With the opioid crisis raging in the United States, one might wonder – is the increasing abuse of pain medication just an American problem? Across the Atlantic, researchers from Norway, Sweden and Denmark urge caution after finding that prescriptions for the strong opioid Oxycodone have significantly increased over the last years in all three countries.
By Ley Muller
On average, 130 Americans die of opioid overdoses each day. The majority of these are caused by prescription drugs, such as oxycodone. The harms of this strong painkiller have been downplayed and its use heavily marketed to doctors by Purdue Pharma, causing an exponential increase in usage until more than one in seven Americans had an oxycodone prescription in 2012.
Norway, Sweden, and Denmark have significantly harsher regulations on the pharmaceutical industry than the United States. In these Nordic countries it is not possible to advertise medications, for example, and marketing to doctors is subject to strict rules. However, these countries also have ageing populations who report some of the highest rates of chronic non-cancer pain in the world. What is stopping a Nordic prescription opioid epidemic?
Analyzing 21 million people’s prescriptions
To investigate this issue, researchers from each of the three countries analyzed twelve years of opioid prescription data. They looked specifically at prescriptions for outpatients, excluding patients in hospitals and nursing homes. Their intention was to capture people who were most likely receiving opioids for chronic non-cancer pain, not after a surgery or other trauma, or at the end of their life.
One of eight women
According to the study, recently published in the Scandinavian Journal of Pain, one out of every eight Norwegian women and one of eleven Norwegian men received a prescription opioid outside of a hospital in 2017.
Opioid prescriptions overall remain steady in all three countries, so researchers looked more closely at three specific types of pain medication: codeine, oxycodone, and tramadol.
They found that oxycodone prescriptions have been increasing in all three countries. In Sweden, the number of people with an outpatient prescription for oxycodone has more than tripled since 2006.
North America vs. the Nordic countries
“It’s easy to get complacent”, says Dr. Ley Muller, the lead author, who is originally American. “It’s easy to think, ‘The United States is so different, so their situation isn’t applicable to us – we have better regulations, different environments, different populations.’ And all of that is true. Yet oxycodone is prescribed more and more.”
In fact, regulation of opioid prescriptions for chronic non-cancer pain has been liberalized in recent years in Norway. For example, it is now easier to get long-term opioids subsidized. At the same time, forensic analyses have shown that these prescription opioids are increasingly involved in deadly overdoses.
According to Muller and colleagues, it is crucial that other countries avoid the North American crisis of prescription opioid overdose deaths: “As a general rule, these strong prescriptions should not be used for chronic non-cancer pain.”
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