The US Opioid Crisis: Extent, Causes, Counter-Measures and the European Situation in Comparison

Opioid abuse and overdose deaths are at crisis levels in the USA. More than 47,000 Americans died of drug overdoses involving opioids in 2017 and lethality continues to stay on a high level, because synthetic opioid (e.g. fentanyl derivates) use has increased significantly during the last 5 years. Several measures have been proposed to tackle the crisis including prescription drug monitoring programs, abuse-deterrent opioid formulations, cognitive behavioral and medication-assisted therapies, and naloxone distribution to treat opioid overdose, with limited success. In comparison, several countries in Europe had an increase in opioid prescription during the last decade. However, lethality due to opioids is significantly lower than in the USA. Reasons for these differences may be due to different marketing permits, prescription rules (e.g. German Guidelines on LONTS long term opioid use in non-tumor pain, update 2019) and better results in quality measures. In the US focus on pain rather than treatment of psychosocial stress facilitate opiod prescription. Finally, MAT/OAT (medication or opioid assisted treatment) may be more frequently and comprehensively available in many European countries compared to the US, in particular in rural areas.