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

Abstract

Major differences exist between the United States and Europe regarding opioid-related morbidity and mortality. Regulatory restrictions, drug policy measures and largescale implementation of proven-effective opioid dependence treatments and harm reduction strategies are advocated to effectively tackle the opioid crisis in the United States, using successful examples practised in Europe.The United States faces an opioid epidemic, with 91.8 million (37.8%) adults using prescription opioids (POs), 11.5 million (4.7%) adults misusing POs, 1.9 million (0.8%) people suffering from a PO use disorder in 2015 and 49 860 opioid-related deaths (ORDs) in 2019 [1,2]. Initially, the increase in ORD was mainly due to POs, but since 2010 ORDs are mainly due to illicit heroin, and since 2014 to illicitly

The impact of tightened prescribing restrictions for PBS‐subsidised opioid medicines and the introduction of half‐pack sizes, Australia, 2020–21: an interrupted time series analysis

“…In the United States, laws requiring lower prescribed quantities of opioid medicines led to fewer initiations of opioid therapy, shorter treatment duration, and reduced opioid medicine use in the community. [8][9][10][11] We similarly found modest declines in the dispensing of several opioid medicines in Australia.…”

“…4 Medicines regulators and funders have attempted to curb pharmaceutical opioid use and its associated harms with updated guidance, 5 package warnings, 6 and supply restrictions. [7][8][9][10][11] The effectiveness of these interventions is not always clear, but norepeat prescribing policies and the availability of short course treatments have been cited as reasons for the lower frequency of opioid-related harms in Europe than in the United States despite similar levels of use. 12 Annual per capita opioid consumption in Australia is the ninth highest in the world.…”

An Inquiry into People’s Use of Substances, Views on Substances, and How Substances Have Affected Them

“…Approximately 75% of all drug-related deaths in the United States involve opioids (often illicitly manufactured fentanyl). It is estimated that around 2 million Americans have an opioid use disorder, while nearly 11.5 million adults are misusing opioids (den Brink et al, 2022). The authors noted that a staggering 92 million Americans are using prescription opioids at any given point in time, which contributed to the nearly 50,000 people that died from opioids in 2019.…”

Fentanyl Induces Novel Conditioned Place Preference in Adult Zebrafish, Disrupts Neurotransmitter Homeostasis, and Triggers Behavioral Changes

“…Fentanyl has strong sedative effects and a high risk of addiction due to its highly esterophilic nature, which allows it to rapidly cross the blood–brain barrier and then bind potently to opioid receptors in the brain [ 7 ]. Short-term overdose or long-term clinical use of fentanyl could lead to brain disorders [ 8 ] accompanied by abnormal social behaviors, such as disorientation, attention deficit, and memory impairment [ 9 , 10 ]. In addition to neurotoxicity, studies have indicated that clinical overdoses of fentanyl could induce chest wall rigidity, which, in turn, leads to respiratory depression and increased risk of death.…”