Is America’s opioid epidemic coming to Europe?

American politicians and scientists are issuing strident warnings to policymakers in Europe and around the world, urging them to prevent an epidemic of opiate addiction like the one that has killed more than half a million Americans in 15 years.

A letter signed by 12 members of US Congress to the World Health Organisation in May emphasised the responsibility of Purdue Pharmaceuticals and its arm abroad, Mundipharma International.

Mundipharma’s headquarters are in Cambridge, England. It has a second base in Singapore, where employees are urged to think of Mundipharma as “the Google of the pharma industry”.

“We write to warn the international community of the deceptive and dangerous practices of Mundipharma,” the congressmen and women said. “The greed and recklessness of one company and its partners helped spark a public health crisis in the US that will take generations to repair.”

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The number of US deaths by drug overdose last year surpasses the combined deaths of the Vietnam and Iraq wars

The synthetic opioid painkiller OxyContin has earned $35 billion in 20 years for Purdue, which is privately owned by the Sackler family, one of the richest families in the US.

“Purdue began the opioid crisis that has devastated American communities since the end of the 1990s,” the Congressmen and women charged. “Today, Mundipharma is using many of the same deceptive and reckless practices to sell OxyContin abroad.”

Those practices include training seminars to encourage doctors around the world to prescribe opioid painkillers, and publicity campaigns to convince members of the public that they need treatment for chronic pain.

Drug that killed Prince

At present the US, with 5 per cent of the global population, consumes 80 per cent of the world’s opioids. The crisis has cost the US an estimated $80 billion. Some 90 Americans die daily from opioid overdoses.

In 2012, the peak year of legal sales, US doctors wrote more than 282 million prescriptions for opioid painkillers. As Forbes magazine notes, that's enough for every American family to have a bottle in their medicine cabinet.

Many heroin addicts started with prescription opioids such as OxyContin. As the US cracked down on painkillers, users turned to heroin and the synthetic opioid fentanyl, which killed the pop star Prince.

Drug traffickers reacted to the widespread legalisation of marijuana by flooding the US with heroin and fentanyl at a fraction of the cost of prescription opioids. Heroin and fentanyl are now marketed as party drugs for US teenagers in miniature plush toys.

The reality of chronic pain and the lack of investment in nonaddictive pain relievers mean Europe, too, is vulnerable

The number of US deaths by drug overdose last year – 62,497 – is 50 per cent higher than deaths by road accident and 4½ times that of death by firearms. It surpasses the combined deaths of the Vietnam (58,000) and Iraq (4,500) wars.

On July 29th the world's leading medical journal, the Lancet, warned that "legally produced pharmaceutical opioids were the origin of the [American] epidemic and still provide much of its fuel . . . The rest of the world should learn from North America's mistakes."

Inappropriate marketing

As early as 2003, the US Drug Enforcement Agency condemned Purdue’s “aggressive, excessive and inappropriate” marketing of OxyContin. In 2007, Purdue paid $635 million in damages when a federal court concluded it had overstated the benefits and understated the risk of addiction to Oxycontin.

Europeans have long thought themselves immune to the opioid crisis, because pharmaceutical companies are not allowed to advertise directly to consumers, and because social safety nets blunt the poverty and despair that foster drug abuse.

In the 1980s, Chinese officials told the Oxford epidemiologist Richard Peto that Chinese people were "genetically immune" to lung cancer. In fact, they had merely started chain-smoking later, so their lung cancer struck later.

Dr Garret FitzGerald, the Irish chair of systems pharmacology at the University of Pennsylvania, says Europeans may be deluding themselves in much the same way as Peto’s Chinese interlocutors.

FitzGerald participated in the Federal Drug Administration study on Pain Management and the Opioid Epidemic, published by the National Academy of Medicine in July, and co-wrote an article on pain research in Science magazine in March.

The reality of chronic pain and the lack of investment in nonaddictive pain relievers mean Europe, too, is vulnerable, FitzGerald said. “There are not many alternatives to opioids; basically Nsaids [non-steroidal anti-inflammatory drugs], which have their own problems.

The level of opioid abuse in Europe is now comparable to that in the US in the early 2000s, "before the epidemic really got going"

“The experience the drug cartels have had of making heroin and fetanyl so accessible can readily be exported to Europe. You don’t need an antecedent OxyContin crisis for that to work.”

FitzGerald cites Mundipharma’s pursuit of the same strategies it used to create the opioid crisis in the US as a third reason for Europe’s vulnerability.

Catching up

The first study of prescription drug abuse in the EU, published in BMC Psychiatry journal in August 2016, found 7-13 per cent of Europeans had abused prescription pain relievers, compared with 20 per cent of Americans. "This suggests the EU may be catching up to the US for . . . opioid pain relievers," said Dr Scott Novak, the lead author of the study.

The level of opioid abuse in Europe is now comparable to that in the US in the early 2000s, “before the epidemic really got going,” Novak said.  Europe, he added, is “potentially at the precipice of a major public health problem if prescribing increases”.

Public Health England reported a 2 per cent rise in drug-related deaths in Britain in 2016, when 3,744 people died from drug use. Although a tiny fraction of drug deaths in the US, the figure was the highest since records started in 1993.

FitzGerald says the Aids epidemic should serve as a model for fighting opioid abuse. As with Aids, massive investment is needed in the social, medical and scientific aspects of the crisis. He calls for a $10 billion research fund, in which pharmaceutical companies would “assume their societal responsibility”.

A broad-based strategy against Aids “converted the inevitable lethality of Aids to a reasonably well controlled, chronic disease”, FitzGerald concludes. “Not only did we deal with it as a US problem, it spilled into global benefit.”