Opioid crisis: Only a US phenomenon?

Addiction to prescription opioids has reached a crisis level in the United States. Now the drug is causing concern across the Atlantic. Researchers from Denmark, Norway and Sweden urge caution after discovering that prescriptions for the pain medication oxycodone have significantly increased during the last decade.

The opioid crisis in the United States shows no sign of abating. On average, 130 Americans die of opioid overdoses each day. The abuse of prescription drugs, such as the pain medication oxycodone, cause the majority of these deaths. A pain relieving drug, oxycodone, is prescribed frequently to alleviate moderate to severe pain. Heavily marketed to doctors in the United States, the dangers of this strong painkiller were downplayed, which led to a significant rise in usage. In 2012, more than one in seven Americans had a prescription for oxycodone.

In Denmark, Norway and Sweden the pharmaceutical industry is subject to stringent regulation and marketing to doctors is strictly limited. However, with ageing populations, reports show these countries have some of the highest rates of chronic non-cancer pain in the world. As a result, the demand for prescription opioids has risen significantly, raising the question of whether the Nordic countries could be headed towards an opioid epidemic like the United States.

To investigate this issue, researchers from each of the three countries analyzed twelve years of opioid prescription data. Their research is presented in the article "Prescribed opioid analgesic use developments in three Nordic countries, 2006-2017" by Ashley Elizabeth Muller, Thomas Clausen, Per Sjøgren, Ingvild Odsbu, and Svetlana Skurtveit, published in De Gruyter's journal Scandinavian Journal of Pain.

The study focused on outpatients only, excluding drugs administered in hospitals and nursing homes. The intention was to capture people more likely to be receiving opioids for non-cancer pain, rather than at the end of their lives or following surgery or other trauma.

The researchers established that oxycodone prescriptions are on the increase in all three countries. In Sweden, the number of people with an outpatient prescription for oxycodone has more than tripled since 2006.

In recent years, Norway liberalized the regulation of opioid prescriptions for chronic non-cancer pain and the study showed that one in eight Norwegian women and one in eleven Norwegian men received a prescription opioid outside of a hospital in 2017. In addition, forensic analysis shows that prescription opioids are increasingly involved in deadly overdoses.

The authors posit that it is crucial to avoid overdose deaths caused by prescription opioids and that their use should be curtailed.

"As a general rule, these strong prescriptions should not be used for chronic non-cancer pain," says study author Ashley Elizabeth Muller from the Norwegian Institute of Public Health. "It's easy to get complacent and think the United States is so different, so their situation isn't applicable to us. Yet oxycodone is prescribed more and more."