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Opioid Use Beyond the United States

Opioid Use Beyond the United States

The pattern of opioid use varies significantly across the globe.
There are notable differences not only in the volume of prescription opioid consumption but also in the types of opioids commonly used.
Today, we will focus on the abuse of these potent prescription drugs outside the United States, though it’s impossible to ignore the severity of the problem within the U.S. itself.
According to the CDC (Centers for Disease Control and Prevention), 130 Americans die every day from opioid overdoses. Between 1999 and 2017, opioid-related deaths increased sixfold, leading to the opioid crisis being declared a public health emergency in the U.S.
To fully understand opioid use outside of the United States, one statistic stands out:
Despite comprising less than 5% of the global population, U.S. residents consume 80% of the world’s opioid supply, with 99% of all hydrocodone being used in the U.S.
While these numbers highlight a U.S.-centric problem, how does opioid use look in the rest of the world?
Before diving into this further, let’s briefly review what opioids are and how misuse can escalate into full-blown opioid use disorder.

Understanding Opioid Use and Abuse

The term “opioids” refers to a class of medications commonly used as pain relievers. While heroin is also an opioid, it is typically excluded from most studies on opioid use due to its illegal status and is treated separately.
Today’s focus is on synthetic opioids, which include:
  • Codeine
  • Fentanyl
  • Hydrocodone (Vicodin)
  • Methadone
  • Morphine
  • Oxycodone (OxyContin)
  • Pethidine
  • Tramadol
Opioids work by altering the brain’s perception of pain, acting on opioid receptors in both the brain and nerve cells throughout the body.
While highly effective when used as prescribed, physical dependence on opioids can develop quickly. If this dependence escalates into addiction, the path to recovery becomes challenging.
For long-term treatment of chronic pain, opioids are less effective. Tolerance develops rapidly, requiring higher doses to achieve the same level of pain relief. Once tolerance sets in, discontinuing use can trigger withdrawal symptoms, even when opioids are used as directed.
At this stage, opioid use disorder can easily take hold.

Opioid Use Disorder

Opioid use disorder occurs when opioids are used with the intent to get high or to avoid withdrawal symptoms. This disorder can manifest in various ways, such as taking higher doses than prescribed, using opioids for non-prescribed reasons, lying to obtain prescriptions, or trading medications with others. Regardless of how it presents, opioid use disorder has devastating consequences for the individual and their family.
Fortunately, despite the severity of opioid addiction, it can be successfully treated. With approaches like medication-assisted treatment and therapies such as CBT (cognitive behavioral therapy), recovery is highly achievable for those who take action.
Now that we’ve covered the basics, how did we reach a point where opioid abuse is a global crisis, affecting not just the U.S. but the rest of the world?

How the Opioid Crisis Began

In the 1990s, American pain specialists and advocacy groups raised concerns about an epidemic of untreated pain. Encouraged by the American Pain Society, both consumers and medical professionals started advocating for the broader use of opioids for pain management.
At the same time, OxyContin (oxycodone) was introduced and aggressively marketed. Its addictive potential was downplayed, and prescriptions were heavily incentivized, igniting the opioid epidemic.
This wasn’t just a strategy for boosting U.S. sales of OxyContin. Between 1996 and 2012, global sales surged from $48 million to over $2.4 billion.
While the U.S. has been at the epicenter of the crisis, the problem has spread worldwide.
Before examining opioid use across different continents, it’s important to take a broader look at the global scope of the issue.

A Brief Overview of Global Opioid Use

In the 2018 World Drug Report released by the UNODC (United Nations Office on Drugs and Crime), opioids were responsible for 76% of all drug-related deaths.
A few years prior, 87 tons of pharmaceutical opioids were seized, a quantity comparable to the heroin confiscated globally in 2016.
Prescription opioid abuse has been identified as a significant issue in Canada, Europe, and Australia.
While fentanyl—up to 100 times more potent than morphine—remains a major concern in North America, tramadol is emerging as a significant problem in parts of Africa and Asia.
So, what’s causing the tramadol crisis outside the United States?

Tramadol Use: Africa and Asia

According to the UNODC, global abuse of synthetic opioids is rising, with the non-medical use of tramadol highlighted as an urgent issue receiving insufficient attention.
As opium production declines, seizures of the opioid tramadol have surged. In 2010, less than 10kg of tramadol were seized worldwide. By 2013, this had increased to 9 tons, and by 2017, seizures reached a staggering 125 tons.
The tramadol crisis is particularly severe in Africa and India.
In several West African countries, tramadol is second only to marijuana in non-medical drug use. Beyond pain relief, it is used for its calming effects, to combat fatigue, and as an appetite suppressant. Tramadol’s stimulant and euphoric properties make it popular for recreational use, and in some communities, it is even given to cattle to help them work in harsh conditions.
In Cameroon, 80% of car accidents resulting in hospital visits are linked to tramadol. In some African nations, tramadol-related deaths now surpass those caused by heroin.
While Africa is consuming more tramadol, India is the primary source of production. Over 1 billion tramadol tablets were seized leaving India last year, according to the Center for Strategic and International Studies. As always with drug seizures, the actual export numbers are likely much higher.
Tramadol shipments from India travel via commercial shipping routes, and supply chains have been linked to terrorist organizations like IS and Boko Haram. With Libya as a key distribution hub, the drug has also spread throughout the Middle East. India also exports tramadol through Southeast Asia. Since tramadol is not on the international drug schedule, regulating the supply is difficult if only one country enforces restrictions. While Egypt has made efforts to control tramadol use, Indian exports to Egypt increased, and it remains the most abused drug in the country.

Why hasn’t India regulated tramadol or other dangerous opioids?

The issue stems from India’s complex approach to addiction. While the government acknowledges the growing tramadol crisis, widespread corruption exacerbates the issue. Transparency International ranked India as having the highest bribery rates in the Asia Pacific region, further fueling the opioid trade.
Without international regulation and cooperation, the problem will likely worsen, highlighting the need for stricter controls and collaborative efforts.

Oxycodone Use: Europe

In Scandinavian countries such as Norway, Sweden, and Denmark, prescriptions for oxycodone—a powerful painkiller—are rising significantly. In 2012, over one in seven Americans had been prescribed this medication, and now its use is increasing in these Nordic nations.
Despite strict pharmaceutical regulations and restrictions on marketing to doctors, the aging population in these countries is driving demand for pain relief. While this trend may seem benign initially, it raises concerns about whether these nations are on the path toward an opioid crisis similar to that of the U.S. Outpatient prescriptions for oxycodone have already tripled in the last decade, a troubling sign.
Ashley Elizabeth Muller from the Norwegian Institute of Public Health warned against underestimating the issue in Norway, stressing that the country should not become complacent. The rise in oxycodone prescriptions suggests that the opioid crisis seen in the U.S. could become relevant in Norway as well.
Meanwhile, Germany ranks second after the U.S. in daily opioid consumption, with fentanyl being twice as likely to be prescribed as other opioids. Fentanyl is not only cost-effective but also convenient to administer via patches, which contributes to its widespread use.
While we can’t cover every country in detail, let’s briefly touch on opioid use in Latin America before exploring potential solutions to this global epidemic.

Opioid Use: Latin America

Following the U.S. declaration of an opioid crisis in 2017, pharmaceutical companies turned to Latin America to compensate for lost sales.
Though the nature of the opioid problem is similar, the specifics vary across the region. In countries like Mexico and Guatemala, there are no reported cases of opioid misuse, despite the presence of poppy cultivation. Colombia and Argentina also report low levels of opioid use, with only 1.8% of those prescribed opioids meeting the criteria for opioid use disorder. However, the reliability of data remains questionable, and misdiagnosis is common.
In Puerto Rico, opioid misuse is notably higher than in other parts of Latin America. Here, the abuse of opioids stems both from legally prescribed analgesics and drugs sourced on the black market.
Tramadol and morphine are the most frequently used opioids in Latin America, as opposed to oxycodone, which dominates in the U.S. That said, the use of oxycodone is on the rise, along with an increase in the use of synthetic opioids like fentanyl.
Given the inconsistent data, this snapshot of opioid use in Latin America provides only a glimpse of the problem, but it’s clear that action is needed to address the issue. The same is true globally, so how can we effectively tackle the opioid crisis?

Solutions to the Global Opioid Epidemic

The UNODC (United Nations Office on Drugs and Crime) has introduced a comprehensive strategy aimed at tackling the synthetic opioid crisis both within and beyond the U.S. This approach is built around five key pillars:
  1. Early warning and trend analysis
  2. Addressing non-medical opioid use
  3. Prevention and treatment
  4. Disrupting trafficking networks
  5. Promoting international cooperation
The success of this strategy will unfold over time, but it provides a framework for addressing the global opioid epidemic.
Countries like Canada, Europe, and Australia have implemented prescription monitoring programs, although their outcomes have yet to be fully evaluated. In the U.S., similar programs have already shown promising results.
It’s important to remember that treating both acute and chronic pain remains essential. Continued research into effective pain management and the reduction of misinformation are critical steps forward.
Equally important is maintaining high standards of care for those in pain, while ensuring that opioids are only prescribed when absolutely necessary.
For individuals struggling with opioid abuse, help is available. Sunrise Recovery in Clarksville, Indiana provides comprehensive care, including residential treatment, medical detoxification, and intensive outpatient programs. If you’re ready to begin the path to recovery, contact our admissions team today.
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