Opioid use: “more controlled” in Europe than in the US

Opioids are powerful painkillers derived from opium, such as tramadol, morphine or codeine, which are prescribed for severe problems, generally for cancer. They are also present in some drugs such as heroin. [Steve Heap/Shutterstock]

The consumption of opioid painkillers increased in Europe during the COVID-19 pandemic. Is this enough to signal the risk of an opioid crisis similar to the one in the United States? Not really, experts say.

“Doctors working in Europe are informed about the precautions to be taken when prescribing and dispensing opioids, but also about how to avoid withdrawal and dependence,” the European Medicines Agency (EMA) explained to EURACTIV France.

To minimise the risks that may be associated with the use of opioids by patients, “educational materials should be made available to health professionals and patients,” the EMA added.

Opioids are potent painkillers derived from opium. They include tramadol, morphine, and codeine, which are commonly prescribed for trauma injuries, or for pain relief with diseases such as cancer. Heroin, an illegal and highly addictive drug, is also derived from opium.

“We haven’t found a better painkiller for severe pain,” said researcher Remy Sounier, co-author of a study on side-effect-free opioids.

US vs EU

According to the WHO, the number of people who died from opioid overdose in the United States increased by 120% between 2010 and 2018, with 93,000 deaths in 2020.

Although an “increase in the use of painkillers since the COVID-19 crisis” has occurred in Europe, it’s a far cry from the U.S. opioid crisis, Sournier said.

Asides from educational materials, more regulated access to drugs helps limit the risks of overdose and addiction. Professionals agree that addiction is an extremely complex issue to treat.

“They are prescribed in Europe in a more controlled way than in the United States, where there was a sales campaign, a pharmaceutical company that lobbied, doctors that were getting bonuses,” added the researcher in an interview with EURACTIV France.

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“An opioid crisis is possible in Europe too”

According to the researcher, even though the risks seem less severe, they should not be discarded completely.

“We shouldn’t think that because we have prescriptions in Europe, this problem doesn’t affect us. This problem can happen,” emphasised Sounier, who has seen an increase in painkiller use since COVID-19. “We can have an opioid crisis in Europe too,” he added.

The decline can happen quickly; “In France, there are still risks. For example, tramadol is prescribed as a painkiller. The problem is that when you continue to feel pain and you increase the dose, you may not be able to control the ensuing dependency”.

“This is the biggest risk. If one wants to continue, they will use stronger or illegal molecules. From there, we enter a societal crisis”, he added.

To keep control of these drugs, the EMA relies on Periodic Safety Update Reports (PSURs), which analyse the safety of a drug worldwide “at a defined point in time after its authorisation”.

“A single evaluation of PSURs is carried out at EU level, regardless of the authorisation process ( be it national or central),” the European Medicines Agency reported.

EMA scientists, in collaboration with the responsible member state, evaluate the information contained in the PSURs to “determine whether the benefit-risk balance has changed and whether updates to the marketing authorisation are required.”

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Illicit opioids

“The illicit market is very dynamic and adaptive. If opioid synthetics are available on the darknet in the US, they are also available in Europe,” Thomas Seyler from the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) told EURACTIV.

In 2019, 5,000 deaths were caused by drug overuse in the EU. “Most of these deaths are due to opioids, and the majority are due to heroin,” says Seyler, before pointing out that “we are far from the American crisis.”

Heroin is the most common opioid killer in Europe, while in the U.S. it is more potent opioids, such as Fentanyl. People treated for heroin-related problems accounted for just under 14,000 in 2019 in Europe.

“The trend is pretty stable or declining. We are not in a major epidemic phase. But we have to keep in mind the limitations of these indicators,” comments Seyler. The illicit nature of this type of opioid makes statistics more difficult to obtain.

To fight this scourge, in December 2020, the Council approved the EU Drugs Strategy (2021-2025), reinforced by an action plan dated June 2021, with the main objective of “reducing supply and demand”.

Even if we must remain “vigilant”, “we can be satisfied with the European approach, which is realistic and balanced”, Thomas Seyler concluded.

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