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. Â 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. Â 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. Â 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. Â This, however, seems not to be the case. Â 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. Â A standard pain-relieving dose of morphine for a non-tolerant patient would be roughly 30 milligrams. Â It takes about 10 milligrams of opium to make 1 milligram of morphine. Â Licit opium in India sells for about $30 a kilogram. Â So for $30 you can have enough opium to make 100 grams of morphine: $0.30Â per gram. Â Thus the opium in a standard dose of morphine costs a little less than a penny. Â Of course processed morphine costs more than that, but growing more opium in Afghanistan won’t change processing costs.
Conclusion: Â The price of opium is not among the barriers to pain treatment in poor countries. Â 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? Â Lessons From India,” forthcoming in the Journal of Drug Policy Analysis.