Is the opioid crisis in the EU really less severe than in the US?

As drugmakers are being held responsible for fuelling the US opioid epidemic, it might look at though they have nothing to fear in Europe, where, it’s often assumed, opioid misuse isn’t so rampant. The EU, though, should take a closer look at the data and make its own move against the irresponsible marketing of opioid painkillers.

In its 2019 report, the European Monitoring Centre for Drugs and Drug Addiction, an EU institution, said with some pride that Europe had averted the kind of public-health disaster opioids have wreaked on the US by introducing “pragmatic harm reduction and treatment measures.” It’s more likely, however, that the EU is failing to collect and thoroughly analyse the same kind of data that provide US observers with a clear picture of the epidemic.

In July, the monitoring center published its latest data on drug-related deaths in Europe. They show that opioids are the drug group responsible for an overwhelming majority of such fatalities — but because it’s collecting data from 30 countries (EU member states plus Norway and Turkey), the monitoring centre has found it difficult to generalise statistics on which particular drugs are killing more throughout the continent. To get a better idea of what’s going on, one must dig into national data, which can often be confusing and unusable for cross-border comparisons.

That country-specific data often shows a clear trend toward more use of prescription opioids.

According to the European drug-monitoring centre, in Norway, heroin used to account for almost half of the drug deaths in 2006; in 2017 — the latest year for which data are available — its share was down to 20%, and synthetic opioids had emerged out of nowhere as the cause of 17% of deaths. The likely reason? A 279% rise in oxycodone prescriptions and a 218% increase in tramadol prescriptions to male patients between 2006 and 2016.

In the UK, a BBC investigation in 2018 found similarly alarming growth in opioid prescriptions between 2007 and 2017 — and an upward trend in opioid deaths.

Last week, a report in the venerable UK medical publication the Lancet showed the Netherlands had the same problem. There, the number of prescription opioid users nearly doubled to 7,489 people per 100,000 inhabitants between 2008 and 2017, mainly because the number of oxycodone users quadrupled. During the same period, the number of opioid-related hospital admissions tripled, with heroin mentioned less and less frequently as the primary intoxicant; and in 2014, the death rate from opioids started increasing.

Data from the UN’s International Narcotics Control Board show that while prescription opioid consumption is going down in the US, the world leader in their use, the same can’t be said about a number of European countries. Doctors there appear to have fallen into the same trap as their US counterparts, sold on the same drugs by the same pharmaceutical companies.

Levels of drug deaths in Europe aren’t as alarming as in the US (although there are some exceptions — Scotland, for one), in part because the continent’s smarter approach to replacement therapy and other forms of harm reduction has made sure there’s less heroin mortality. That tends to create a false sense of security. There’s a lag between consumption increases and growth in fatalities, and some European countries may well face visible epidemics of their own before regulators and politicians take notice, the way they have done in the US

Historically, doctors in most European countries have taken a more demanding stance on pain than their US colleagues: they haven’t been as ready to prescribe opioids. One reason for that is they haven’t come under as much pressure from activists insisting that pain relief is a human right. Prescription guidelines are tighter and more closely followed, and insurance companies are more hesitant to cover certain treatments. But when doctors respond to pharmaceutical companies’ marketing efforts, things start changing quickly: patients start demanding their opioid of choice, and doctors — who are often overloaded with work — find it harder and harder to refuse.

Europe shouldn’t feel excessively proud that it has avoided a US-style emergency. It’s time to unify standards for data collection and analysis to make it clear which countries face dangerous shifts in the way doctors handle pain. It’s also time to look at the European practices of the same pharmaceutical companies that are found guilty of overaggressive opioid marketing in the US Damage control should pre-empt, not follow, spikes in the fatality statistics.

• Bershidsky is Bloomberg Opinion’s Europe columnist. This column does not necessarily reflect the opinion of the editorial board or Bloomberg and its owners.

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