Opioid epidemic

See Opioid epidemic in the United States for a more detailed treatment of the situation in the USA.

Opioids are a diverse class of moderately strong painkillers, including oxycodone (commonly sold under the trade names OxyContin and Percocet), hydrocodone (Vicodin, Norco), and a very strong painkiller, fentanyl, which is synthesized to resemble other opiates such as opium-derived morphine and heroin. The potency and availability of these substances, despite their high risk of addiction and overdose, have made them popular both as medical treatments and as recreational drugs. Due to their sedative effects on the part of the brain which regulates breathing, the respiratory center of the medulla oblongata, opioids in high doses present the potential for respiratory depression, and may cause respiratory failure and death.

Canada follows the United States as the second highest per capita user of prescription opioids.

In Alberta emergency department visits as a result of opiate overdose rose 1,000% in the previous five years. The Canadian Institute for Health Information found that while overall a third of overdoses were intentional, among those ages 15–24 nearly half were intentional.

In 2017 there were 3,987 opioid-related deaths in Canada, 92% of these deaths being unintentional. The number of deaths involving fentanyl or fentanyl analogues increased by 17% compared to 2016.

Outside North America

Approximately 80 percent of the global pharmaceutical opioid supply is consumed in the United States. It has also become a serious problem outside the U.S., mostly among young adults. The concern not only relates to the drugs themselves, but to the fact that in many countries doctors are less trained about drug addiction, both about its causes or treatment. According to an epidemiologist at Columbia University: "Once pharmaceuticals start targeting other countries and make people feel like opioids are safe, we might see a spike [in opioid abuse]. It worked here. Why wouldn't it work elsewhere?"

Most deaths worldwide from opioids and prescription drugs are from sexually transmitted infections passed through shared needles. This has led to a global initiative of needle exchange programs and research into the varying needle types carrying STIs. In Europe, prescription opioids accounted for three-quarters of overdose deaths among those between ages 15 and 39. Some worry that the epidemic could become a worldwide pandemic if not curtailed. Prescription drug abuse among teenagers in Canada, Australia, and Europe were comparable to U.S. teenagers. In Lebanon and Saudi Arabia, and in parts of China, surveys found that one in ten students had used prescription painkillers for non-medical purposes. Similar high rates of non-medical use were found among the young throughout Europe, including Spain and the United Kingdom.

From January to August 2017, there were 60 fatal overdoses of fentanyl in the UK. Opioid prescribing in English general practice mirrors general geographical health inequalities.

Accessibility of prescribed opioids

The worry surrounding the potential of a worldwide pandemic has affected opioid accessibility in countries around the world. Approximately 25.5 million people per year, including 2.5 million children, die without pain relief worldwide, with many of these cases occurring in low and middle-income countries. The current disparity in accessibility to pain relief in various countries is significant; the U.S. produces or imports 30 times as much pain relief medication as it needs while low-income countries such as Nigeria receive less than 0.2% of what they need, and 90% of all the morphine in the world is used by the world's richest 10%. America's opioid epidemic has resulted in an “opiophobia” that is stirring conversations among some Western legislators and philanthropists about adopting a “war on drugs rhetoric” to oppose the idea of increasing opioid accessibility in other countries, in fear of starting similar opioid epidemics abroad. The International Narcotics Control Board (INCB), a monitoring agency established by the U.N. to prevent addiction and ensure appropriate opioid availability for medical use, has written model laws limiting opioid accessibility that it encourages countries to enact. Many of these laws more significantly impact low-income countries; for instance, one model law ruled that only doctors could supply opioids, which limited opioid accessibility in poorer countries that had a scarce number of doctors.

In 2018, deputy head of China's National Narcotics Commission Liu Yuejin criticized the U.S. market's role in driving opioid demand.

North America's first safe injection site, Insite, opened in the Downtown Eastside (DTES) neighborhood of Vancouver in 2003. Rather than trying to prevent people from using drugs, safe injection sites are intended to allow addicts to use drugs in an environment where help is immediately available in the event of an overdose. Health Canada has licensed 16 safe injection sites in the country. In Canada, about half of overdoses resulting in hospitalization were accidental, while a third were deliberate overdoses.

OxyContin was removed from the Canadian drug formulary in 2012.