Opioids are a type of narcotic medication that have become the basis of therapy for the treatment of moderate to severe pain in many developed countries, for instance, in cases of acute pain management, post-operative pain, and palliative care. In addition, some opioids are used in combination with counselling and behavioural therapies for the treatment of heroin and other opioid dependence. Opioid analgesic prescribing has steadily increased in the past years in OECD countries, and many patients are being treated with opioids for chronic non-malignant pain.
In parallel, opioids have been used as nonmedical drugs, creating illegal global markets where illicit opioids are increasingly commercialised. Both diverted prescription opioids (e.g. oxycodone, hydrocodone, morphine, fentanyl) and illicitly produced opioids (e.g. heroin, fentanyl analogues) are present in dynamic domestic and international trade networks, including on the surface web and darknet. Other illicit drugs (e.g. cocaine) are not part of the scope of the present paper, since the current crisis in some OECD countries involves opioids as the main substance of problematic use. However, it is important to note that polysubstance use is prevalent and that non-opioid drugs are sometimes contaminated with powerful synthetic opioids, such as fentanyl.
Growing use of opioids has rapidly escalated the use of health care services such as emergency consultations and hospitalisations. The number of overdose deaths has mounted to alarming numbers, creating the so-called ‘opioid crisis’, impacting Canada and the United States. Other OECD countries, such as Australia and some European countries are also experiencing a trend of rising opioid consumption and overdose deaths.
The purpose of this paper is to develop a comparative analysis of international strategies to address and prevent problematic opioid use, and their effectiveness in reducing/preventing opioid-related harm. The paper analyses the rates of problematic opioid use that OECD countries are facing and identifies the main drivers underpinning these rates. It also identifies best practices to address problematic opioid use in OECD countries. The paper presents data analysis on selected priority indicators, as well as the results of an extensive literature review and a short questionnaire addressed to countries.
This document is organised into four sections. Section 2provides a brief description of what opioids are and the main characteristics of opioid use. Section 3 explores the magnitude of the opioid crisis in OECD countries and the factors underpinning it. Section 4 presents a policy framework to guide actions to address the opioid crisis, along with existing evidence about their effectiveness and some examples of good practice in OECD countries. Finally, Section 5 highlights preliminary policy lessons for OECD countries.