JC, thanks a lot for your comments. The short article I linked to summarised the situation but you’re right that it doesn’t provide additional sources. I would, however, maintain that much of the concerns about opioid misuse do come from the US, even though the context is different, which is why it is so important to show the weakness of the arguments made linking justified prescriptions and misuse. Two white papers by the Alliance for the Treatment of Intractable Pain are useful and contain many references:
Also this article by noted pain patient advocate Thomas Kline, MD:
See also this article in The Guardian:
The situation of opioid misuse in West Africa hasn’t received nearly as much scrutiny. But as is the case in the US, it’s critical to distinguish between the use of street drugs and medically appropriate prescriptions, and to be careful about drawing any putative link between them. There are already tight controls on the import of most opioids, including morphine, and government restrictions are generally stricter than necessary to prevent diversion. The Economist article refers to codeine, a weak opioid that isn’t as strictly regulated as more powerful opioids, and tramadol, which is a medically used opioid that, as far as I know, is not included in UN conventions and in many countries has not been subjected to the same domestic regulations as other opioids, making it easier to import and distribute for non-medical uses. So this is a public health issue with socioeconomic causes as well, and there are different potential strategies to address it, including more balanced regulations for the drugs in question. But there is no good reason to think that making morphine widely available within the medical system under controlled conditions would contribute in any significant way to this problem.
The fact that the lack of access to morphine in most of the world has been meticulously studied and highlighted in a major Lancet article as a huge public health problem in itself, and the lack of evidence that balanced domestic policies to make morphine available to those in need result in diversion to street use, should give sufficient cover to EAs and any others who want to help address this issue. Things are changing far too slowly, and if there were issues along the way that emerged in some countries they could be corrected. Even if the EA movement were to embrace this issue as a major cause area, I would see the risk of “devastating” consequences as being extremely low.
I am unaware of any major flow-through effects, other than allowing chronic pain patients to function and work, and reducing stress and suffering in family members and others supporting those in pain.