Thank you very much, Neil, for initiating this important discussion.
On behalf of the Addiction Training Program for Health Professionals (ATHP) of the Frank Foundation/NextGenU, as co-sponsors of this Forum, we also want to welcome and encourage HIFA members and friends to participate in this discussion.
I hope this exchange will be as fruitful as the Tobacco and Alcohol Forums that HIFA has developed and that we supported.
I confess that I have no experience with the issue of opioid abuse because, as I will explain below, the consumption of these substances is not yet a health or social problem in Uruguay, where I was born and live. Uruguay is a small South American country with 3.5 million inhabitants.
In any case, for several years now, the Uruguayan government has been concerned about the potential arrival of a significant illicit fentanyl trade in our country, promoted by drug trafficking networks. (1) Current data on opioid use is scarce and does not appear to represent a major problem.
In Uruguay, at least ten opioids are registered for sale, including: fentanyl, remifentanil, tramadol, morphine, codeine, ethylmorphine, methadone, oxycodone, meperidine, and dihydrocodeine. Oxycodone is unavailable.
In 2024, the VIII National Survey on Drug Use in the General Population, conducted by the National Drug Secretariat, reported a heroin use prevalence of 0.1% among the adult population. It did not provide information on other opioids. (2)
The most commonly used opioids in Uruguay are primarily for medical use, predominantly in hospital settings.
Evidence regarding their illicit use is scarce, and it likely originates mainly from the diversion of medical opioids, especially fentanyl, which would explain the involvement of healthcare personnel in many cases.
Regarding opioid overdose episodes: they are very infrequent and generally associated with medical use.
The predominant profile of the few users is linked to patients and staff of the healthcare system. For example, patients with chronic pain, cancer, post-operative care, etc. As mentioned previously, healthcare professionals, who have access to potent drugs (fentanyl) and may conceal their use, would be at greater risk of overdose.
At the regional level, it is relevant to note that in April 2021, the Chilean Early Warning System issued an alert due to the presence of fentanyl in a seizure carried out in the Puente Alto district, located in the Santiago Metropolitan Region of Chile.
Subsequently, in February 2022, the province of Buenos Aires experienced an outbreak of poisoning linked to the consumption of cocaine adulterated with carfentanil, an opioid analgesic used in veterinary medicine to anesthetize large animals, affecting 253 people and claiming the lives of 24 of them.
More recently, in the Argentine province of Misiones, a shipment containing 500 ampoules was seized.
Seizures have also occurred in Colombia, Panama, Brazil, Honduras, and Venezuela, but in all cases, the drugs were the result of theft from the healthcare system. (3)
Uruguay is in a phase of low prevalence, with a significant window for prevention.
As a personal anecdote, a doctor with whom I worked for a long time, who was married to another doctor, required opiates after suffering a fracture and became addicted. This cost him his marriage and caused him problems at work. He is still struggling with this addiction.
We invite you to share information about what is happening in your countries and your personal experiences.
Regards,
Eduardo
References
1. https://www.infobae.com/america/america-latina/2025/01/20/el-gobierno-ur...
2. VIII Encuesta Nacional sobre Consumo de Drogas en Población General https://www.gub.uy/junta-nacional-drogas/datos-y-estadisticas/encuestas/...
3. CERES. Fentanyl, the synthetic drug that transformed consumption in the US and keeps Uruguay on alert. https://ceres.uy/index.php/estudios/ficha_estudio/101
Eduardo Bianco, MD, MSc, BIR
ATHP Director
Addiction Training for Health Professionals
Email: ebianco@nextgenu.org
HIFA profile: Eduardo Bianco is a medical doctor and Cardiologist, Certified Tobacco Cessation Expert with a Master's in Prevention and Treatment of Addictive Disorders. Bianco also has a degree in International Relations. Currently, he is Director of International Policy Education in Addictions of the Frank Foundation for International Health and Member of the Interim Policy Committee of the Global Alliance for Tobacco Control (GATC). He had a prominent role in promoting smoking cessation, tobacco control, WHO-FCTC implementation and NCD control in his country (Uruguay) as well as in Latin America for over 25 years. Bianco participated directly in most of the development process of the WHO-Framework Convention on Tobacco control and in the Sessions of the Conference of the Parties to this treaty. He was Director or Tobacco Control Program of InterAmerican Heart Foundation, Regional Coordinator for the Americas of the Framework Convention Alliance (FCA), Chair of the Tobacco Expert Group of the World Heart Federation and Technical Director of the MOH Center for International Cooperation for Tobacco as well as Founder and Former President of the Tobacco Epidemic Research Center (CIET) in Uruguay. Eduardo helps coordinate the HIFA working group on substance use disorders. https://www.hifa.org/support/members/eduardo https://www.hifa.org/projects/mental-health-meeting-information-needs-su...