50,000 Americans take doses of opioids every day.

The US and New Zealand are the only countries that allow prescription drugs to be advertised on television

opioids

When it comes to taking opioids, the United States is the world leader.

For every one million Americans, almost 50,000 doses of opioids are taken every day. Nationally, opioids killed more than 33,000 people in 2015, according to the Centers for Disease Control and Prevention.

That figure includes deaths from heroin, an illegal opioid. But almost half involved a prescription opioid – that is, a painkiller available from a pharmacy with a note from a doctor. Unlike most European countries, the US does not have universal healthcare paid for by taxes.

Instead, Americans must get their own insurance – usually via an employer or the government.

The CDC says opioid prescriptions have fallen by 18% from their peak in 2010. But the total is still three times higher than in 1999. According to the research firm Kantar, spending on advertising by pharmaceutical companies in the US reached $6.4 billion in 2016 – a rise of 64% since 2012.

None of the 10 most-advertised brands in 2016 was an opioid. But mass-marketing of drugs has an effect, says Professor Feinberg.

“As a clinician, people will come and say ‘I saw this on TV – can you give me this drug’.

“Sometimes they were so confused, they were already on the drug – they were using the brand name, where I used the generic name.”

In 2015, the American Medical Association called for a ban on adverts for prescription drugs. It didn’t happen.

Three months later, the extent of America’s opioid culture was seen at half-time of the Superbowl – the country’s most expensive advertising slot.

A 60-second ad was devoted to opioid-induced constipation. The advert – paid for by AstraZeneca – advised sufferers to visit their doctor and “ask about prescription treatment options”

In the US, it is common for drug companies to court doctors, in an effort to promote their products.

“When you’re a doctor in the US, these detailing people (salespeople) come in from the industry,” says Professor Keith Humphreys from Stanford University.

“They are invariably smooth, friendly, attractive, sharply dressed, adorable, they’re giving out gifts to everybody. They host dinners, they sponsor conferences, they sponsor junkets.

“That is going to affect prescribing.”

For the past four years, the US government has published the amounts paid by drug and device companies to doctors and teaching hospitals.

On Thursday President Trump directed the U.S. Department of Health and Human Services to declare a limited 90-day public health emergency. Speaking at the White House on Thursday, surrounded by the families of Americans touched by the epidemic, he insisted he is committed to an unprecedented new effort to take on the spread of opiates, including heroin, prescription painkillers and dangerous synthetic drugs such as fentanyl. He also listed other efforts his administration is taking, including prosecuting drug traffickers, educating physicians about how to safely prescribe opioids and supporting research into nonaddictive pain medicines.

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