Trends in the consumption of opioids for the treatment of severe pain in Europe, 1990–2016

Abstract

Background Over the last decades, consumption of opioids for the treatment of pain increased steadily in the United States, Australia, and a few European countries. To date, no study has analysed time trends in opioid consumption across Europe. Methods We analysed data provided by International Narcotics Control Boards on the consumption of fentanyl, oxycodone, morphine, hydromorphone and pethidine in 40 European countries over the last decade. Trends in total opioid consumption from 1990 to 2016 in 22 selected European countries, the European Union (EU) as a whole, and, for comparison purpose, the United States, were analysed using the joinpoint regression analysis. Results In 2014–2016, opioid use was >10,000 defined daily doses for statistical purposes (s‐DDD) per 1,000,000 inhabitants die in Western/Northern countries, whereas it was <1000 s‐DDD in Southern/Eastern ones. In most European countries, opioid consumption increased to a great extent between 2004–2006 and 2014–2016; it rose from 6,477 to 8,967 s‐DDD (+38.4%) in the EU, and from 14,598 to 16,491 s‐DDD (+13%) in the United States. The increase in opioid use was steady since the early to mid‐1990s in most European countries and it slowed down after the mid‐ to late 2000s. In Denmark, Finland, France, Ireland, Switzerland, Poland and the EU, opioid use levelled off or declined over most recent years. Conclusions Consumption of opioid analgesics sharply increased in most of European countries since the early to mid‐1990s. This notwithstanding, in the mid‐2010s there was still a more than 10‐fold difference between the highest consumption in Western/Northern countries and the lowest one in Southern/Eastern countries. Significance This study provides an updated and comprehensive analysis of time trends and geographic variations in opioid consumption use across European countries over the last three decades.

Trends in opioid prescribing in Estonia (2011‐2017)

“…In 2017, the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) reports that while some parallels exist, the overall European situation remains different to that reported from the United States . The highest use of (legal in and outpatient care) opioids (fentanyl, oxycodone, morphine, hydromorphone, pethidine) in 2014‐2016 was documented in Germany and Austria (> 20 000 defined daily doses (DDD)/1 000 000), and this use significantly exceeds that described for the United States (16 500 DDD/1 000 000) . Yet, the literature highlights the absence of an opioid crisis in Germany or Austria…”

“…Within Europe, there is still a more than 10‐fold difference between the highest consumption in the Western/Northern countries and the lowest consumption in the Southern/Eastern countries. In several countries (including Estonia) the estimated opioids use is well below 2000 DDD/1 000 000, with the lowest in the Russian Federation (135 DDD/1 000 000) . While high opioid usage is undoubtedly a serious problem, the underuse of opioid analgesia (low opioid prescribing) is also a threat.…”

Utilization of transdermal fentanyl in German nursing home residents from 2010 to 2014

“…Several recent studies discuss the rising opioid use in the United States and Europe focusing on different settings including primary care and nursing homes …”

Verordnungshäufigkeit, Missbrauch und Abhängigkeit von Benzodiazepinen, Z-Substanzen und Opioidanalgetika

“…Der Gesamtverbrauch pro Einwohner weist zwischen den einzelnen Staaten erhebliche Unterschiede auf; er war z. B. im Zeitraum 2014-2016 in Deutschland etwa 4-mal so hoch wie in Luxemburg, Irland und Finnland sowie etwa doppelt so hoch wie in Schweden, der Schweiz und den Niederlanden [50]. Die Vergleichbarkeit der Daten wird allerdings dadurch erschwert, dass Methadon in einigen Ländern nur zur Substitution, in anderen hingegen auch als Analgetikum zugelassen ist, sowie dadurch, dass der Wirkstoffgehalt der Pflasterzubereitungen von Fentanyl und Buprenorphin nicht mit oralen Dosierungen gleichzusetzen ist.…”