Does the BBC know what an Opioid is?

Fact checking seems to have been outsourced.  It used to be the domain of in-house sub-editors, but now it is almost entirely up to volunteers to spot accuracy in the media.  And, unfortunately, what passes for investigative journalism these days is little more than academic conjecture.

Take the BBC’s recent report claiming that the “real” opioid crisis is that poor countries don’t get enough.   The more you examine the facts, the more difficult that claim is to believe.

The video shows one woman who doesn’t have access to painkillers.  She does not appear to be in any of the countries that have an alleged opioid lack.

First of all, an unmet demand for morphine does not mean a lack of painkillers.  If you notice, the BBC video only mentions one opioid, and that’s morphine.  There are, of course, other opioids besides morphine, and other pain killers besides opioids.

Opioids are a class of drugs which include opium, heroin, fentanyl, morphine and other drugs created by the poppy plant.  Most of these are in limited supply, yes, but that’s not because of a lack of economic distribution, it’s because of the addictive behaviours and other harmful effects associated with opioids.

The “statistics” shared on the BBC’s video seem to be taken from a drug dealer who has given up on the US market.  Mexico 36 percent, and China only 16 percent, of what?  Both those countries are known exporters of drugs, with internal drug addiction problems of their own.  Do we really believe that India on gets only 4% of its opioid “needs?”  It’s almost right by Afghanistan, the world’s largest exporter.   If you listen to Indians, the problem there doesn’t seem to be too little drugs, it’s too much drug use, especially opioids.

According to Dr Yatinder Pal Singh Balhara of the National Drug Dependence Treatment Centre “Heroin is the most commonly abused opioid in India. But we are also seeing a significant increase in prescription opioid abuse. If steps are not taken to halt this trend, we [India] may face a situation similar to the US in next 10 years.”  That does not sound like a country with a lack of opioids, it sounds like one with a surplus.

“If steps are not taken to halt this trend, we [India] may face a situation similar to the US in next 10 years.” – Dr Yatinder Pal Singh Balhara.

We think that perhaps the words “needs” and “demand” have been mixed up here.  While it’s heart rendering to see a patient in pain who is unable to relieve that pain, that individual is more likely to be an exception than a rule.  China and India don’t have an opioid lack.

“Health care workers often become victims of opioid addiction because the drugs are easily available to them,” says Dr  Atul Ambekar. “I am treating a nurse who was taking opioid medication initially for pain relief, but then she got addicted to it.”  Dr Ambekar said that prescription opioid addiction was more common among women in India.

China, on the other hand, once fought a war to keep their people from being addicted to opioids, while foreign governments fought to force open their markets to opium.  China has been accused of supplying opium to other markets, including selling cheap raw materials that have been blamed for the crisis in the United States.

China’s response to the accusations includes saying that they busted illegal drug companies.  In other words, they admit that there are opioids being produced for export, but they are cracking down.  Would they need to crack down if opioid supplies were insufficient for the local market?

In fact, China has its own internal problems with drug addiction.  If you look for China opioid shortage, you’re more likely to find news on an epidemic of excess opioids, or even a shortage of donkeys.  That’s right, donkeys.  Of course, that only leads to another story by the BBC.

One other source seems to imply an opioid shortage, and that is the Financial Times (other than the Lancet, which quotes a study that may be funded or indirectly funded by the pharmaceutical market.)  However, another article shows that an old opioid taboo in China is beginning to wane, due to over-consumption of tobacco, and the increased rates of cancer, not that the “need” is outstripping supply.

In addition to real opioids, China creates many synthetic opioids.  Perhaps this is where the false statistics come from.  Perhaps China only uses “authentic” opioids for 16% of its painkillers, making up the rest of the market with cheaper substitutes.  The preference for cheaper substitutes for medical uses isn’t a crisis for anyone, unless you’re counting poppy growers and others who benefit financially from the opium trade.

So, the opioid shortage is a myth.  If anything, the developing world is set to face the same problem as the united states.  While there may be areas of famine and lack of distribution, the major markets have far more opioids than they need.

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