The ecstasy and the agony

“PLEASURE is oft a visitant; but pain clings cruelly,” wrote John Keats. Nowadays pain can often be shrugged off: opioids, a class of drugs that includes morphine and other derivatives of the opium poppy, can dramatically ease the agony of broken bones, third-degree burns or terminal cancer. But the mismanagement of these drugs has caused a pain crisis (see ). It has two faces: one in America and a few other rich countries; the other in the developing world.In America for decades doctors prescribed too many opioids for chronic pain in the mistaken belief that the risks were manageable. Millions of patients became hooked. Nearly 20,000 Americans died from opioid overdoses in 2014. A belated crackdown is now forcing prescription-opioid addicts to endure withdrawal symptoms, buy their fix on the black market or turn to heroin—which gives a similar high (and is now popular among middle-aged Americans with back problems).