The state of opioid abuse in America has been deemed an epidemic.
Overdose related deaths involving prescribed opioids have reached an all-time high, jumping from 19,000 in 2014 to 22,000 in 2015, according to the Centers for Disease Control and Prevention. Considering all opioids (not just prescribed ones), the figures get even worse: In 2015, 33,091 died from opioid related overdoses.
Missouri Sen. Claire McCaskill has set her sights on curbing the issue, writing an op-ed in the Kansas City Star and dedicating a page of her website to facts and figures. One tweet in particular caught our eye: "We have 5% of world population. 80% of opioids."
Such drastic numbers paint a dire picture for the state of opioid use and abuse in America. We wanted to fact-check her claim.
What we found was that while America certainly consumes more opioids than any other country, the notion that we consume 80 percent of the global supply is greatly exaggerated.
‘One startling number’
Checking the first part of McCaskill’s claim was simple: The United States’ population is, according to the U.S. Census bureau, 324.8 million. The global population is 7.4 billion. That means the United States accounts for roughly 4.4 percent of the total world population.
Checking the other half was more complicated.
We reached out to McCaskill’s spokesperson, Drew Pusateri, and he supplied us with the source of the figure: a CNBC article published on April 27, 2016.
And while the article provides the figures McCaskill cited, it is vague about where exactly the 80 percent figure comes from. Upon its first reference it is simply "one startling number from recent years," and later it is noted that the figure was "cited in various studies," including one by Express Scripts.
The Express Scripts study, "A Nation In Pain," was released on Dec. 9, 2014. And while it does cite the 80 percent figure, it was not a study designed to measure American opioid consumption or global consumption.
The reality, according to Christopher Jones, the director of the Division of Science Policy in the Department of Health and Human Services, is that America consumes 30.2 percent of globally distributed opioids.
According to data collected by the International Narcotics Control Board, the United States consumed roughly 30.2 percent of opioids in 2015.
A Vienna-based "quasi-judicial expert body," the International Narcotics Control Board is tasked with tracking global opioid consumption, among a myriad of other things.
The board releases three annual reports on narcotic drugs. "Narcotic Drugs: Estimated World Requirements for 2017; Statistics for 2015" is the most recent publication, and includes data for the year 2015.
Using the International Narcotics Control Board figures, Jones calculated that the United States consumed 173,332 kilograms of 574,693 kilograms of opioids consumed globally (382,131.6 of 1,266,981.2 pounds), or 30.2 percent.
The drugs Jones included in the measurements are: codeine, dihydrocodeine, ethylmorphine, hydrocodone, morphine, oxycodone, pholcodine, dextropropoxyphene, diphenoxylate, methadone, pethidine and tilidine. The figures also include the calculated consumption of buprenorphine.
To be clear, Jones noted, such data is limited in several ways. The first is that it is government-reported data. The second is that many drugs are marketed in one country and not another; while used frequently in the United States, hydrocodone is virtually unused elsewhere.
Additionally, some of the data include drugs that may have been exported from the country of manufacture and consumed in another country. Thus, data from INCB should be considered with great care when comparing consumption levels of narcotic drugs across countries.
And finally, the board makes special note that comparing countries by the weight of opioids consumed is not recommended. Instead they suggest using a statistical measurement called "defined daily doses."
Defined daily doses
A defined daily dose is the quantity of a particular narcotic drug used in a day by one individual. It is not a recommended dosage, but rather it is a calculation created by the International Narcotics Control Board to statistically measure opioid use with a ratio that directly relates a country’s population to its consumption.
For example, the daily dose of hydrocodone is 15 milligrams. So, if 60 milligrams are consumed, four defined daily doses would be recorded. The final results are calculated per million inhabitants.
The United States consumed the most using this measure from 2013 to 2015: 47,580 doses of narcotic drugs were consumed per day per million people.
Canada comes in second with 34,444 defined doses consumed per day, and Germany in third with 30,796.
Using such a measurement, it is easy to see that consumption in America, while noticeably higher than in similarly developed countries, is not as astronomical as McCaskill’s cited figure makes it appear.
‘A life of its own’
Jones said it’s common for people to cite the 80 percent figure that McCaskill did, despite its inaccuracy.
"I would say it is a commonly quoted statistic...people across a variety of disciplines, who even are somewhat expert on the topic, have repeated that statistic," he said.
Jones said he believes the number originated as the percentage of oxycodone that America consumes compared to the world.
From there, he said, the figure has "taken a life of its own. It’s now a ‘fact’ because it’s been repeated so many times."
But it’s not the full picture. Because while America does consume over 75 percent of oxycodone, and 99 percent of hydrocodone, it doesn’t consume even half of all opioids globally, according to the International Narcotics Control Board data.
Which, in part, according to Jones, has to do with marketing. Oxycodone and hydrocodone are marketed in America. Similar opioids are more prevalent elsewhere.
Drug control systems
Despite conflated numbers, experts agree there is a problem.
Martha Maurer, a policy program manager and researcher at the Pain and Policy Studies Group at the University of Wisconsin-Madison, agreed that opioid abuse in the United States was an epidemic.
But part of the solution, she said, was continuing to figure out how to view the problem.
"It’s clear that there has been a lot of harm associated with overdose and abuse," Maurer said, "but it goes back to the question of where (abused) medication is coming from, which we just don’t know."
Something worth noting, Maurer said, was that when you look at the milligram-per-person statistics, "some countries, including Germany, Austria, Denmark and Switzerland, have opioid-consumption levels comparable to that in the US, but they are not having the same problems with harms caused by overdose. Their drug-control systems ensure a balanced approach to opioid access."
For Jones, it’s about finding the right balance.
"From a policy perspective, we’re trying to ensure that opioids are available when they are needed, but that they are being used as a part of comprehensive evidence-based pain care," he said, "not that we’re relying on them just because they’re the easiest thing to prescribe, or there are other external pressures to prescribe them."
In setting out to combat America’s opioid epidemic by holding pharmaceutical companies accountable, Missouri Sen. Claire McCaskill said that with just 5 percent of the population, the United States consumes "80 percent of opioids."
McCaskill’s figure, widely cited as it is, is inaccurate. It presents a narrow view of opioid consumption globally, where some opioids are marketed in select countries, but not others. It also discounts using defined daily doses, which provide a far more accurate representation of consumption when comparing nations.
So, while the United States is clearly the largest consumer of opioids, it, at most, accounts for roughly 30 percent of global consumption. We rate McCaskill’s claim False.
Tweet, Sen. Claire McCaskill’s Office, March 28
Opioid Data Analysis, Centers for Disease Control and Prevention, Feb. 9, 2017
"More resources needed to battle the opioid epidemic," Kansas City Star Oped, Aug. 9, 2016
Opioids crisis in Missouri, Sen. Claire McCaskill’s website
U.S. and World Population Clock, United States Census Bureau
"Americans consume vast majority of the world’s opioids," CNBC, April 27, 2016
"A Nation in Pain," Express Scripts, Dec. 9, 2014
Interview with Christopher Jones, director of the Division of Science Policy in the Department of Health and Human Services, April 18, 2017
"Narcotic Drugs: Estimated World Requirements for 2017; Statistics for 2015," International Narcotics Control Board, 2017
Interview with Martha Maurer, policy program manager and researcher at the Pain and Policy Studies Group at the University of Wisconsin-Madison, April 18, 2017
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