The opioid crisis in different contexts around the world: a scoping review

Aim This scoping review examined how peer-reviewed literature conceptualizes and contextualizes opioid-related harms worldwide, with attention to regulatory environments, opioid types, including prescribed and illicit opioids, and population-level consequences. Subject and methods This scoping review followed Joanna Briggs Institute guidance and PRISMA-ScR reporting standards. Systematic searches were conducted in LILACS, Scopus, Embase, and MEDLINE up to January 2026. Eligible studies were peer-reviewed primary quantitative investigations examining opioid-related harms in relation to structural, regulatory, or contextual factors. Two reviewers independently screened records and charted data using a standardized form. Findings were synthesized narratively through inductive thematic analysis. Results Twenty-two studies met the inclusion criteria, primarily from North America and Europe, with limited representation from Latin America and Asia and no eligible studies from Africa. The literature described substantial structural heterogeneity. A multi-phase trajectory, characterized by medical opioid diffusion followed by increasing involvement of illicit synthetic opioids, particularly fentanyl, was predominantly reported in North America. Several Western European and Oceania settings were described as experiencing medical opioid expansion within centralized regulatory systems, without sustained fentanyl-dominated mortality escalation. Other contexts reflected illicit supply-driven harms independent of prescription diffusion or persistent under-access to opioid analgesics for legitimate medical use. Across settings, harms were framed as arising from interactions among regulation, illicit markets, healthcare systems, and socioeconomic conditions. Conclusion Opioid-related harms are portrayed in the literature as structurally differentiated rather than globally uniform. Comparative analysis may support context-sensitive alignment of surveillance, regulation, treatment infrastructure, and harm reduction strategies.