The changing nature of the opioid problem

Comparison with developments in North America is also relevant to an analysis of Europe’s opioid drug problem. A review of the data presented in this report suggests that, while the overall EU situation remains different, some parallels do exist.

The latest data show that heroin use still accounts for the majority, around 80 %, of new opioid-related treatment demands in Europe. In addition, the overall decline in treatment demand related to heroin, observed since 2007, is no longer evident. Of particular concern is the increasing European estimate for drug overdose deaths, which has now risen for the third consecutive year; heroin is implicated in many of these deaths.

North America has also experienced considerable morbidity and mortality associated with the misuse of prescription opioids, rising levels of heroin use and, most recently, the emergence of highly potent synthetic opioids, in particular fentanyl derivatives. One difference between the two regions is that in Europe, very few clients presenting for specialised drug treatment do so for addiction to opioid pain medicines. This probably reflects the different regulatory frameworks and approaches to marketing and prescribing that exist between Europe and the North America. However, the possibility of underreporting cannot be dismissed, as Europeans experiencing problems with prescription medicines may access different services than those used by illicit drug users.

Medicines used for opioid substitution treatment, however, now play a more significant role in treatment demands and health harms in a number of European countries. Overall, non-heroin opioids account for around a fifth of all opioidrelated demands to specialised drug services. The role that synthetic opioids, such as methadone, play in overdose deaths is difficult to quantify at EU level, but in many countries these substances are now important, and in a few countries they predominate.

Reducing the misuse of medicines, including those used for opioid substitution treatment, is a growing challenge for many European healthcare providers. A strong evidence base supports the appropriate use of opioid substitution medicines, which has been shown to reduce morbidity, mortality and offending among those receiving it. Good clinical practice together with an understanding of how prescription opioids are diverted from their legitimate use, and how to reduce this, are therefore important if the clear health benefits that accrue from this treatment approach are not to be undermined.