Addressing Problematic Opioid Use in OECD Countries
Over the past few years, Canada and the United States have been experiencing an opioid
crisis as a result of problematic opioid use fueled by the emergence of synthetic
opioids such as fentanyl and carfentanil. Problematic opioid use is also spreading
in other OECD countries, due to the upward trend of prescription opioid use and the
complexities of the illegal drug supply. This report presents evidence on the magnitude
of problematic opioid use across OECD countries, describes the main drivers, and identifies
a set of policy actions to address them. The report highlights the opioid crisis as
a complex public health issue that requires a comprehensive approach across all sectors,
including health, social services, and law enforcement. Strong health information
systems are also needed, particularly data and research. Preventing problematic opioid
use requires a combination of policies that ensure more information is provided to
patients and health care practitioners, while providing access to appropriate pain
management treatment for patients. A public health approach to problematic opioid
use must incorporate socio-economic considerations (e.g. employment and housing),
which also need to be addressed to prevent problematic substance use in general.
In 25 OECD countries for which data are available, the average of opioid-related deaths (ORD) has increased by more than 20% in 2011-2016, with the rise most pronounced in the United States, Canada, Sweden, Norway, Ireland, and England & Wales.
The average availability of prescription analgesic opioids has been steadily growing in the past 15 years across the OECD. There was a boom in the last decade. Between 2002-04 and 2005-07, analgesic opioids availability grew on average by more than 58% and almost 110% in the decade. More recently, between 2011-13 and 2014-16, the growth rate dropped to around 5% on average.
Opioid overprescribing is considered one of the most important root causes of the crisis. In the United States alone, there were 240 million opioid prescriptions dispensed in 2015, nearly one for every adult in the general population. The influence of pharmaceutical manufacturers on pain management has been considered significant, by conducting marketing campaigns targeted mainly at physicians and patients, downplaying the problematic effect of opioids.
Illicit opioids constitute a significant product of international illicit trade. Heroin is a semi-synthetic opiate synthesised from morphine and is the most prevalent illicit opioid worldwide. Approximately twice as potent as morphine, heroin has a high potential for problematic use. In recent years, fentanyl and fentanyl analogues have become much more prominent in the illicit drugs scene in many countries.
The opioid crisis is not only a health crisis. It also has social and law enforcement dimensions. Economic and social conditions, such as unemployment, housing, exclusion and stigma are also linked to the issue.
Countries can consider four key areas for a better approach to dealing with opioid use and harms: better prescribing practices and opioid-related literacy; better care expanding access to treatment and harm minimisation interventions; better approach across the health, social and criminal justice systems; and better knowledge and research for supporting decision-making at all levels.