Opioids: The United States as Outlier

Amanda Erickson at WP:

We have about 4 percent of the world's population but about 27 percent of the world's drug-overdose deaths. 

What explains the discrepancy? 

The U.S. medical system. 

Americans are prescribed opioids significantly more often than their counterparts in other countries. In the United States, 50,000 opioid doses are taken daily per every million residents. That is nearly 40 percent higher than the rate in Germany and Canada, and double the rate in Austria and Denmark. It is four times higher than in Britain, and six times higher than in France and Portugal. As the BBC put it, “American doctors prescribe — a lot.”

That is in large part a result of our health insurance structure. Unlike countries that provide universal health care funded by state taxes, the United States has a mostly privatized system of care. And experts say insurers are much more likely to pay for a pill than physical therapy or repeat treatments. “Most insurance, especially for poor people, won't pay for anything but a pill,” Judith Feinberg of the West Virginia University School of Medicine told the BBC. “Say you have a patient that's 45 years old. They have lower back pain, you examine them, they have a muscle spasm. Really the best thing is physical therapy, but no one will pay for that. So doctors get very ready to pull out the prescription pad. Even if the insurance covers physical therapy, you probably need prior authorization which is a lot of time and paperwork.”