ABSTRACT
Chapter 7 changes the focus of the book, again. This time, the chapter calls attention to the opioid epidemic in the wider world. There are two major issues: the abuse of opioids in other countries and drug trafficking. The chapter begins by looking at international issues mostly focused on drug trafficking. The prescription part of the epidemic is a result of activities, again, by pharmaceutical companies, searching for new markets, especially as the United States eventually began to place restrictions on opioid medications. Heroin, which has been around for quite a while, and synthetics such as fentanyl, became a major part of drug trafficking, as did tramadol, a relatively mild, but still addictive, opioid. The chapter looks at the role of the United States in influencing countries to reduce or stop trafficking as well as the role of international organizations in reinforcing that influence. Much of the chapter looks at the two sets of problems in four countries. The United States clearly has the worst opioid problem, but Canada is the second. In India, the use of opioids for pain relief is relatively limited by culture and government restrictions, though tramadol is the major opioid producing addiction. India is a major producer and supplier of tramadol, often sending the drugs through other countries. Mexico has been a major source of illegal drugs to the United States and its cartels have become major players in the drug trafficking. Use/abuse of opioids tends to be in the border areas with the United States. The final country is Nigeria (and West Africa). Again, the use of opioids is much less in Nigeria than in the United States or Canada, though Nigeria has become a way station in drug trafficking. The United States has heavily influenced Mexico and Nigeria to stem the tide of drugs. An important finding of this chapter is that the availability of treatment for addicts is much less in India, Mexico, and Nigeria than it is in the United States. As with the United States, treatment policies pale before the scope of the problem.
