Emergency Department Presentations Related to the Abuse of Illicit and Prescription Opioids Through a European Sentinel-centres-Based Registry.

Abstract

Opioid use, both prescribed and illicit, has caused considerable harm and fatalities. This study aims at characterising patterns of emergency department (ED) presentations related to opioid abuse across Europe. Data on demographics, clinical features, and epidemiology were extracted from the Euro-DEN Plus data set for presentations involving acute opioid toxicity between October 2013 and December 2021. Of 62,545 presentations, 3888 (6.2%) involved prescription opioids, 11,252 (18.0%) illicit opioids, and 587 (0.9%) both. Heroin accounted for 99.8% of illicit opioid cases. The most commonly reported prescription opioids were methadone (51.3%), buprenorphine (13.9%), morphine (9.3%), fentanyl (6.8%), and tramadol (6.7%). Co-use of benzodiazepines and Z-drugs (35.6%) and pregabalin (6.6%) was significantly higher in prescription opioid cases compared with illicit (20.6% and 1.5%, respectively; P < 0.001). Mortality was greater with prescription opioids (1.2%) than illicit opioids (0.4%, P < 0.001). Heroin remains the predominant opioid; though the relative contribution of prescription opioids varies significantly across centres and countries. Methadone and buprenorphine predominate among prescribed opioids, while fentanyl and oxycodone account for a small proportion, contrasting with North American patterns.