Synthetic opioids (SOs) are among the leading causes of death among people who use drugs and one of the most important challenges in drug policy in today’s world. The rate of overdose and overdose mortality involving SOs in North America has been higher than in any other region in the world. The present study aimed to find key lessons learned from the experience of the US and Canada to mitigate the use and harms of SOs and prevent an opioid epidemic in Europe. In the present qualitative study six North American experts (three from the US and three from Canada) were invited to participate in in-depth interviews. The interviewees were selected based on their professional background reflected in their scientific publications and on recommendations from SO-PREP partners. Using an interview guide, the participants were asked about their knowledge and opinions of the development of the opioid epidemic, advantages and disadvantages of the current strategies to prevent, control, and reduce the harms of SOs in their countries, as well as other lessons that the European countries can learn from their experience.

A set of policies and interventions implemented by the governments of the US and Canada to respond to the opioid epidemic were reported and discussed by the participants. These include regulations of prescription opioids, intensified border control, opioid substitution treatment (OST), emergency medical technician (EMT) ambulances to respond to overdoses, street-based care interventions, drug checking, overdose prevention sites, and naloxone distribution. Particularly the adequate coverage of good quality OST was highlighted as an effective measure in reducing the use of illegal opioids. Strength and weaknesses of the interventions from the viewpoint of the interviewees, challenges towards implementing these services, and lessons that Europe can learn from the experience of the US and Canada are discussed in detail. In conclusion, the US and Canada were unprepared for the emerge of SOs. Despite ongoing efforts, both countries are still struggling to adequately respond to protect people who use opioids. The North American experts interviewed in this study believe that, over time, an increase in the availability of SO in Europe is unavoidable. Results of the present study may help European policy makers to take timely and evidence-based actions to respond to the harms caused by SOs. Effective responses require well-prepared and coordinated actions on the side of the government. Services will need to be available, accessible and accepted by those who are in need of them. A coordinated effort of varying stakeholders and services will be necessary to mitigate the burden of SOs in Europe and prevent a potential crisis in this region.