Is Europe facing an opioid epidemic: What does European monitoring data tell us?

Abstract

This paper addresses the question of whether Europe is facing an opioid epidemic and utilizes data from the European monitoring system on opioid use, harms and availability, to help assess the situation. Data sources covering the last decade on overdose deaths, drug treatment entrants and drug-related emergencies suggest that the health burden associated with opioid use is mostly related to the consumption of heroin -and to a lesser extent diverted opioid substitution treatment medicationsand that it is primarily affecting an ageing cohort of vulnerable users, with little evidence of an increase in initiation. While opioid-related deaths are currently at much lower levels than in the United States, they still represent a large preventable health burden with differences across EU countries. There is also increasing concern related to the high availability of heroin, illicitly produced synthetic opioids and diverted opioid pain medications on the European drugs market. Trends in the latter categories are poorly monitored and we may miss signs of emerging problems. Moreover, the economic recession following the COVID-19 pandemic has a potential to lead to resurgence in opioid use and harms. Significance: This paper looks at data from the European monitoring system to address the question of whether Europe is facing an opioid epidemic. It reviews available health and supply side indicators, considering the limitations of each data source.A summary of the available evidence would suggest that while opioid-related deaths in Europe represent a large preventable health burden with differences across EU countries, Europe as a whole is not facing an opioid crisis of the size and nature seen in the US.How to cite this article: Seyler T, Giraudon I, Noor A, Mounteney J, Griffiths P. Is Europe facing an opioid epidemic: What does European monitoring data tell us?.

What lessons from Norway’s experience could be applied in the United States in response to the addiction and overdose crisis?

“…However, the volatility of the unregulated drug supply predates the pandemic, with fentanyl supplanting heroin over the last 5-7 years in much of Canada and the United States. It is this shift that has driven the acceleration in opioidrelated death rates, with unregulated fentanyl responsible for 87% of opioid-overdose deaths in Canada in 2021 [1].…”

“…In the United States, widespread and extremely liberal prescription opioids access started in the 1990s. The current fentanyl-dominated opioid crisis stems from that liberalization of opioid access [1]. Today, opioid deaths in the United States are more than 10-fold European levels [2].…”

Opioids in COVID-19: Two Sides of a Coin

“…The United States of America faces a growing epidemic of opioid use, in fact, since 2007 statistical data has shown increased death rates related to opioid consumption, with the death of nearly 91 American individuals every day and over 100 million individuals treated in emergency rooms for opioid use ( Rudd, 2016 ; Dayer et al, 2019 ; Understanding the Epidemic | CDC’s Response to the Opioid Overdose Epidemic | CDC, 2021 ; CDC WONDER). Also, from 1999 to 2018, the United States of America estimated about 450,000 deaths related to opioid use disorder ( Wilson et al, 2020 ; Seyler et al, 2021 ). This particular country has a greater variety of opioids than Brazil; therefore, fentanyl and morphine, heroin, oxycodone (OxyContin), methadone, and hydrocodone (Vicodin) are widely used and responsible for the opioid use disorder (Opioid Basics | CDC’s Response to the Opioid Overdose Epidemic | CDC, 2021 ).…”

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“…Recently, the FDA has included the control of rapid-acting opioids as a means of addressing the current crisis of abuse and misuse of opioids [5]. Europe, although not facing a crisis of the same dimensions as the US [6,7], has evaluated risks [8] and taken fragmentated actions especially for immediate release substances [9]. Obviously, the problems regarding drug abuse and misuse do not exclusively relate to opioids, as the illicit use and abuse of carisoprodol has increased in the last 20 years.…”