Opioid dependence

see also Opioid tolerance

Although the prevalence of opioid dependence among European adults is low and varies considerably between countries, it is associated with a disproportionate amount of drug-related harm that includes infectious diseases and other health problems, mortality, unemployment, crime, homelessness and social exclusion. Heroin use remains a major concern but in many European countries the use of synthetic opioids has also been growing and in a few countries now predominates.

Opioids were understood as being addictive with long-term use promoting a downward spiral of tolerance and withdrawal driving the pain, leading to continued prescription. Long-term opioid therapy could be justified for patients who improved in function, and who were perceived as trustworthy. Inadequate follow-up of patients, poor training in pain management and addiction medicine, personal attitudes and beliefs about opioids, a perceived professional obligation to treat patients with pain, and lack of collegial support, were factors understood to promote clinically unindicated long-term opioid therapy ¹⁾.