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Opioid Use in the Twenty First Century: Similarities and Differences Across National Borders

  • Substance Use Disorders (FG Moeller, Section Editor)
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Opinion statement

The global prevalence in the use of opiates and opioids has remained stable, though there were some unprecedented recent increases in opioid use and associated mortality and morbidity in the USA. Internationally, there is a strong tendency for consolidation of drug treatment strategies in favor of more systematic, structured, and balanced approaches to regional and national drug policies. However, there are considerable differences in the scope, focus, and implementation of national drug policies and the political context is shaping drug prevention, treatment, and rehabilitation efforts to an extent not typically observed in other public health domains. As a result, though in theory, there is a considerable multi-national agreement about the efficacy and effectiveness of different treatment modalities for opioid dependence, in practice, there are striking differences among different world regions and countries in the degree of implementation of these treatment modalities into clinical practice. Such discrepancies between theory and practice are observed even in high-income countries such as the USA and European Union member states, where evidence-based treatment modalities are still not well implemented into clinical practice. Despite the lack of evidence-based support for the role of detoxification as a stand-alone treatment for opioid use disorders, it appears to be the most widely used intervention for opioid use across the world.

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Notes

  1. The UN Single Convention on Narcotic Drugs 1961; the UN Convention on Psychotropic Substances 1971; and the UN Convention Against Illicit Traffic in Narcotic Drugs and Psychotropic Substances of 1988.

  2. General Assembly Twentieth Special Session, Political Declaration and Plan of Action, UNGASS 1998; and High-Level Segment Commission on Narcotic Drugs, Political Declaration and Plan of Action on International Cooperation

    Integrated and Balanced Strategy to Counter the World Drug Problem, Vienna, 2009.

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Acknowledgments

This research was supported by grant R01DA021421 from the Fogarty International Center and the National Institute on Drug Abuse.

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Authors and Affiliations

  1. Bulgarian Addictions Institute, 93 Antim I, Sofia, 1303, Bulgaria

    Georgi Vasilev MD, MPH

  2. University Hospital Sveta Marina, 1 Hristo Smirnenski blvd, Varna, 9100, Bulgaria

    Svetla Milcheva MD

  3. Department of Psychiatry, Institute for Drug and Alcohol Studies, Virginia Commonwealth University, 203 E. Cary Street, suite 202, Richmond, VA, 23219, USA

    Jasmin Vassileva PhD

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Svetla Milcheva reports personal fees from Novartis, Alkermes, KCR, and Janssen unrelated to the submitted work.

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Vasilev, G., Milcheva, S. & Vassileva, J. Opioid Use in the Twenty First Century: Similarities and Differences Across National Borders. Curr Treat Options Psych 3, 293–305 (2016). https://doi.org/10.1007/s40501-016-0089-2

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