Is Europe on the verge of an opioid crisis?

Is Europe on the verge of an opioid crisis?
Is Europe on the verge of an opioid crisis?

Budapest, Hungary — Europe is far from being on the brink of an opioid crisis, according to research presented at the 32nd European Congress of Psychiatry (EPA 2024). Deaths from prescription opioid use are unrelated to the level seen in the United States.

A slight increase but no increase in mortality

By examining trends in the medical use and abuse of opioid painkillers over the past two decades, the Dr. Arnt Schellekens, a professor of psychiatry at Radboud University Medical Center in Nijmegen, the Netherlands, acknowledged that there had been a “slight increase” in opioid prescribing in Europe as a whole. However, this increase has not translated into an increase in the mortality rate in most countries.

Indeed, in a retrospective study published three years ago in European Psychiatry, Dr. Schellekens and colleagues reported that in 15 of 19 European countries examined, there was no indication of an opioid crisis comparable to that of the United States. The exceptions were the United Kingdom (Scotland, Northern Ireland and England/Wales) and Ireland, which had high rates of opioid-related adverse events.

Prescription opioid use in Europe varies widely, he told Medscape Medical News Dr. Schellekens, who is also Scientific Director of the Nijmegen Institute (Radboud University) and Research Director for the International Collaboration on ADHD and Substance Abuse consortium. “Health systems are so diverse. European countries have different problems to solve, and the simple injunction to stop consuming these drugs is “not a solution at all”, he added.

Caution is obviously required when considering the use of opioids, Dr. Schellekens continued. These medications are associated with a risk of dependence and the development of opioid use disorders. There is generally a good system of care in Europe for people who develop opioid-related problems, and such care is reimbursed in the Netherlands, Dr. Schellekens said.

“I am primarily concerned about the use of synthetic opioids, such as fentanyl and nitazenes,” he added. If they come onto the market, the problem could get worse.” Data he presented at EPA 2024 indicates that these drugs are increasingly being used instead of other drugs such as morphine, especially in the Baltic States. The problem with these drugs is that they are riskier in terms of addiction, complications and overdose, Dr. Schellekens said.

Inappropriate use

THE Dr. István BitterPhD, DSc, emeritus chair of psychiatry and psychotherapy at Semmelweis University in Budapest, said at EPA 2024 that he was “concerned” about the use of certain opioids “not because of the situation in Hungary, but because of the news we receive from other countries in Europe.

A colleague working in northern Europe told Mr. Bitter that oxycodone, a semi-synthetic opioid, was used to treat people with chronic back pain. But opioids would never be considered for this condition in Hungary, Bitter said. Additionally, prior oxycodone use may play a role in later misuse of outpatient prescribed benzodiazepines, Bitter observed.

Some have argued that it may be a gateway to substance abuse, Dr. Schellekens said. Although addiction to one drug or behavior can theoretically increase the risk of addiction to another substance, this is not necessarily the case. “If the change is done appropriately, there is no reason to think that the patient will end up having other problems,” Dr. Schellekens said.

Prevention is essential

Psychiatric disorders, pain, and problematic opioid use are associated with each other. The reasons for this association are complex, and researchers suggest that patients should be carefully screened before being prescribed opioids.

Despite this association, “psychiatric patients should not be deprived of adequate analgesia,” Dr. Schellekens said. It has been shown that patients with psychiatric comorbidity require higher doses of opioids to achieve an analgesic effect than patients without such comorbidity. The former therefore need a multidisciplinary approach to pain management.

Current recommendations help clinicians decide when and how quickly to taper opioids in patients who have developed an opioid use disorder. The use of psychoeducation and psychosocial support is an integral part of opioid tapering. Data also shows that incorporating buprenorphine in place of the misused opioid may help some patients.

In summary, long-term use of opioids for chronic pain has no place in the treatment of patients with psychiatric comorbidity, Dr. Schellekens said. “On the other hand, there are people who have already increased their opioid use. In this case, you should not simply stop treatment. Instead, you need to build trust with the patient, write a taper plan and timeline, and work together to get it done. »

Drs. Schellekens and Bitter have disclosed no relevant financial relationships.

This article was translated from Medscape US edition using several editorial tools, including AI, in the process. The content was reviewed and supplemented by the editorial staff before publication.

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