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Heroin Addiction and Related Clinical Problems: 2016, 18, 3 (pages: 43 - 52)

Opioid misuse in the 30 days prior to entering Agonist Opioid Treatment in four European Countries. A pilot study

Maremmani I., Somaini L., Deruvo G., Maremmani A.G.I., Touzeau D., Walcher S., Fonseca F., Bacciardi S., Guareschi M., Green J.L., McBride K., and Dart R.C.

Summary: Introduction: The broad availability of opioid analgesics (OAs) probably complicates the misuse of Agonist Opioid Treatment (AOT) medications, or even pave the way to dependence on heroin. Methods: In this observational study, based on a thorough survey of new AOT enrollees, our main aim was to determine the extent to which the problem of prescription opioid (PO) misuse that is currently evident in the US is also a concern in the EU. We assessed the prevalence of primary substances of abuse (PSAs), and differences in patterns of PO misuse in the previous month, by reviewing the situations to be found in four European countries. Results: In the centers investigated by us, heroin was preferred as PSA in Spain, buprenorphine and opioid analgesics were the prevalent PSAs in France, while methadone and fentanyl prevailed in Germany. Heroin alone frequently proved to be the substance used in Italy and Spain. AOT medications only were used more frequently in Italy, less so in Spain. Opioid analgesics only were used more frequently in France. Combined use occurred more frequent in Italy, with special reference to heroin and AOT medications; in Germany especially with heroin and opioid analgesics; in France especially with opioid analgesics and AOT medications. The combined use of heroin, AOT medications and opioid analgesics was a frequent finding in Germany. Conclusions: In Europe, the combined use of opioid analgesics, AOT medications and heroin – already dreaded in the US, and rightly so – is just beginning to appear, notably in Germany and in France.