Spooked by North America’s deadly opioid epidemic, Europe is waking up to the signs that abuse of pain medication is rising.

The EU’s drugs monitoring agency on Thursday warned that synthetic opioids are a “growing concern” in Europe.

One in five people entering drug treatment facilities for an opioid-related problem “now reports a synthetic opioid, rather than heroin, as their main problem drug; and these drugs are becoming more commonly detected in drug overdose cases,” says the report from the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA).

Although Europe is not yet experiencing the crisis that has caused thousands of deaths in the U.S. and Canada, it’s a sign that the Continent cannot remain complacent about opioid abuse.

Belgium, Finland and the U.K. have in recent months issued new guidelines for doctors on prescribing opioids-based medicines in an effort to stop a similar development taking hold in their countries.

"We can give opioids in acute ways, but we have to avoid the long-term use or the overuse” — Jan van Zundert, anesthesiologist at the Hospital Oost-Limburg

Opioids are a class of drugs that produce feelings of pleasure and pain relief. They include illegal substances, such as heroin, but also codeine, oxycodone, fentanyl, buprenorphine, methadone, morphine and tramadol, which are found in medicines prescribed by doctors to manage severe pain. They were initially used for cancer patients battling pain toward the end of their lives, but their prescription has since been extended to manage other types of pain.

Synthetic opioids that are usually prescribed as medicines appear to be playing an increasing role in the drug problem in many parts of Europe, the EMCDDA report says. The report points to fentanyl as a problem drug in Estonia, buprenorphine in Finland and the Czech Republic and methadone in Germany and Denmark.

It says that 11 new synthetic opioids were detected in 2018, including six new fentanyl derivatives. Since 2009, there have been 34 fentanyl derivatives detected in Europe, the EU agency says.

In Belgium, health insurance organizations’ reimbursement of opioids-based pain medication has increased by almost a third between 2010 and 2017, according to a recent report by Belgian health care payer INAMI, cited by broadcaster RTBF.

“We're learning from what's happening in the U.S.” — Bart Morlion, director of the Leuven Center for Algology and Pain Management at the University Hospital Leuven

General practitioners prescribe such medication most often, the report said. It advised doctors not to prescribe them too quickly and to regularly re-evaluate their use when they do.

That’s what Jan van Zundert, an anesthesiologist who heads the pain centre of the Hospital Oost-Limburg in the Belgian town of Genk, has been doing. “I prescribe it for cancer patients, but I try to avoid it for non-cancer pain. We can give opioids in acute ways, but we have to avoid the long-term use or the overuse,” he said.

While for cancer pain, prescription opioids are still considered the gold standard, they are not a magic bullet for managing chronic pain in general, he said.

In Europe, the weaker opioid tramadol is used more frequently, while in the U.S. powerful opioids like fentanyl and oxycodone are fueling the current epidemic, according to van Zundert.

In Finland, which has seen a rise in oxycodone prescription, the social insurance authority will send out letters to some 7,000 doctors and dentists this summer urging them to be cautious when prescribing strong opioids due to the risk of addiction, Yle reported.

In Britain, powerful painkillers will have to carry addiction warnings, Health Secretary Matt Hancock announced in late May. He said he is concerned “by the recent increase in people addicted to opioid drugs.” A 2018 BBC investigation showed that GPs in England prescribed 23.8 million opioids-based painkillers in 2017, 10 million more than a decade earlier.

The U.K. is not among the countries with the highest availability of prescription opioids, however. In the EU, those were Germany, Austria, Belgium, Denmark, the Netherlands and Spain, the OECD said in a report last month, which was based on 2014-2016 data.

“At the moment, we have less of a problem than the U.S. We’re at an earlier stage and we have to be very watchful,” said Bart Morlion, the director of the Leuven Center for Algology and Pain Management at the University Hospital Leuven in Belgium.

Morlion — who also serves as president of the European Pain Federation, which represents health care workers in the field of pain medicine — said that there was now a greater awareness of the risk of addiction than a few years ago.

“We're learning from what's happening in the U.S.,” he said.

Jillian Deutsch contributed reporting.

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