Introduction
Fentanyl, a synthetic opioid, is distinguished by its exceptional potency—surpassing that of heroin by fiftyfold and morphine by a hundredfold. Its pronounced potency elevates the risk of overdose significantly, with a mere 2mg dose deemed lethal, rendering it the main cause of death among adults aged 18-45 in the United States. This crisis has led the country to designate fentanyl as a national security threat through the enactment of the Disrupt Fentanyl Trafficking Act. The surge of fentanyl represents not only a public health crisis but also a complex challenge to global security. In Europe, the lethal potential of synthetic opioids is becoming evident in certain EU countries, particularly in Germany and the Baltics. However, the European context has unique characteristics that, so far, have protected its citizens from experiencing a synthetic opioid crisis on the scale seen in the United States. This post will explore the potential crisis posed by fentanyl and other synthetic opioids in Europe, and how EU Member States are adapting and responding to a threat that, while still largely invisible, is poised to emerge with significant impact.
The diffusion of fentanyl in Europe
The situation in Europe is currently much safer than in the US, with the opioid crisis not yet in full swing. The US is particularly vulnerable to an influx of these drugs, where fentanyl and its analogs are primarily sourced from China and trafficked by Mexican cartels. These cartels not only facilitate the acquisition of fentanyl precursors (the substances used as ingredients in drugs) and pre-precursors (those chemicals used to produce precursors) from China but are also increasingly producing synthetic opioids themselves and shifting their focus from traditional plant-based narcotics to synthetic opioids, particularly fentanyl. In contrast, the situation in Europe is far less dramatic. While more than 70.000 people in the US died of synthetic drug overdose in 2022, in Europe the newly founded EU Drug Agency reported only 163 overdose deaths. Germany had the highest number of fatalities (73), followed by Lithuania (33), Denmark (20), Sweden (17), Estonia (8), and other countries. However, a significant share of these fatalities is thought to be associated with diverted fentanyl medicines rather than illicit fentanyl.
Despite this difference in scale, concerns are growing that highly potent synthetic opioids are increasingly appearing on the European drug market and causing harm. Even if the North American context is different, it provides a stark warning on how rapidly trends in opioid use can develop, with dramatic implications for public health.
Fentanyl is often detected in deficient concentrations, complicating detection in most European clinical labs. Consequently, the true extent of fentanyl's presence is likely underestimated. Its high potency allows for small-volume trafficking, evading detection and complicating anti-trafficking efforts. Limited lab capabilities exacerbate these challenges, posing significant risks to public health and safety, potentially leading to severe impacts in the near future.
The rise in synthetic opioid trafficking in Europe is believed to be linked to a significant decline in opium poppy cultivation in Afghanistan, the primary source of Europe’s heroin. According to the latest UNODC figures for 2023, there has been a 95% reduction in opium production since April 2022. This mirrors a short-lived 2001 ban that led to the introduction of stimulants and synthetic opioids into Europe. While these changes were temporary in most countries, long-term shifts in the opioid market were observed in a few. Consequently, the heroin shortage expected in the coming years may create conditions favorable for the increased availability and use of synthetic opioids. Concerns in this area include the adulteration of heroin with new synthetic opioids (the quality of heroin is reduced by mixing it with fentanyl or related toxic opioid substances), the mis-selling of these new substances (the fraudulent sale of new synthetic opioids as if they were heroin), and, in an extreme scenario, the complete replacement of heroin by synthetic opioids.
European authorities are observing that organized crime groups are targeting the opioid market. Italian secret services found that the Calabrian 'Ndrangheta, a mafia-kind of criminal organization based in the peninsular region of Calabria and known for flooding Europe with cocaine, is now testing the fentanyl market on the continent. Another primary concern is Europe's existing lab capacity to produce synthetic drugs. According to 2023 data from the EU Drug Agency, European authorities dismantled 434 laboratories producing illicit synthetic drugs. Officials conclude that if criminals wanted to produce fentanyl in Europe, they would have the capacity to do it and, consequently, to trigger a crisis very quickly. There is no reason for criminal networks not to sell fentanyl in Europe. The pressing question is not whether a fentanyl crisis in Europe will occur but when and with what intensity it will hit the continent. U.S. Secretary of State Antony Blinken echoed this sentiment a year ago, telling his European counterparts that they either have an undiscovered problem with fentanyl or may have one soon. This impending threat is pushing European governments to take decisive action, as the spread of lethal drugs could spark a crisis at any moment.
Broader European initiatives
The European effort to prevent a potential outbreak of addiction to these drugs has been twofold. On the one hand, the continent is reinforcing and adapting its fight against producers and traffickers, including the regulation of precursors. On the other hand, it is preparing on the healthcare front to prevent overdose deaths.
One key measure has been creating a new drug agency for the bloc, transforming the former European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) founded in 1993, into a full-fledged agency called the European Union Drugs Agency (EUDA). This new EU-wide body, operational from July 2024, has an extended remit and a stronger role, becoming the central authority on illicit drugs in the European Union. The EUDA will conduct health and security assessments, closely monitor synthetic drug developments, and support the adoption of countermeasures. Additionally, the new agency will monitor drug precursors and establish a network of laboratories to identify new substances and define emerging trends in the synthetic drug market. The European Commission, through the EU Roadmap, plans to expedite and expand the scheduling of drug precursors to prevent criminal networks from finding new ways to obtain chemicals for illicit drug production. These are crucial actions: staying up to date with the evolving drug and precursor market enables law enforcement agencies to keep pace with criminal networks that frequently bypass regulations by synthesizing new molecules. Minor molecular modifications in precursors can evade legal restrictions, outpacing regulatory frameworks like the UN conventions of 1961, 1971, and 1988 aimed at controlling precursor chemicals.
The Italian case
Italy was among the first European countries to act promptly and develop a counter-strategy to combat the diffusion of fentanyl and other synthetic opioids. In recent years, the spread of fentanyl in Italy has become increasingly pervasive. Between 2020 and 2023, numerous seizures occurred, the most notable in Piacenza. During this period, several investigations led to the arrest of doctors and pharmacists accused of trafficking fentanyl-based medications through forged prescriptions and warehouse thefts. In April 2024, traces of fentanyl were detected in a dose of heroin analyzed by a street unit in Perugia, marking the first such instance. Recognizing the emerging threat and the risk of a potential crisis similar to that in the U.S., the Italian government implemented a National plan to prevent the misuse of fentanyl and other synthetic opioids.
On the enforcement side, Italy has strengthened its monitoring and regulation of fentanyl and its precursors. This includes tighter controls on the importation and distribution of fentanyl-containing medicines and enhanced surveillance of the retail market, including online sales. Italian law enforcement agencies have been equipped with advanced technologies, such as portable mass spectrometers to detect synthetic drugs and their precursors during customs checks and street patrols.
In the healthcare sector, significant steps have been taken to prevent overdose deaths and treat those affected by synthetic opioids. These measures include bolstering security in hospitals and pharmacies to prevent theft, training medical professionals to recognize and treat fentanyl intoxication, and ensuring the widespread availability of naloxone for first responders to treat overdoses promptly.
However, such a strategy does not lack criticism. Banning fentanyl derivatives and precursors is seen as overly simplistic and could lead to the emergence of new, more potent synthetic opioids that evade existing regulations. This complicates enforcement efforts and increases overdose risks. Additionally, it could push production and distribution further underground, making it harder for law enforcement to control the illicit drug market and potentially disrupting the supply of legitimate medications, affecting patients in need.
Conclusion
The hidden threat of fentanyl is poised to have a significant impact across Europe. This article has highlighted the unique characteristics of the European context that have, until now, mitigated the severity of the crisis seen in the United States. However, the increasing presence of synthetic opioids poses a substantial risk. Italy’s proactive approach through the National Plan to prevent misuse of fentanyl and other synthetic opioids, despite its critical limitations and somewhat simplistic approach, may serve as a model for other European nations to act promptly to prevent a potential crisis. Robust measures, enhanced monitoring, and comprehensive healthcare responses should be critically implemented to address this emerging threat effectively.
European countries must implement robust strategies on the domestic level and continue a promising trend of international collaboration to prevent a fentanyl crisis. This includes tightening regulations, improving detection capabilities, and ensuring adequate resources for law enforcement and healthcare systems. Sharing information and best practices among EU member states can strengthen the collective response to this emerging threat.
The importance of preparedness and proactive strategies cannot be overstated. As the drug landscape evolves, so too must the measures to combat it. By staying ahead of trends and adapting to new challenges, Europe can protect public health and security from the potentially devastating effects of synthetic opioids.