Prescriptions in Countries Some countries struggle to have enough pain medication to provide for those in their populations who are chronically ill or have extreme pain. These countries tend to be poorer. Patients in many countries in Africa, Asia, and Latin America with severe pain often do not receive opioid prescriptions because they are too expensive. Why have opiod makers avoided the potential profits available in developing countries? While opioid manufacturers were promoting the prescription of large numbers of opioids in the United States and other relatively rich countries, they were paying little attention to countries that have high rates of individuals with severe, illness- related pain. One possible explanation is that the companies were solely interested in promoting opioids due to their interest in profiting from advanced health insurance systems of the US and similar countries. As opposed to those of countries such as India and Nigeria, the US health care system is incredibly profitable for drug companies with large markets. The issue that many countries have too few opioids is what some have called “the other opioid crisis.” This “other” opioid crisis highlights the difference between the health care systems of rich and poor nations. Criminality of Opioid Distribution and Abuse Another issue that nations face is the criminality of opioid distribution and abuse. Various countries have taken different Some countries stances on the punishments for it using or distributing illicit opioid have opened safe drugs. Recently, in December 2018, China announced that it would injection sites in consider making the distribution of fentanyl subject to the death order to monitor penalty. US President Donald Trump praised this action from drug users and Chinese President Xi Jinping; earlier in the year, Trump proposed ensure that they will imposing the death penalty for some drug offenders.
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