Abstract
Given the ongoing opioid crisis in the United States (US), we investigated the opioid situation in Europe. The aims of the study are to provide an overview of trends in prescription opioid (PO) use and opioid-related adversities between 2010 and 2018 for different opioids in 19 European countries and to present a comparison with similar data from the US. A multisource database study with national data from 19 European countries evaluating trends between 2010 and 2018 in (a) PO consumption, (b) high-risk (HR) opioid users, (c) opioid-related hospital admissions, (d) opioid-related overdose deaths, (e) opioid use disorder treatment entries, and (f) patients in opioid substitution therapy (OST). Within and between-country comparisons and comparisons with data from the US were made. There was considerable variation between European countries. Most countries showed increased PO consumption with the largest increase and the highest consumption in the United Kingdom (UK) compared to the rest of Europe and the US in 2018 (UK: 58,088 defined daily doses for statistical purposes/1000 population/day). In 2018, Scotland had the highest rates (per 100,000 population) of HR opioid users (16·2), opioid-related hospital admissions (118), opioid-related deaths (22·7), opioid use disorder treatment admissions (190), and OST patients (555) of all included European countries. These rates were similar or even higher than those in the US in 2018. Other countries with high rates of opioid-related adversities were Northern Ireland (synthetic and "other" opioids), Ireland (heroin and methadone), and England (all opioids). All other countries had no or little increase in opioid-related adversities. Apart from the British Isles and especially Scotland, there is no indication of an opioid crisis comparable to that in the US in the 19 European countries that were part of this study. More research is needed to identify drivers and develop interventions to stop the emerging opioid crisis in the UK and Ireland.
Highlights
The opioid crisis in the United StatesThe United States (US) is currently facing a serious “opioid crisis” with an increase in opioidrelated deaths between 2000 and 2018 from 3 to almost 15 per 100,000 population per year [1]
The 19 European countries included in the analysis cover most European regions except for central and eastern Europe and Turkey (Figure 1)
illicitly manufactured fentanyl (IMF) was an important driver of the third phase of the opioid crisis in the US, becausefentanyl is a very potent opioid with a high abuse liability and because it is regularly used as an adulterant of heroin and cocaine, or sold as a falsified prescription opioid (PO), resulting in fatal incidents in drug users unaware of the presence of a highly potent opioid [6]
Summary
The opioid crisis in the United StatesThe United States (US) is currently facing a serious “opioid crisis” with an increase in opioidrelated deaths between 2000 and 2018 from 3 to almost 15 per 100,000 population per year [1]. A multisource database study with national data from 19 European countries evaluating trends between 2010 and 2018 in (a) PO consumption, (b) high-risk (HR) opioid users, (c) opioid-related hospital admissions, (d) opioid-related overdose deaths, (e) opioid use disorder treatment entries, and (f) patients in opioid substitution therapy (OST). In 2018, Scotland had the highest rates (per 100,000 population) of HR opioid users (16Á2), opioid-related hospital admissions (118), opioidrelated deaths (22Á7), opioid use disorder treatment admissions (190), and OST patients (555) of all included European countries. These rates were similar or even higher than those in the US in 2018.
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