The North American opioid crisis: a European perspective

With great interest and enthusiasm we read the Commission led by Keith Humphreys and colleagues.1

  • Humphreys K
  • Shover CL
  • Andrews CM
  • et al.

Responding to the opioid crisis in North America and beyond: recommendations of the Stanford–Lancet Commission. For the past few years, we have been investigating the use of prescription opioids, and prescription opioid-related harm in Europe.2

  • van Amsterdam J
  • van den Brink W
  • Pierce M

Explaining the differences in opioid overdose deaths between Scotland and England/Wales: implications for European opioid policies., 3

  • Pierce M
  • van Amsterdam J
  • Kalkman GA
  • Schellekens A
  • van den Brink W

Is Europe facing an opioid crisis like the United States? An analysis of opioid use and related adverse effects in 19 European countries between 2010 and 2018., 4

  • Kalkman GA
  • van den Brink W
  • Pierce M
  • et al.

Monitoring opioids in Europe: the need for shared definitions and measuring drivers of opioid use and related harms., 5

  • Kalkman GA
  • Kramers C
  • van Dongen RT
  • van den Brink W
  • Schellekens A

Trends in use and misuse of opioids in the Netherlands: a retrospective, multi-source database study. Similar to the Humphreys and colleagues’ analysis, we found an increasing trend in prescription opioid use in almost all European countries.3

  • Pierce M
  • van Amsterdam J
  • Kalkman GA
  • Schellekens A
  • van den Brink W

Is Europe facing an opioid crisis like the United States? An analysis of opioid use and related adverse effects in 19 European countries between 2010 and 2018. However, we generally found no evidence for a substantial increase in opioid-use-related adversities (eg, hospitalisations, opioid dependence, and opioid overdose deaths) or an opioid crisis that is similar in magnitude or nature to the crisis in the USA.3

  • Pierce M
  • van Amsterdam J
  • Kalkman GA
  • Schellekens A
  • van den Brink W

Is Europe facing an opioid crisis like the United States? An analysis of opioid use and related adverse effects in 19 European countries between 2010 and 2018. The one important exception is Scotland, UK, which is reporting opioid-related overdose deaths similar to North America.3

  • Pierce M
  • van Amsterdam J
  • Kalkman GA
  • Schellekens A
  • van den Brink W

Is Europe facing an opioid crisis like the United States? An analysis of opioid use and related adverse effects in 19 European countries between 2010 and 2018. Many of the Commissioners’ recommendations are already a reality in most European countries. Furthermore, the role of widely implemented universal health care in Europe, including addiction care, is, in our opinion, underappreciated by Humphreys and colleagues. Universal health care has been a major factor in preventing an opioid crisis of US proportions across Europe for several reasons. First, universal health care provides access to appropriate care without high costs for the individual. This ensures that people never have to choose between high-cost (appropriate) care or cheaper (less appropriate) care such as, for example, a hip or knee replacement instead of chronic pain management with opioid painkillers. Second, European health-care systems are much more centralized than in the USA. In many European countries, general practitioners (GPs) are central to health care, important gate keepers to specialist care, and integrate all patient care. GPs thereby minimize fragmentation of care, resulting in fewer solitary sources of prescription opioids, subsequently preventing opioid diversion, development of iatrogenic opioid disorders, and opioid overdose deaths from prescription opioids. For example, 80% of opioids in the Netherlands are prescribed by a GP.5

  • Kalkman GA
  • Kramers C
  • van Dongen RT
  • van den Brink W
  • Schellekens A

Trends in use and misuse of opioids in the Netherlands: a retrospective, multi-source database study. in contrast, primary care physicians in the USA account for only a third of all opioid prescriptions. 6 Opioid prescribing by specialty and volume in the US Third, evidence-based addiction care covered by health insurance (including opioid substitution treatment) is more widely available in European countries than in the USA.3

  • Pierce M
  • van Amsterdam J
  • Kalkman GA
  • Schellekens A
  • van den Brink W

Is Europe facing an opioid crisis like the United States? An analysis of opioid use and related adverse effects in 19 European countries between 2010 and 2018. As Humphreys and colleagues state, availability of low-threshold addiction care is inevitable to counteract an opioid epidemic and lower opioid overdose mortality.

We strongly support the analyzes and recommendations by Humphreys and colleagues and would like to complement them with this European perspective, given the major differences in the opioid epidemic between the USA and Europe. The availability of universal health care in the broadest sense, including professional addiction care, is a cornerstone of European health-care systems and contributes greatly to preventing and tackling an opioid epidemic of US proportions.

WvdB reports personal fees for consultation and presentations from Camurus. All other authors declare no competing interests.

References

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    • Shover CL
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    Responding to the opioid crisis in North America and beyond: recommendations of the Stanford–Lancet Commission.

    lancet 2022; 399: 555-604

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    Explaining the differences in opioid overdose deaths between Scotland and England/Wales: implications for European opioid policies.

    Your Addict Res. 2021; 27: 399-412

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    • van Amsterdam J
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    Is Europe facing an opioid crisis like the United States? An analysis of opioid use and related adverse effects in 19 European countries between 2010 and 2018.

    Your Psychiatry. 2021; 64: e47

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    Monitoring opioids in Europe: the need for shared definitions and measuring drivers of opioid use and related harms.

    Your Addict Res. 2022; 28: 231-240

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    • Kalkman GA
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    Trends in use and misuse of opioids in the Netherlands: a retrospective, multi-source database study.

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Article Info

Publication History

Published: 22 October 2022

Identification

DOI: https://doi.org/10.1016/S0140-6736(22)01594-X

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© 2022 Elsevier Ltd. All rights reserved.

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