đ„ Debunking the Lie: âThe U.S. is 5% of the worldâs population but consumes 80% of the worldâs opioids and 99% of the worldâs hydrocodone.â
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â ïž TL;DR:
The claim that the U.S. consumes 80% of the worldâs prescription opioids and 99% of its hydrocodone is outdated, misleading, and based on cherry-picked data from over a decade ago.
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These stats do not reflect current U.S. prescribing practices, which have dropped dramatically since 2011.
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Global opioid access is severely limited in low- and middle-income countries, skewing comparisons. Many countries canât access opioids even for cancer pain.
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The â99% of hydrocodoneâ stat is technically true for raw quantity, but itâs misleadingâmost countries donât use hydrocodone at all. The U.S. did prescribe it widely because of FDA classification and prescribing preferences.
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Repeating this stat without context has been used to justify dangerous policies, vilify pain patients and prescribers, and ignore the real issue: inequitable global access to pain relief.
đ Table of Contents
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Where Did This Stat Come From?
Tracing the origins of the â80%/99%â opioid consumption stat and how it entered public discourse. -
U.S. Opioid Prescribing Has Plummeted
Reviewing the actual decline in opioid prescriptions and MME volume since 2011. -
Global Access to Pain Relief Is Deeply Unequal
Why the U.S. looks like an outlier: not because of overuse, but because most of the world has almost no access to pain medication. -
The Truth About Hydrocodone Use
Why the U.S. historically accounted for 99% of hydrocodone useâand why this stat is deceptive. -
The Harm of Using This Myth in Policy
How this misleading claim has fueled anti-opioid propaganda, justified forced tapers, and erased the suffering of pain patients worldwide. -
What the Data Really Shows
Using current international and U.S. data to reframe the conversation with facts, not fear. -
Call to Action
What advocates, policymakers, and journalists should do insteadâand why this myth needs to be retired. -
Citations
Full reference list with links and written-out sources.
1. Where Did This Stat Come From?
The statement that âthe U.S. is 5% of the worldâs population but consumes 80% of the worldâs opioids and 99% of its hydrocodoneâ has been repeated in media, academic journals, legislative hearings, and even Supreme Court testimony. But itâs not current, not contextualized, and not the full story.
The Numbers Came From an INCB Report â Over a Decade Ago
This statistic traces back to a 2011 report by the International Narcotics Control Board (INCB). The report reviewed 2010 global opioid consumption and stated:
âThe United States of America accounted for 99.1 per cent of the consumption of hydrocodone. The country also accounted for 83.1 per cent of the consumption of oxycodone.â
â INCB Technical Report 2011, p. 119
https://www.incb.org/documents/Narcotic-Drugs/Technical-Publications/2011/Part_FOUR_Comments_NAR-Report-2011_English.pdf
This reflected a period when U.S. opioid prescribing was at its peak â before the CDC guidelines, before the DEA crackdowns, and before widespread PDMP surveillance. But the stat has been frozen in time and repeated long after the data stopped being relevant.
đŁ Who Repeated It?
After 2011, the stat took on a life of its own. It was used by:
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Public health officials to justify prescribing restrictions
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PROP-affiliated activists to promote opioid reduction
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Media outlets and government agencies to sensationalize the crisis
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Plaintiffs in the opioid multidistrict litigation (MDL) to show âoverprescribingâ and corporate excess
A 2018 article in Pain News Network traced the spread of the stat and how itâs often misrepresented:
âLike many statistics, the 80% claim has a kernel of truth, but lacks context and is being used to support a false narrative.â
â Pat Anson, Pain News Network (2018)
đ Hydrocodone Was Mostly an American Drug
The â99% of hydrocodoneâ figure is technically true â but itâs also misleading. It doesnât mean Americans were more addicted or irresponsible. It means:
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The U.S. favored hydrocodone over other opioids for decades
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Hydrocodone was Schedule III until 2014, making it easier to prescribe than oxycodone
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Most countries donât even use hydrocodone â they rely on morphine, tramadol, or codeine
âHydrocodone has long been the most prescribed drug in the United States. In 2012, doctors wrote 135 million prescriptions.â
â Drug Topics, 2014
https://www.drugtopics.com/view/hydrocodone-question
âïž A Stat Built for Blame â and Lawsuits
This framing didnât just happen by accident. It served the opioid litigation narrative perfectly:
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It made the U.S. look like the epicenter of a corporate-fueled disaster
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It gave lawyers and policymakers a way to blame volume instead of context
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It helped secure massive opioid settlements by depicting American prescribing as uniquely excessive
Instead of pushing for better global access to pain relief, the stat was used to justify:
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PDMP crackdowns
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Forced tapers
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Doctor prosecutions
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Surveillance of stable pain patients
It became a weapon against care, not a call for equity.
đ§ What Was Left Out
What this stat never acknowledged is the global pain divide. Most of the world doesnât have access to basic pain relief:
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According to the INCB, 89% of global morphine is consumed by the richest 10% of countries
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In many countries, cancer patients die in agony due to lack of access to opioids
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Low- and middle-income countries are drastically under-supplied â not because of caution, but because of poverty, stigma, and international restrictions
By comparing the U.S. to countries with no access, the stat manufactures excess by erasing global inequality.
2. U.S. Opioid Prescribing Has Plummeted
Even if the U.S. once led the world in opioid prescribing, that is no longer the case. Since its peak around 2011â2012, prescription opioid volume has dropped dramatically, both in total prescriptions and in morphine milligram equivalents (MME).
Yet the old â80% of the worldâs opioidsâ stat continues to circulateâas if nothing has changed.
đ By the Numbers: A Decade of Decline
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According to IQVIA Institute (2022), the U.S. saw a 60% drop in total opioid prescribing volume (by MME) from its 2011 peak.
đ Source: IQVIA Opioid Trends Report -
The CDC reported over 255 million prescriptions in 2012, compared to around 125 million in 2023âmore than a 50% drop in prescriptions dispensed.
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The average MME per capita has decreased year after year, and prescribing thresholds are now embedded in PDMPs, insurance rules, and even legal prosecutions.
According to the IQVIA Institute, total national prescription opioid use has declined by 60% from its peak in 2011. Meanwhile, the CDC reported 107,941 drug overdose deaths in 2022, highlighting that overdose deaths have continued to rise.
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IQVIA Institute Report: Prescription Opioid Trends in the United States
This report indicates that prescription opioid volume is expected to drop for the ninth consecutive yearâa decline of 60% from its peak in 2011.
đ Read the full reportâ -
CDC Data Brief: Drug Overdose Deaths in the United States, 2002â2022
This brief reports that in 2022, 107,941 drug overdose deaths occurred, resulting in an age-adjusted rate of 32.6 deaths per 100,000 standard population.
đ Access the data brief
đ Hydrocodone Use Has Collapsed
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Hydrocodone was once the most prescribed drug in the U.S.
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After it was rescheduled from Schedule III to Schedule II in 2014, prescribing plummeted.
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The U.S. still leads in hydrocodone useâbut the total volume has dropped drastically.
This is crucial because the 99% hydrocodone stat is still repeated as if nothing changed, even though usage has been curtailed by:
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Scheduling changes
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Insurance limitations
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NarxCare risk flags
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Practitioner fear of regulatory scrutiny
đ Doctors Are Prescribing Less Than EverâBut Facing More Punishment
Despite the massive reduction in opioid prescribing:
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Overdose deaths have increased, driven by illicit fentanyl, not pain medications.
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Doctors are still being prosecuted, patients still cut off, and outdated consumption stats are still used in courtrooms and news stories to justify policies based on volumeânot reality.
Pain patients, meanwhile, are left untreated or abandonedâwhile anti-opioid advocates continue to cite decade-old consumption stats to defend surveillance and restrictions.
đ Why This Matters
Repeating the â80% of the worldâs opioidsâ claim today is like saying:
âThe U.S. leads the world in flip phone sales.â
It was once technically true, but the world has changedâand the policies built on that outdated narrative are still hurting people today.
3. Global Access to Pain Relief is Deeply Unequal
The claim that âAmerica consumes the vast majority of the worldâs opioidsâ implies overuseâbut thatâs only true if everyone else has equal access.
They donât.
The real story isnât that the U.S. uses âtoo manyâ opioids. Itâs that most of the world uses almost noneâeven for devastating conditions like cancer or end-of-life pain. Thatâs not excess. Itâs inequality.
đ Most Countries Canât Access Basic Pain Relief
According to the 2017 Lancet Commission on Palliative Care and Pain Relief, over 61 million people globally suffer each year without access to adequate pain relief. Nearly 83% of the worldâs population consumes just 10% of the morphine distributed worldwide.
âThe poorest 50% of the worldâs population receives only 1% of the morphine distributed.â
â Lancet Commission, 2017
Source
These disparities are driven by:
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Fear of opioid misuse and international pressure to restrict use
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Lack of training in pain management
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Government refusal to stock opioids in public hospitals
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Onerous import regulations and licensing rules
In many countries, morphine is legally available but practically inaccessibleâand patients with advanced cancer are often left to suffer.
đ INCB Data Confirms Global Inequality
The International Narcotics Control Board (INCB) has acknowledged this disparity for years. Their 2020 technical report confirms:
âThere is a stark contrast in the availability of opioid analgesics between high-income and low-income countries.â
â INCB Technical Report, 2020
Source PDF
For example:
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The United States and Canada consume the bulk of medical-grade morphine, oxycodone, and hydromorphone.
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Many countries across Africa, Asia, and Latin America receive so little morphine that their entire annual supply wouldn't be enough for a single large U.S. hospital.
đ€Ż When Low Access Gets Used to Manufacture "Overuse"
The narrative that the U.S. uses âmost of the worldâs opioidsâ only holds up if you:
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Ignore the fact that most countries canât access opioids
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Treat absence of pain treatment as the norm
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Frame pain relief as a luxury, not a human right
In reality, Americaâs âlarge shareâ of opioid consumption says more about how little the rest of the world has than about how much the U.S. uses.
Pain is global. Access to pain relief should be too.
4. The Truth About Hydrocodone Use
The claim that the U.S. consumes â99% of the worldâs hydrocodoneâ is often used as a rhetorical hammer to suggest reckless overuse. But like the â80% of opioidsâ stat, it leaves out critical context that completely changes its meaning.
â Yes, the U.S. Consumed Nearly All Hydrocodone â But Thereâs a Reason
The INCB 2011 report stated that the United States accounted for 99.1% of global hydrocodone consumption in 2010. INCB Report, 2011 â Page 119
But hereâs what that stat doesnât explain:
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Most countries donât prescribe hydrocodone at all.
It was never adopted as a first-line analgesic outside the U.S. -
The U.S. preferred hydrocodone due to drug scheduling.
Until 2014, hydrocodone combination products (e.g., Vicodin) were Schedule III, making them easier to prescribe than oxycodone (Schedule II). This incentivized overreliance in primary care. -
Hydrocodone was used primarily in combination pills.
Many other countries prescribe plain morphine or codeine instead.
So yes, the U.S. used the vast majority of hydrocodone â not because Americans overused opioids, but because hydrocodone was an American regulatory oddity.
âHydrocodone has long been the most prescribed drug in the United States. In 2012, doctors wrote 135 million prescriptions for it.â
â Drug Topics (2014)
Source
đ What Happened After It Was Rescheduled?
In 2014, the DEA reclassified hydrocodone combo products as Schedule II, aligning it with oxycodone in terms of restrictions. The results were immediate:
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Hydrocodone prescribing plummeted
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Doctors turned to alternative treatments or stopped prescribing opioids altogether
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Many pain patients faced new barriers to access and stricter refill limits
Despite this, the â99%â stat is still repeated in articles, testimony, and medical education â without mentioning that use has dropped dramatically in the decade since.
đ€ Why the Stat Persists
Because it sounds damning. It works as a headline. It plays into the idea that the U.S. is uniquely irresponsible with opioids. But it only works if you:
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Ignore scheduling laws
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Ignore global prescribing norms
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Ignore that prescribing patterns have since changed
And most of all, it only works if you want to weaponize volume without explaining why that volume existed in the first place.
5. The Harm of Using This Myth in Policy
The claim that the U.S. consumes 80% of the worldâs opioids and 99% of its hydrocodone didnât just shape opinions â it shaped laws, medical practice, surveillance systems, and courtroom outcomes.
What started as a flawed data point became a policy weapon, used to justify restriction, criminalization, and abandonment of people in pain.
đ It Fueled the CDCâs 2016 Guidelines
The CDCâs 2016 opioid prescribing guideline â now widely recognized as harmful and misapplied â was introduced in a climate dominated by volume-based rhetoric. Policymakers and media emphasized the âAmerica uses 80%â stat as evidence that doctors were overprescribing, and patients were overusing.
That narrative:
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Ignored global under-treatment of pain
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Dismissed patients with legitimate chronic conditions
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Justified dose thresholds, prescription limits, and blunt surveillance tools like PDMPs and NarxCare
âïž It Strengthened the Opioid Litigation Narrative
In the opioid multidistrict litigation (MDL), attorneys for states and municipalities needed to show excess, damage, and corporate irresponsibility. The â80%â and â99%â stats were perfectly suited for this.
They helped establish:
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A public image of âpill floodingâ
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A villainous narrative of American overconsumption
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A simplified version of the crisis that ignored fentanyl, poverty, trauma, and policy failure
This narrative brought in billions in settlement funds â but did little to improve pain care or provide nuanced solutions.
đ§ It Justified Abandonment, Surveillance, and Tapering
Once policymakers accepted the premise that âAmerica uses too many opioids,â it became easy to:
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Flag high-dose patients as outliers, regardless of individual need
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Force tapers under the assumption that opioid use = addiction
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Criminalize prescribers simply for operating above an arbitrary MME threshold
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Deny surgeries, refills, and care access to people flagged in NarxCare or PDMP systems
All of this was fueled by the belief that volume equals wrongdoing.
If America was using 80% of the worldâs opioids, someone had to be blamed.
And instead of looking at systemic inequality in global access, the blame fell squarely on:
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Pain patients
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Primary care doctors
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Palliative and hospice clinicians
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Rural and underserved communities
đ The Lie Has Outlived the Reality
U.S. prescribing has dropped by over 60%.
Hydrocodone has been rescheduled.
Deaths are now driven by illicit fentanyl, not prescription pills.
And yet â this myth is still being repeated in:
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Public health campaigns
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Opioid prescriber education
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Addiction treatment literature
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Testimony and policy proposals
Itâs used to shame, restrict, and surveil â not to help.
6. What the Data Really Shows
The idea that the U.S. âuses most of the worldâs opioidsâ makes for a good headline â but the data tells a different story.
Today, opioid prescribing in the U.S. has dropped dramatically, while most of the world still faces crippling under-access to basic pain relief. The result is a misleading picture that frames inequality as overuse.
Letâs set the record straight.
đ U.S. Opioid Prescribing Has Fallen â A Lot
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According to the IQVIA Institute (2022), total prescription opioid volume in the U.S. dropped by 60% since its 2011 peak.
đ IQVIA Report -
CDC data confirms that opioid prescribing peaked at 255 million prescriptions in 2012, and dropped to ~125 million by 2023 â a 50%+ reduction in volume.
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The U.S. now prescribes fewer opioids per capita than it did in the early 2000s â yet myth-based policies persist as if nothing has changed.
đ Most of the World Still Canât Access Pain Relief
From the Lancet Commission on Palliative Care and Pain Relief (2017):
âThe poorest 50% of the worldâs population receives only 1% of the morphine distributed globally.â
đ Lancet Source
And from the INCB Technical Report (2020):
âThere is a stark contrast in the availability of opioid analgesics between high-income and low-income countries.â
đ INCB Report PDF
Despite legitimate need, many countries:
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Restrict or ban opioids outright
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Lack trained providers
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Face crushing import/export regulations
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Fear international penalties for âoveruseâ
This is why opioid consumption data skews so heavily toward the U.S. and a handful of wealthy countries â not because those countries overprescribe, but because most others can't prescribe at all.
đ What the INCB Actually Reports
The INCB provides annual narcotic drug consumption statistics. Hereâs what they show:
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The U.S. still consumes more morphine and oxycodone than most countries â but so do Canada, Germany, Australia, and the UK.
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High-income countries consistently represent the vast majority of total opioid use â not because of abuse, but because of access.
In short: The U.S. consumes a large share because it can. That doesnât mean itâs abusing the system. It means the system is failing most of the world.
đ§ The Real Takeaway
Opioid consumption numbers donât tell us whoâs overusing.
They tell us who can access relief â and who canât.
Framing this as a story of American excess erases global suffering and has been used to punish pain patients instead of solving disparities.
The real public health question isnât âWhy does the U.S. consume so much?â
Itâs âWhy canât the rest of the world access what they need?â
7. Call to Action
The myth that âAmerica is 5% of the worldâs population but consumes 80% of the worldâs opioids and 99% of its hydrocodoneâ has been used for over a decade to shame doctors, punish pain patients, and drive one-size-fits-all policies rooted in volume â not context.
But the truth is clear:
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The U.S. no longer leads the world in opioid prescribing per capita the way it once did.
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Prescribing has dropped by more than half, while overdose deaths (driven by illicit fentanyl) have surged.
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The so-called âoveruseâ is mostly a reflection of the rest of the worldâs inaccessibility to pain relief, not excess in the U.S.
Itâs time to retire this myth â and the policies built on it.
What You Can Do:
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Stop Repeating the Stat
Whether you're a policymaker, public health leader, journalist, or educator: donât repeat the â80%â or â99%â claim without context. Itâs outdated, misleading, and harmful.
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Correct the Record
Push back when this myth is used in hearings, academic papers, litigation narratives, or opioid guidelines. Use verified sources like the INCB, IQVIA, and The Lancet.
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Push for Global Access â Not Global Restriction
We donât need fewer opioids in the U.S. â we need better, safer, more compassionate access to pain care worldwide.
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Support Balanced Policies
Pain patients shouldnât be punished to make numbers look better on a chart. Policies should reflect individual needs, not arbitrary national consumption stats.
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Educate with Facts, Not Fear
If you advocate for addiction treatment, donât do it at the expense of pain patients. Donât use weaponized stats to win funding or political leverage. We can solve multiple problems without sacrificing people who are suffering.
Final Thought
Pain isnât a luxury.
Opioid access isnât proof of abuse.
And using distorted global stats to justify local harm isnât public health.
Letâs stop using this myth to build bad policy â and start building systems that care for everyone in pain, everywhere in the world.
Citations
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International Narcotics Control Board (INCB). (2011). Report of the International Narcotics Control Board for 2011: Part Four â Comments on the Reported Statistics on Narcotic Drugs. Page 119.
Retrieved from: https://www.incb.org/documents/Narcotic-Drugs/Technical-Publications/2011/Part_FOUR_Comments_NAR-Report-2011_English.pdf -
IQVIA Institute for Human Data Science. (2022). Prescription Opioid Trends in the United States.
Retrieved from: https://www.iqvia.com/insights/the-iqvia-institute/reports-and-publications/reports/prescription-opioid-trends-in-the-united-states -
Centers for Disease Control and Prevention (CDC). (2023). Drug Overdose Deaths in the United States, 2002â2022: Data Brief No. 491.
Retrieved from: https://www.cdc.gov/nchs/products/databriefs/db491.htm -
The Lancet Commission on Palliative Care and Pain Relief. (2017). Alleviating the Access Abyss in Palliative Care and Pain Relief â An Imperative of Universal Health Coverage.
Retrieved from: https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(22)00013-5/fulltext -
International Narcotics Control Board (INCB). (2020). Narcotic Drugs: Estimated World Requirements for 2021 â Statistics for 2019.
Retrieved from: https://www.incb.org/documents/Narcotic-Drugs/Technical-Publications/2020/Narcotic_Drugs_Technical_publication_2020.pdf -
Anson, P. (2018, March 8). The Myth That Americans Consume 80% of the Worldâs Opioids. Pain News Network.
Retrieved from: https://www.painnewsnetwork.org/stories/2018/3/8/the-myth-that-americans-consume-80-of-the-worlds-opioids -
Drug Topics. (2014). Hydrocodone: The Question We Need to Ask.
Retrieved from: https://www.drugtopics.com/view/hydrocodone-question -
United Nations Office on Drugs and Crime (UNODC). (2023). World Drug Report 2023.
Retrieved from: https://www.unodc.org/unodc/en/data-and-analysis/world-drug-report-2023.html -
Maia Szalavitz. (2021, July 18). [Tweet].
Retrieved from: https://twitter.com/maiasz/status/1416770617131552777 -
Stefan Kertesz. (2021, November 15). [Tweet].
Retrieved from: https://twitter.com/StefanKertesz/status/1460329586399580166
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