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

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Keywords: Europe; opioid crisis; opioid mortality; prescription opioids.

Figure 1.

Flow chart and map of participating European countries.

Figure 2.

PO consumption. Different scales are used on the Y-axis. In the case of missing data, the available data points were connected with a line. The data presented in tables and figures as 2008–2010 are from the 2011 INCB report, the data presented as 2010–2012 from the 2013 INCB report, 2012–2014 from 2015 INCB report, 2014–2016 from the 2017 INCB report, and 2016–2018 from the 2019 INCB report.

Figure 3.

Opioid-related hospital admissions. Different scales are used on the Y-axis. In the case of missing data, the available data points were connected with a line. The Y-axis refers to population age, for example, inhabitants aged ≥15 years. *Similar definition of data, all other countries different definitions (see Supplement D).

Figure 4.

Opioid-related overdose deaths. Different scales are used on the Y-axis. In the case of missing data, the available data points were connected with a line. The Y-axis refers to population age, for example, inhabitants aged ≥15 years. *There were a number of underreporting issues (see Supplement C).

Figure 5.

Opioid treatment admissions. Different scales are used on the Y-axis. The Y-axis refers to population age, for example, inhabitants aged ≥15 years. In the case of missing data, the available data points were connected with a line. *Limitations to data coverage resulting in underestimation (see Supplement C for more detailed explanation). (a) Only outpatient treatments recorded. (b) Overestimate: patients could be counted twice in the database if they received treatment at the same center more than once per calendar year. (c) Overestimate: all patients in treatment (not treatment admissions). (d) All patients hospitalized in psychiatric hospitals for opioid addiction. (e) Overestimate: all assessments for treatment.

Figure 6.

Patients in OST. Different scales are used on the Y-axis. The Y-axis refers to population age, for example, inhabitants aged ≥15 years. In the case of missing data, the available data points were connected with a line. (a) Underestimation due to nonregistration of all patients receiving OST. (b) Data excludes small number of patients receiving OST with suboxone. (c) An estimate based upon Community Health Index numbers captured on prescriptions. (d) Underestimate because patients prescribed buprenorphine through an independent DATA 2000-waivered medical practitioner or naltrexone through an independent practitioner not affiliated with a substance abuse treatment facility are not represented in the dataset.