There have been a number of recent efforts to change the prescribing patterns for opioid painkillers. That’s in response to the opioid epidemic and the fatalities that continue to mount.

But it’s also because the country has finally awakened to the reality that the USA already consumes far more opioids than any other nation in the world — by a wide margin. The most glaring example: we in the US account for 99% of hydrocodone use (that’s Vicodin, Norco, among others).

We’re clearly not in that much greater pain than folks in other nations. So what else could it be? This WaPo article posits a few explanations.

One encouraging sign: Though there’s still a long way to go, opioid prescribing is finally on the decline!

That’s important. In our preoccupation with street drugs, it’s easy to forget that prescription opioid fatalities still outpace heroin, per CDC figures.

It’s generally agreed that prescription painkillers continue to serve as a ‘gateway’ for many users who eventually turn to heroin. Opioid overprescribing also contributes to the flow of prescription drugs to the streets, where they’re resold at a profit.

So reducing our dependence on opioids becomes a goal. It’s an achievable one. For example, here’s one institution where a simple change in procedure significantly reduced the reliance on opioids  post-surgery.

Surgeons were given clear guidelines as to how many narcotic pain meds to prescribe to patients following specific operations. In the past, such guidelines didn’t exist. It was left up to the individual surgeon. They’d largely followed their instincts or acceded to patient request. Apparently, when doctors do that, the size of prescriptions tends to increase.

Without good data to rely on, you’ll see considerable variance in physician practice. Once reliable data is supplied, most doctors will make good use of it. Their decision-making becomes evidence-based.

As a nation, we’ve been such overconsumers of opioids that we should anticipate some blowback from pharma firms as efforts to reduce consumption show signs of succeeding. After all, that’s money out of their pockets. Companies, even very large ones, may depend on revenue from existing products and struggle to replace it. What happens to profit margins? What does the CEO tell shareholders when the stock price begins to fall?

It’s just the natural tension between the needs of a profit-making business and the needs of its customers.  When they dovetail, life is great. When they don’t, something has to give. Eventually it’s the business that adapts to a changed environment. But before that happens, some businesses will go to great lengths to prop up the revenue potential of their current opioid products.

For instance, we might expect a sudden uptick in advertising and marketing– already a huge part of Big Pharma’s budget. Or heavily-publicized new research that downplays the risks and hazards related to  opioid use. Some of this will come from “astroturf” nonprofits of the sort we’re familiar with from political campaigns. It’ll take effort on the consumer’s part to stay aware.

We need opioids in medicine. But it’s clear that we don’t need so many opioids to ensure good health. And we can definitely do without the dramatic consequences of an opioid epidemic.