Fentanyl has devastated America. Why is Europe spared?

In San Franciscos Tenderloin, the downtown neighborhood notoriously known for its rampant homelessness, crime and drug abuse, fentanyl users are scattered on the streets, their numbing bodies abandoned in unlikely positions on benches and sidewalks.

These are the scenes Gen-Z activist Darren Stallcup, who has lived in Tenderloin all his life, regularly records with his phone’s camera and then shares with the world on Twitter.

Fentanyl, a powerful synthetic opioid, is killing Americans – and San Francisco residents – at an alarming rate. Between January and March of 2023, 200 people died of overdoses in the Tenderloin, with 159 deaths caused by fentanyl, more than in the same period a year earlier. Nationwide, the number of Americans who die from drug overdoses it rose from over 70,000 in 2019 to over 100,000 in 2021. Most of these deaths are due to fentanyl.

Stallcup told Euronews he has seen so many people die of overdoses on the streets of his neighborhood that he feels absolutely traumatized.

When the 25-year-old activist recently went to London for a holiday, he said he felt refreshed. No one died of fentanyl on the streets of the European capital, no one used the drug in plain sight. Most importantly, Stallcup said, is to make sure fentanyl doesn’t find its way into the UK and Europe.

But fentanyl has already been found to be circulating in Europe, though it often sneaks in under false pretenses.

In December 2016, an 18-year-old boy died after buying what he thought was a morphine pill at a Cannes carnival. He died of an overdose later that evening after consuming the pill that contained fentanyl, a few milligrams of which can be lethal. Fentanyl is similar to morphine, but is 50 to 100 times more potent.

Fentanyl also kills in Europe, but much less than in the United States

Tragedies similar to that of the 18-year-old in Cannes are common in the United States, where the powerful synthetic opioid painkiller has killed tens of thousands of Americans in recent years, becoming the deadliest drug in the country’s history. But they are unusual in Europe, a continent that has remained largely sheltered from the spread of the killer drug.

According to the European Monitoring Center for Drugs and Drug Addiction (EMCDDA), there were around 5,800 deaths from overdoses in the EU in 2020, an underestimated estimate, EMCDDA chief scientist Paul Griffiths told Euronews. Opioids accounted for three-quarters of all these deaths, while fentanyl likely accounted for a couple of hundred, Griffiths said.

By comparison, in the same year, the United States reported 53,480 fentanyl-induced deaths.

In the United States, fentanyl was available by prescription as a pain reliever. Thousands of people have become addicted after being prescribed the drug by their doctors since the 1990s.

Once the country’s authorities realized the seriousness of the situation, it was already too late. Although pharmaceutical companies have stopped making and selling fentanyl, the drug’s production and supply has been taken over by criminal gangs, with manufacturing reportedly taking place illegally in countries such as China and Mexico.

Because of how easy it is to produce, fentanyl is often mixed by drug dealers with other drugs such as heroin, cocaine, methamphetamine and MDMA. This means that addicts often end up consuming fentanyl without knowing they are doing it.

According to a recent analysis by The Washington Post, fentanyl is the leading cause of death for Americans aged 18 to 49.

A fentanyl epidemic in Estonia

Europe has a precedent with fentanyl that long predates the incident involving 18-year-old Joseph in Cannes in 2016.

In the early 2000s, Estonia experienced a heroin shortage which led to a sudden increase in fentanyl use, with the synthetic drug quickly becoming the most widely used opioid among addicts.

For nearly two decades, the Baltic country battled a fentanyl epidemic, until police cut off the supply in 2017 by shutting down a clandestine laboratory, and fentanyl finally seemed to be disappearing from Estonia.

But fentanyl has left a trail of death across the country. According to data estimated by the EMCDDA, between 2001 and 2020, around 1,600 people died from overdoses in the Baltic state, most of them due to the use of fentanyl and other synthetic opioids.

A shortage of opioids manufactured by the Taliban looms over Europe

The story of the fentanyl epidemic in Estonia should be a warning to the present, especially as an opioid shortage could soon hit the continent. In Afghanistan, where the bulk of Europe’s heroin supply comes from, the Taliban imposed a ban on poppy cultivation in April 2022, the impact of which is likely to be felt on the continent next year as the year’s crop last was exempt from the ban.

Nearly all opium in Afghanistan is harvested between April and July, and according to 2022 estimates by the United Nations Office on Drugs and Crime (UNODC), harvesting to heroin markets takes one to a year and a half.

The sudden shortage of opioids could open an opportunity for criminals to manufacture and sell synthetic drugs such as fentanyl, which is much more profitable than heroin. According to the US Drug Enforcement Administration, one kilogram of fentanyl purchased in China for between $3,000 and $5,000 (2,768 to 4,613) can be resold for more than $1.5 million (1.38 million). Due to its potency, which is 30 times that of heroin, fentanyl could rapidly replace other drugs and conquer the European local drug scene.

It will be interesting to see what happens with the alleged Taliban ban and whether that actually has a long-term impact, Griffiths said. Right now, what we’ve seen looks like a very, very slight contraction in poppy growing area, but it’s still quite large by historical standards. A little less is being produced than now, and one would expect at least a year – due to the existence of stocks, due to the time it takes to bring the drugs to market – to have an impact on the drug market in Europe.

But Griffiths is skeptical of the ban, saying the move is more likely to manipulate the price of opioids by reducing their availability on the market.

Could fentanyl conquer Europe?

While there is currently no market for fentanyl in Europe, the risk that the drug could eventually take over Europe is real and has been recognized by the European Union Agency for Law Enforcement Cooperation (Europol), l law enforcement agency of the EU which assists law enforcement authorities in EU member countries.

In a recent report, Europol writes that the same Mexican drug cartels that are flooding the US illicit drug market with fentanyl are collaborating with EU-based criminal networks to traffic and smuggle cocaine and methamphetamine into Europe. The agency warns that these Mexican criminal groups could try to expand the portfolio of drugs trafficked into the EU either by smuggling them to the EU drug market or by aiding in the production of such drugs, such as fentanyl, in the EU.

While there are currently no indications of a market for fentanyl in the EU, the discovery of fentanyl production facilities and seizures of the substance in the EU raise concerns about the development of a market for fentanyl. writes the agency.

On its side in the battle against fentanyl, Europe has time, Griffiths said, as well as a completely different attitude towards medicines and painkillers. We don’t have the same dynamics as most in terms of aptitude for prescribing painkillers and tend to have treatments available for people with permanent conditions, Griffiths said.

Prescription opioids are rarely given to patients in Europe, although prescription fentanyl consumption grew from 1.66 to 2.77 DDD/1000 population/day in Spain between 2010 and 2021, according to the Spanish medical agency.

The illegal drug market is also different in Europe. The terrain [in the US] it was primed for the illicit drug market, and then some Mexican drug trafficking organizations got into fentanyl production because of the benefits attached to it, Griffiths said.

But that doesn’t mean we should be complacent. In the future, there may be the possibility of seeing more synthetic opioids in Europe’s illicit drug markets, Griffiths said. Synthetic opioids such as fentanyl are easy to produce and highly profitable.

There are many reasons why these could be attractive to organized crime groups and gangs if there is a sufficient market, if market dynamics change, Griffiths concluded.