In 2017, the BBC published an article that wondered aloud why opioids are “an American problem.” Is it true? Is opioid addiction so unique to the U.S.?
The statistics don’t lie. People in the U.S. take almost 50,000 doses of prescription opioids per million people per day, which is four times the rate of use in the UK. What’s more, the common explanations as to why Americans use opioids at such a high rate don’t explain the issue fully: chronic pain is not unique to the American population, and several European countries have populations aging faster than the U.S.
What has prevented the UK and the European Union from facing a similar fate as the Americans? The evidence suggests that the answer is systemic — on both sides of the Atlantic.
Strong Social Healthcare Aids Pain Management Programmes
In the UK and across Europe, the vast majority of healthcare is paid for by the public purse. The only justification required for a procedure is that a patient’s physician deems it medically necessary. The same is not true for Americans, and it is a product of their healthcare system.
Americans rely heavily on the privatized insurance and healthcare industries. Insurance companies require justification for every point on the itemized bills they receive. As such, Americans rely on opioid pills not because opioids are more clinically effective, according to Professor Judith Feinberg of the West Virginia University School of Medicine in the BBC article noted above, but often because their insurance won’t pay for physical or occupational therapy.
Across the EU, chronic pain patients enjoy a wide range of pain management programs (that vary significantly by country) that leave opioids as a last resort only for short-term use after significant surgeries and among cancer patients. Because these programs fall under the national healthcare service, there is no reticence on behalf of GPs when prescribing them to patients. In short, both GPs and patients have both more resources and lower barriers to access, which leads the system away from a reliance on the quick fix offered by opioids.
European Governments Limit Access to Opioids
A culture and healthcare system that doesn’t consider opioids as a primary form of pain management goes a long way in limiting the number of prescription painkillers in our homes. However, the EU and its member state governments also pick up where the culture leaves off.
Even if GPs in the UK and EU wanted to prescribe opioids more widely, they can’t. The laws governing these prescriptions are described as “unnecessarily strict.” For example, German physicians can provide a prescription for a narcotic, but it is only valid for seven days. In Italy, Poland, and Portugal, physicians must travel to a regional office to get the forms used to prescribe opioids. Portuguese doctors must also pay an extra fee for those forms. These regulations make certain that even if GPs might want to prescribe opioids, they must jump through several hoops to do so, which requires further justification.
It is safe to say that this is not the case in the United States, where ethical prescribing has long been an issue. Not only are American GPs allowed to prescribe opioids as they see fit, but they are under a constant barrage of lobbying by opioid manufacturers. In 2016, drug and device companies handed out $8 billion in gifts to GP practices and teaching hospitals. Purdue Pharma (the manufacturer of OxyContin) gave away $7 million across 80,000 transactions. Studies have found that receiving freebies increased doctor’s prescription rates. The amount paid in total in the UK in 2016 (£116m) was less than 2% of the total amount paid in the U.S. in the same period.
European Health Systems Tackle Addiction Differently
All this is not to say that European countries do not struggle with opioid and opiate addiction. In Britain, we understand the impact of heroin on our friends, neighbors, and society. The heroin injection issue in Scotland, and in Glasgow particularly, has not only gone on for decades but is now presenting new challenges as users mix heroin with other drugs, like benzodiazepines, which has seen a spike in overdose-related deaths. Indeed, while our issues do not always begin with prescriptions like Vicodin, Europeans are struggling with other types of addiction, including codeine.
What’s more, the 2019 European Monitoring Center for Drugs and Drug Institution report found that while Europe has avoided a disaster of the same scale, there’s still a risk. Both issues with data collection and a recent spike in opioid prescriptions could cause an epidemic to sneak up on regulators, similarly to the way it did in the U.S.
However, even then, Europeans are still at an advantage as national healthcare programs cover rehabilitation and addiction services, despite being underfunded. These services are sorely missing from the U.S., where state funding for treatment varies by state and many people rely on their private insurance plans. Moreover, addiction treatment is booming nationally and it’s simultaneously under-regulated, which means patients can spend thousands on rogue care providers who participate in unethical and even dangerous behaviors.
European countries have prevented an opioid epidemic at the scale of the U.S., but ultimately, it is important to remember that those measures have not made us immune to it. It is important for Europeans to continue to fight for non-opioid-based pain management systems as it is for the public health systems that allow us access to the treatment we need — without undue influence from the private insurance industry.
