When it comes to taking opioids, the United States has the dubious honour of leading the world. For every one million Americans, almost 50,000 doses of opioids are taken every day. That’s four times the rate in the UK. Take too many and you have a problem, and America certainly has a problem. The number of opioid prescriptions has fallen by 18% from its peak in 2010, but the total is still three times higher than in 1999.

Nationally, opioids killed more than 33,000 people in 2015, according to the Centers for Disease Control and Prevention. That figure includes deaths from heroin, an illegal opioid. But almost half involved a prescription opioid – that is, a painkiller available from a pharmacy with a note from a doctor.

So why does America – more than any country in the world – have an opioid problem? There is more than one cause, but one issue is that American doctors prescribe – a lot. Most insurance, especially for poor people, won’t pay for anything but a pill. Often the best thing is physical therapy, but no one will pay for that, and in any case it often needs prior long-winded pre-authorisation (for bureaucracy and procrastination healthcare insurers beat the Federal government). So doctors write a prescription.

Then there is the incessant advertising for drugs on TV, which use medical gobbledegook and are seldom explained. What they want you to focus on are the beautiful, healthy “patients” gambolling on stunning Caribbean beaches, better, presumably, for having taken the unpronounceable drug.

The US and New Zealand are the only countries that allow prescription drugs to be advertised on television. Pharmaceutical company spending in the US reached $6.4 billion in 2016 – a rise of 64% since 2012. None of the 10 most-advertised brands in 2016 was an opioid, but mass-marketing of drugs has accustomed the public to a plethors of advertised drugs that collectively promise to cure almost everything. In 2015, the American Medical Association called for a ban on adverts for prescription drugs, but they were not going to prevail against Big Pharma, whose only nod towards medical safety seems to be to include in every ad a warning “not to take the drug if you are allergic to it “. Well, yes!

It is cheaper to order American-made harmceuticals from Canada, but Big Pharma hit that idea out of the stadium. Oh, and I haven’t even mentioned the breathtaking profiteering of some pharmceutical companies with effective monopolies.

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