Opioids' addictive nature stems from their ability to produce euphoria in addition to pain relief. This euphoria can lead to recreational use, which quickly spirals into dependency. The body builds a tolerance to the drug, requiring higher doses to achieve the same effect. This increases the risk of overdose, which causes fatalities.
The World Health Organisation estimated that in 2019, around 125,000 people died globally from opioid overdose. During and after the COVID-19 pandemic, opioid addiction increased, leading to record deaths and a higher economic burden.
Market dilemma
The market for both legal and illegal opioids is vast. In 2020, the global analgesics (painkillers) market was valued at around $26bn, with opioids making up a significant portion. The legal market comprises pharmaceuticals prescribed for legitimate medical use, but the illegal opioid market—including heroin and synthetic opioids like fentanyl—adds an unquantifiable amount to this total.
Fentanyl has been a particular driver of the current opioid crisis due to its potency and the ease with which it can be manufactured and distributed illicitly. Yet, in many places, including Asia and the Middle East, the opioid market is expanding.
Until recently, Afghanistan produced four-fifths of the world's opium, but in August 2021, the Taliban—an Islamist fundamentalist group—took control of the country, and in April 2022, they announced a ban on poppy cultivation. By 2023, this had had a dramatic effect. Opium poppy cultivation and opium production had declined by 95% in Afghanistan, from 6,200 tonnes in 2022 to 333 tonnes in 2023.
By August 2023, the monthly farm-gate price of a kilogramme of dried opium was $408—nearly five times more than before the Taliban takeover. The Taliban ban was driven by ideology, but it can be a double-edged sword as farmers suffer and other countries replace the lost Afghan supply to meet the global demand.
Economic burden
The medicinal opioid market is growing in nations with advanced healthcare systems, like Egypt, Saudi Arabia, and the UAE, while the illegal market remains substantial. In these countries, there has been an increase in the prescription of opioids for pain management, which also increases the risk of diversion and abuse.
The economic impact of opioid abuse is enormous. This covers health, productivity, criminal justice, and social welfare. The healthcare costs include addiction treatment, emergency room visits, and long-term care.
In the United States, the overall cost stemming from opioid abuse during the pandemic was estimated at around $1.5tn. Yet there are non-financial costs, too, with families and communities often devastated by addiction and its consequences.
In the Middle East, opioid abuse also imposes significant economic burdens. Healthcare systems are strained by the need to treat addiction and related health issues, while police spend considerable resources combating the illegal drug trade.
In Egypt, millions of dollars are spent every year on addiction, including through public health campaigns, rehabilitation centres, and treatments. Egypt's economy can ill afford any increase in this problem.
