James Wimberley’s plea to do something about the under-treatment of pain in Africa (and other parts of the developing world) addresses a problem that has received less attention than it deserves, partly because pain, unlike death, isn’t very easy to count. His first-choice solution is to buy opium in Afghanistan to make into opiates to be used in Africa, thus providing Afghan poppy farmers with a licit outlet for their crop as well as relieving pain. As a fallback, James proposes producing more opium where licit opium is already produced.
Whether providing a licit outlet for Afghan poppy-farmers is the best way to help them, whether doing so would reduce the production of opium for illicit purposes in Afghanistan, and whether reducing illicit poppy-growing is in fact worthwhile objective, are all interesting questions. My tentative answer to each of them would be “N0.”
But putting that aside, James’s proposal assumes that the reason, or at least a reason, that pain patients in Africa don’t get enough opiates is that there aren’t enough opiates around. This, however, seems not to be the case. Custom, poor doctoring, and regulation can all lead to under-treatment of pain (a problem not unknown in the United States, for example).
Opiates are naturally cheap. A standard pain-relieving dose of morphine for a non-tolerant patient would be roughly 30 milligrams. It takes about 10 milligrams of opium to make 1 milligram of morphine. Licit opium in India sells for about $30 a kilogram. So for $30 you can have enough opium to make 100 grams of morphine: $0.30 per gram. Thus the opium in a standard dose of morphine costs a little less than a penny. Of course processed morphine costs more than that, but growing more opium in Afghanistan won’t change processing costs.
Conclusion: The price of opium is not among the barriers to pain treatment in poor countries. I applaud James’s refusal to bow down to the idols of the tribe, but I fear that his proper irreverence has, in this case led him into a form of commodity fetishism.
Footnote The academic paper James refers to is Victoria A. Greenfield, Letizia Paoli, and Peter H. Reuter, “Is Medicinal Opium Production Afghanistan’s Answer? Lessons From India,” forthcoming in the Journal of Drug Policy Analysis.