Addressing Problematic Opioid Use in OECD Countries

Foreword
Acknowledgments
Executive summary
1 Introduction
2 Opioid use in context
	2.1. What are opioids and how have they been used?
	2.2. The thin line between appropriate and inappropriate opioid use
3 The opioid crisis and the rise of an epidemic in some OECD countries
	3.1. What is the magnitude of the opioid crisis in OECD countries?
	3.2. Factors underpinning the development of the opioid crisis
		3.2.1. Increased opioids prescription and over-prescription in health systems
			Uncorroborated claims about the safety and risks of prescription opioids
			Opioid manufacturers and advocacy groups have influenced pain management
			Poor opioid prescribing practices and insufficient education in pain management
			Limited alternatives for chronic pain management and lack of insurance coverage
			Defective approach to mental health and opioid use
		3.2.2. A dynamic illicit drugs market has fuelled the crisis
			High purity and increasing availability of illicit opioids at a low cost
			Polysubstance use and problematic use
			Prison and jail post-release period
		3.2.3. Poor treatment and actions to minimise the negative consequences for OUD patients
			Barriers to access medication assisted therapy
			Predominance of abstinence-only rehabilitation therapies
			Inadequate access to evidence-based harm minimisation interventions
		3.2.4. Social and economic conditions contributing to the crisis
			Unemployment appears to be linked to the opioids issue
			Lack of housing affecting the most vulnerable population
			Social stigma as a relevant barrier for prevention and recovery
4 Policies to address the opioid crisis and prevent opioid-related harms
	4.1. Health system policies and interventions to address the needs of opioid use disorder patients and the population
		4.1.1. Prevention: changing behaviours of patients, providers, and industry practices
			Patient and family opioid-related literacy, general population awareness and reduction of stigma
			Opioid prescription support and surveillance to improve provider practices
			Regulation of industry: marketing of prescription opioids and financial payments to providers
		4.1.2. Effective treatment and actions to minimise opioid use negative consequences are key for patient management
			Medication assisted therapy can be part of long-term programmes benefits patients
			Integration and coordination with specialised services contributes to early detection and managing co-occurring diseases
			Naloxone is an effective harm minimisation intervention
			Needle and syringe programmes help to reduce blood borne diseases
			Medically supervised consumption centres and alternative medical approach to opioids are used in some OECD countries
	4.2. Social policies to address the economic and societal factors of the opioid crisis
	4.3. Regulation and enforcement to address illegal opioids use
		4.3.1. Law enforcement practice
		4.3.2. Criminal justice system approaches to people who use drugs
	4.4. Information and knowledge generation as relevant levers for policy development and implementation
		4.4.1. Better data and analytics for improved decision making
		4.4.2. Encouraging research and development for new pain and OUD-related treatments
		4.4.3. Better evaluation of opioid-related policies and interventions
5 Findings and conclusions
References
Annex A.  Description of the opioid crisis in Australia, Canada and the United States
	Description of the opioid crisis in Australia, Canada and the United States
		Australia’s epidemic is situated mainly around prescription opioids
		Canada’s recent unfold of an opioid crisis
		Opioid crisis in the United States: a tale of three cumulative waves over more than 20 years