Synthetic Opioid Preparedness in Europe (SO-PREP)

Background and aims of the project

The European project SO-PREP has been designed to address the growing concern and alertness in many countries in Europe as a result of increasing number of incidents with synthetic opioids (SO). This concern may be justified, given the ongoing North American opioid overdose crisis that is fuelled by use of new synthetic opioids, and an increasing number of countries in Europe that report prevalence of use of SO and increased incidents.

The project will produce diversified outputs and deliverables, aiming to serve a mixed group of relevant stakeholders like policy makers, health managers, and service providers at a wider European level. These involve: policy makers in the area of health, health managers, researchers, staff of drug services and drug treatment agencies, and most importantly the final beneficiaries: People Who Use Drugs (PWUD), first responders (e.g. law enforcement, ambulance and A&E personal) and other people who might accidently get in contact with SO.

The overall objective of SO-PREP is to contribute to enhancement of the European Member States’ SO preparedness and responding policy and practice capabilities to related SO health risks, hazards, and harms.

The project will contribute to:

• Strengthened awareness and information about current and potential developments in the field of SO among EU Member States (MS) and in 5 MS in particular.
• Strengthened national ‘SO preparedness’ in terms of available policies and services, building on existing health protection systems, to be validated in 5 partner countries and recommended Europe-wide.
• Strengthened key responses to monitor SO trends and/or effectively intervene with targeted prevention, treatment and The project addresses 2 priorities of the call, notably by ‘supporting epidemiology and responses towards potent new Synthetic Opioids (SO) and online markets’ and by ‘promoting translation of research into practice’ harm reduction responses.

In addition to the Trimbos Institute (the Netherlands) as the project leader, the project is carried out by five other institutions including Frankfurt University of Applied Sciences; the National Institute for Health Development (TAI, Estonia); Correlation-European Harm Reduction Network (C-EHRN, The Netherlands); University Ghent (Belgium); and the Finnish Institute for Health and Welfare (THL, Finland).

The Institute of Addiction Research (ISFF) at the Frankfurt University of Applied Sciences is responsible for the second work package of the project, while Prof. Heino Stöver (the work package leader) and Mr. Babak Moazen (research collaborator) are representatives of the University in this project. The aims and objectives of the second work package of the project are explained as follows:

Work Package 2: Research

Rationale for this Work Package

The goals of this work package are to collect up-to-date epidemiological data and information on the use and spread of synthetic opioids in Europe and North America, to analyse in-depth the situation of the consumption of SO in one model case (case study Estonia), and to assess national government’s preparedness with regard to the upcoming issue of SO in six countries. Since a decade the number of reports on the spread of the availability and use of the synthetic opioid fentanyl and its derivatives in Europe has been growing. High levels of fentanyl use among injectors have been reported from Estonia, however in many countries SO have detected. SO also play an increasing role in the causes of opioid-related overdose deaths (e.g. Germany/Bavaria). The EMCDDA has carried out a trend spotter study on fentanyl in Europe (EMCDDA 2012), other reports also indicate an increase of fentanyl in confiscated drugs.

Objective of the work package

The aim of this work package is foremost to elaborate an epidemiological overview of the data an information available around SO in Europe (and North America) in order to better understand the nature, dynamics, and consequences of an increased availability and use of SO in Europe.

Aim of the work package is to

1. map and analyse the existing data and information on the availability, use and consequences of SO in Europe
2. collect key lessons learned from the situation of SO in North America
3. conduct a case study of SO use and SO markets in a selected country (Estonia)
4. assess national governments preparedness with regard to upcoming issues OS SO use in 6 countries.

Activities

The activities in WP2 focus on epidemiological issues, a case study and an assessment of the situation around availability and use of SO in Europe and North America. Close and steady cooperation and communication will be initiated with EMCDDA and “Correlation” network.

1. Epidemiological overview of synthetic opioid use in Europe

1.1. Analysis of the data of the EMCDDA latest workbooks 2019
In order to elaborate a basis for further research the data set of the EMCDDA will be analyzed. All data and information available will be collected to be able to describe trends and developments.

1.2. Enquiry of recent data of Reitox Focal Points (latest data)
To get even more recent data a questionnaire will be sent to all European Reitox Focal Points. These data will complement the analysis of collected data so far.

1.3. Close Cooperation and communication with the Monitoring Group of “Correlation”
To validate the data collected, and to get recent data and information a close cooperation and communication with the Monitoring Group of the European network “Correlation” will be initiated. This

1.4. Cooperation with international bodies working in Europe

All international bodies working in Europe on drug-related topics will be contacted and interviews with key experts will be lead via telephone and/or skype in order to get more background information. Key experts will be contacted at WHO, UNODC, police ECDC organizations, etc.

1.5. Enquiry in preparedness of user’s organizations in the 6 countries; plus international user’s organization (e.g. IMPUD)
In order to learn more about the preparedness of drug user’s unions, these organizations will be contacted and key experts will be interviewed (like JES in Germany, and international IMPUD). Are they preparing their members to upcoming issues of SO use?

1.6. Collect key lessons learned from SO situation (opioid/overdose crises) in North America.
In order to learn more about the health crisis with regard to the use of SO in North America key experts will be contacted in face-to-face interviews and telephone/skype interviews.

1. Case study: Assessment on SO use in a selected country (Estonia).

2.1. Interviews with users of synthetic opioids in Estonia.
To learn more about SO users Estonia has been selected. Through key experts and drug service organizations SO users will be contacted and interviewed either in focus groups or individual interviews. The main goals are:
- Exploration of users’ knowledge and competencies in dealing with SO
- Awareness of SO in the situation of buying drugs
- Level of competence with regard to dealing with synthetic opioids (purchase questions, effects, overdose experiences etc.)
2.2. Focus groups with key experts on SO usage
In order to study the context, focus groups with key experts on SO usage will be conducted in Estonia (e.g. service staff, community members, researchers, forensic experts). The results will help to better understand the dynamics of the spread of SO in the country as well as to draw a comprehensive picture of the history and current spread of SO.

1. Assessment of national government preparedness with regard of the upcoming issue of synthetic opioid use in 6 countries

3.1. Six countries have been selected, where SO have been identified (Estonia, Netherlands, Germany, Finland, Netherlands, UK; the Estonian situation will be covered already within activity 2). Project partners will collect information and data on the history and current spread of SO. Future perspectives, gaps and bottlenecks of responses will be analyzed. A common overarching report will be produced to serve future discussions and planning as a baseline.

3.2. Collection of user’s experiences from other European countries
User’s experiences in other than the 6 countries will be collected in order to see, which different experiences have been made. For this reason user groups will be contacted to get a comprehensive overview.

Expected outputs and deliverables

• Mapping report on SO spread and prevalence in EU
• Report on key lessons learned from the situation around SO in North America
• Case study report on spread of SO use in Estonia and the responses to SO related challenges
• Report on user’s knowledge, competencies in dealing with SO, views and assessment of service providers working in the field of opioid usage and SO
• Assessment report on national health system preparedness in 6 countries
• Presentation of epidemiological data on international conference (Lisbon Addiction Conference)

The project was started in the beginning of 2020, and will be finished by the end of 2021. More information regarding the SO-PREP could be found on the project website: (https://so-prep-project.eu/).

Laufzeit: 01.01.2020 – 30.06.2022

Förderer: EU-Kommission

Projektleitung: Prof. Dr. Heino Stöver; Frankfurt University of Applied Sciences, Fachbereich “Soziale Arbeit und Gesundheit“ 

Projektmitarbeiter: Babak Moazen