Why growing opium in Afghanistan will not help treat pain in Africa

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.

Author: Mark Kleiman

Professor of Public Policy at the NYU Marron Institute for Urban Management and editor of the Journal of Drug Policy Analysis. Teaches about the methods of policy analysis about drug abuse control and crime control policy, working out the implications of two principles: that swift and certain sanctions don't have to be severe to be effective, and that well-designed threats usually don't have to be carried out. Books: Drugs and Drug Policy: What Everyone Needs to Know (with Jonathan Caulkins and Angela Hawken) When Brute Force Fails: How to Have Less Crime and Less Punishment (Princeton, 2009; named one of the "books of the year" by The Economist Against Excess: Drug Policy for Results (Basic, 1993) Marijuana: Costs of Abuse, Costs of Control (Greenwood, 1989) UCLA Homepage Curriculum Vitae Contact: Markarkleiman-at-gmail.com

3 thoughts on “Why growing opium in Afghanistan will not help treat pain in Africa”

  1. Prof. Kleiman, I will take your for it that opiates are plenty cheap. But in terms of getting Afghani farmers on our side and cutting into the Taliban drug trade, might it still be worthwhile? Glutting the market might be bad, but maybe some good use could be put to them. Maybe lessen the burden of the beleaguered insurance companies?

  2. Prof. Kleiman,

    I most enjoy your posts for their erudition and the fact that I often actually learn something new when visiting the R.B.C. Thus I was a little disappointed with what seems to me to be a hand-waving type dismissal of James' proposal, i.e., that your "tentative" answers to his "interesting questions" is a simple no. And by this I simply mean that it would be nice to offer some explanation to those of us less educated in your area of specialty as to why these are your conclusions.

    I also don't see that there is necessarily a straight linear negation of the idea that "there aren’t enough opiates around" – within the specific, impoverished geographic sphere under consideration – proven by the statement that "opiates are naturally cheap". I mean I understand that basic economics suggests a certain systemic bias towards this being the case, but certainly it isn't a 100% 'ergo' case like dropping a rock from 10' (where it will always be pulled toward the earth's center by gravity notwithstanding physical impediments to doing so).

    Submitted in the hopes of motivating you provide some additional explication of your thoughts.

  3. The price has never been the issue. Licit opium production is run on a nearly pure command socialist system of quotas, from farm to country to world level. The farm-gate price is set high enough to make it worth the farmers' while, that's all. I made it clear in my first post that IMHO the real barrier to pain relief in the Third World is the absence of a delivery system and political will, reinforced by superstitious fear of opiates as such. That said, when the priorities of Third World élites are so inhumane, it's a proper use of rich-world leverage, both governmental and private, to try and change or get round them. You could say that since the anti-opiate superstition is our creation, we are responsible for alleviating the damage it has done.

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