That is in large part a result of our health insurance structure. Unlike countries that provide universal health care funded by state taxes, the United States has a mostly privatized system of care. And experts say insurers are much more likely to pay for a pill than physical therapy or repeat treatments. “Most insurance, especially for poor people, won’t pay for anything but a pill,” Judith Feinberg of the West Virginia University School of Medicine told the BBC. “Say you have a patient that’s 45 years old. They have lower back pain, you examine them, they have a muscle spasm. Really the best thing is physical therapy, but no one will pay for that. So doctors get very ready to pull out the prescription pad. Even if the insurance covers physical therapy, you probably need prior authorization which is a lot of time and paperwork.”

As a result, Americans were being prescribed opioids. Often, they were given several more pills than they could be expected to use, to avoid repeat visits. “Other countries deal with pain in much healthier ways,” said Feinberg, a professor in the Department of Behavioral Medicine and Psychiatry at the WVU School of Medicine.