Epidemiology

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GeneesmiddelenverslavingPublished by: Domus Medica | SSMGLast published: 2011Assuétude aux médicamentsPublished by: Domus Medica | SSMGLast published: 2011

Opioid use disorder remains a significant and rapidly evolving public health concern worldwide, as opioids account for two-thirds of drug-related deaths.[4] The number of opioid users worldwide has nearly doubled since 2010.[4] As of 2022, there were approximately 60 million people worldwide who used opioids, 30 million of whom used opiates (mainly heroin).[4]

​In the US, the number of opioid prescriptions began to expand significantly in the 1990s, driven by multiple factors such as: aggressive marketing, increased clinical focus on pain management, and the launch of a sustained-release formulation of oxycodone.[5] Prescription of opioids for acute and chronic pain, and subsequent opioid use disorders, quickly became widespread, establishing an opioid crisis.[5] This was followed by a resurgence of the heroin market in around 2010, driven by an increase in demand from people addicted to prescription opioids.[6] A third wave of the crisis began in 2014, characterised by further increases in addiction and fatal drug overdoses linked to synthetic opioids such as fentanyl.[6] Subsequently, there has been an estimated 95% decrease in opium poppy production between 2022 and 2023 in Afghanistan. This production change will likely have a global impact on opioid markets, potentially causing an increased demand for alternative substances.[4]

Trends in opioid use disorder prevalence in the US are difficult to assess due to limitations in direct survey data. Using multiplier methods to adjust for underreporting, estimates suggest that opioid use disorder prevalence increased from 2010 to 2014, then stabilised and slightly declined each year until 2019.[7] This is potentially related to the implementation of stricter prescribing regulations. In 2022 an estimated 3.7% of adults in the US needed treatment for opioid use disorder; of these, 25.1% received pharmacotherapy and 30.0% received treatment for opioid use disorder without pharmacotherapy.[8]

The US has experienced a 24-fold increase in opioid-related deaths since 2010, driven largely by increases in potent illicitly-manufactured types of fentanyl.[9] The rate of overdose deaths in the US involving synthetic opioids increased by 64% between 2019 and 2022, although between 2022 and 2023 there was a slight decline.[10] Opioid-related deaths have increased at higher rates among black Americans.[11]​​​​​​

​Studies prior to 2016 estimated that over 25% of opioid-related deaths in the US also involved benzodiazepines.[12][13][14]​​​ Updated US Centers for Disease Control and Prevention guidelines advising against concurrent opioids and benzodiazepines led to a decrease in co-prescription; however, whether this translates to a decrease in mortality is not yet clear.[14] Co-use of synthetic opioids, such as fentanyl, with other central nervous system depressants, including animal tranquilisers such as xylazine and medetomidine, is an emerging and concerning trend in the US that further complicates the ongoing crisis of opioid-related overdose deaths.[15][16][17]

​​​​​In Europe, opioid usage has remained fairly stable since 2016, with a prevalence of 0.3% reported in the European Union (EU) in 2022.[18]​​ Heroin remains the dominant illicit opioid used in Europe; synthetic opioids such as fentanyl are currently less prevalent than in the US, although are becoming an emerging problem in some locations.[18]​ In Africa, non-medical use of tramadol is a growing concern, with over 90% of global tramadol-related seizures occurring there.[4]​ In South-West Asia, opioid use is high, with an estimated 3.2% of adults using opioids in the past year. Opiates such as heroin (in Pakistan and India) and opium (in Afghanistan and Iran) are the main substances misused, though non-medical use of pharmaceutical opioids is also substantial.[4]​ Nitazenes, synthetic opioids which have since 2019 appeared on the illegal drugs market in some parts of the world (Asia, Europe, North America, Oceania, and South America), pose an emerging threat to public health due to their extremely high potency.[4]​ In parallel with increasing worldwide prevalence among the general population, an increase in opioid use has been observed in pregnancy.[19]​ In 2022, approximately 14.1% of women reported the use of prescription opioid analgesics during pregnancy, with 1 in 5 of these reporting misuse.[20]​​[21]​​​ Frequency of opioid use during pregnancy in Europe, Canada, and Australia is around 5%.​[22]​​

Many people with opioid use disorder use needles to administer opioids, resulting in infectious complications, including hepatitis B and C and HIV.​[23]

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