In 2021, there were 6166 overdose deaths reported in the EU [1]. An estimated adult mortality rate of 18.3 per million. In comparison, in 2021 the age-adjusted rate of overdose deaths in the United States was 324 per million [2, 3]. This difference is striking and arguably reflects differences in both patterns of use and public health provision. In North America, a growing public health emergency has been linked to an increase in the use of synthetic opioids among a population in which service contact is often limited [4]. Illicitly manufactured fentanyl has displaced heroin and prescription opioids to become the main driver of an epidemic in opioid-induced deaths. In the EU, things look different.