I'd summarize the article differently:
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Europe has established pathways for heroin. Those weren't supplanted by fentanyl.
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European docs are less likely to prescribe painkillers (seems pretty wild to refer to a few dozen healthcare systems like this, but ok). More supports are available to people suffering pain.
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Europeans were more skeptical of Oxycontin overall and docs were less likely to prescribe it.
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European countries have more effective law enforcement, who arrest and prosecute people more effectively, but "Studies have shown that criminal penalties for drug use have been ineffective in reducing substance reliance or overdose deaths".
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European countries offer more treatment options for people trying to end their addictions.
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Harm reduction sites in Europe are better integrated into the surrounding community: He pointed to countries like Spain and the Netherlands, where local stakeholders – such as police, health authorities and neighbourhood groups – work together to integrate drug consumption spaces into communities. These services, which he noted are also adequately funded, then become “part of the city fabric.”
Again, Europe is a bunch of countries. This article seems to paint with a broad brush, but my takeaway is that European countries generally have more comprehensive healthcare, and didn't jump on the oxy bandwagon. And they did harm reduction better.
I suspect that existing drug distribution networks staying on heroin is pretty significant too, but the article doesn't give numbers.