The synthetic opioid fentanyl was first synthesized in Belgium around 1960. With effects similar to those of morphine but a potency 100 times higher, it became widely used in surgeries and the treatment of chronic painful diseases. Meanwhile in the United States, unregulated and unprescribed fentanyl became a highly addictive and dangerous illegal drug—one that is 50 times stronger than heroin, with even a 2 milligram dose proving to be lethal to most people. But drug policy experts and government officials agree that there has not been a fentanyl crisis in Europe, its place of origin—at least, not until now.
In 2022, more than 70,000 people died in the U.S. of synthetic drug overdose, according to estimates made by the country’s Centers for Disease Control and Prevention. By contrast, in Europe, the latest data from the European Union’s drug monitoring agency shows that 137 people died of drugs of fentanyl’s ilk in 2021, with most of those deaths coming from diverted fentanyl medicines rather than illicitly manufactured substances. Last year, the U.S. Drug Enforcement Agency reported that it seized more than 79.5 million fentanyl-laced fake pills and nearly 12,000 pounds of fentanyl powder. Such confiscations in Europe, although rising recently, have been sporadic.
But European governments are increasingly fretting that fentanyl and similar synthetic opioids may grip the continent and plunge it into a U.S.-style crisis. Late last year, U.S. Secretary of State Antony Blinken told his European counterparts that they either have an undiscovered problem with fentanyl or may have one soon. And scattered signs that the lethal drugs may be starting to spread into the continent are now prompting governments to act.
There are several reasons for the rising fears about fentanyl in Europe. The European Union estimates that most of the roughly 1 million European consumers of illicit opioids use heroin. So far, almost all of that supply has come from Afghanistan. But beginning in April 2022, the Taliban banned “poppy cultivation and all types of narcotics,” and as a result, the area where poppy flowers—from which opium is produced—are grown in the country shrank by 95 percent last year, according to a November 2023 report by the United Nations Office on Drugs and Crime. This has drastically reduced the supply of quality heroin coming out of last year’s harvest.
Facing the shortage, criminal groups are expected to either start supplying heroin mixed with other synthetic opioids such as fentanyl to increase its strength, or to replace it altogether with fentanyl.
“The experience in North America with fentanyl overtaking heroin in major drug markets is illustrative of how a cheaper and readily available synthetic opioid can easily displace heroin,” wrote researchers in the United Nations Office on Drugs and Crime report.
European authorities are already seeing signs that organized crime groups are eyeing the trade of these opioids in Europe. The Italian secret services found that the powerful Calabrian ‘Ndrangheta mafia, which has been flooding Europe with cocaine over the past decades, is testing the fentanyl market in the continent, senior Italian government official Alfredo Mantovano said in March.
Another major concern is that Europe has an existing lab capacity to produce synthetic drugs on its soil. Europol, the European Union’s police agency, said this month that synthetic drug production and trafficking has expanded from mainly Belgium and the Netherlands to Eastern Europe, including Ukraine. In 2021, European authorities dismantled 434 laboratories producing illicit synthetic drugs, according to the latest data published by the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA). 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.
“To be frank, I don’t see how we can avoid it in Europe. I don’t see why criminal networks would avoid selling fentanyl in Europe. The question for me is not if it’s going to touch Europe; it’s when and how big the wave or the hurricane will be. European governments are fully aware of it,” said Pierre Lapaque, a board member of the International Narcotics Control Board, in an interview with Foreign Policy.
The European effort to prevent a potential outbreak of addiction to these drugs has happened on two levels. On the one hand, the continent is reinforcing and adapting its fight against producers and traffickers, including precursors (the substances used as ingredients in drugs). On the other, it is preparing on the health care front to prevent overdose deaths.
One key measure has been the creation of a new drug agency for the bloc, turning the EMCDDA into a full-fledged agency called the European Union Drugs Agency. This new EU-wide body, which becomes operational in July, will carry out health and security assessments on synthetic drugs, closely monitoring any developments across the bloc and helping with the adoption of countermeasures. The new agency will also monitor drug precursors and set up a network of laboratories to identify new substances and define possible trends in the synthetic drug market.
The European Commission, the EU’s executive arm, also plans to speed up and broaden the way that drug precursors are scheduled in order to prevent criminal networks from finding new ways to get the chemical substances needed to produce illicit drugs. It is also seeking to improve checks at European ports. To this end, it has earmarked more than 200 million euros (about $214 million) to fund modern kits for scanning containers for hidden drugs or precursors.
“We are seeing what is happening in the U.S., and we are monitoring any development in the EU to make sure we can anticipate and disrupt any production or trafficking activities of these drugs,” said Claire Georges, Europol’s deputy spokeswoman. The EU police agency is working with the United States to get a better intelligence picture of which criminal groups may be involved.
“Those are the right responses,” said Vanda Felbab-Brown, a senior fellow at the Brookings Institution. “This is in striking contrast with what, until several months ago, was the attitude of many European drug policy experts, who would often say ‘Look, we are not going to have a fentanyl problem because we didn’t have the same initiation through pharmaceutical opioids.’ I was always very uncomfortable with that answer.”
The EU is also seeking to boost cooperation with China, a major producer of fentanyl and its precursors. Chinese representatives held talks in Brussels on April 23 on illegal drug production as well as the diversion and trafficking of precursors and other chemical substances needed to manufacture synthetic drugs.
Collaboration with China is crucial for both the United States and Europe. A 64-page report issued in mid-April by the U.S. House of Representatives’ select committee on China defined the country as “the ultimate geographic source of the fentanyl crisis.” The committee has further argued that China encourages the manufacturing and export of illicit fentanyl chemicals and other narcotics through tax rebates and holds ownership interest in local companies tied to drug trafficking. Additionally, its security services have failed to cooperate with the United States when law enforcement officials requested assistance, according to the report.
European countries are also taking measures at the national level. For instance, Italy has started to monitor the import and export flows of medicines containing fentanyl and the chemical precursors of synthetic drugs, as well as the retail market—including on the web—as part of a national plan against the deadly drug that Rome unveiled last month. At the same time, it plans to equip police officers with portable mass spectrometers to spot synthetic drugs and precursors, both during custom checks and while patrolling the streets.
The Italian Ministry of Health has instructed hospitals and pharmacies to strengthen the protection measures against the theft of fentanyl and similar opioids. It also instructed doctors assisting patients displaying a range of specific symptoms—such as respiratory depression, nausea, vomiting, and vertigo—to consider that they could be intoxicated by fentanyl and could be treated with naloxone, which is an opioid antagonist, or other medicines that can rapidly reverse an opioid overdose. Naloxone will also be provided to the police, who may need it as first responders facing an overdose or after inadvertently inhaling fentanyl during investigations. All ambulances will also be required to carry the medication.
In Spain, where there have been a few instances of drug dealers found with small amounts of fentanyl, some regional authorities are training drug users and emergency personnel on overdose reversal. The national government is also working to speed up the existing warning system on drugs by expanding free drug-checking programs across the country and the testing of wastewater to detect anomalies related to opioids, Joan Villabí, the official in charge of drugs and addiction at the Spanish Health Ministry, told Foreign Policy.
“We are monitoring in a very systematic way. When heroin hit Spain in the late 1970s, we were completely unprepared. It was a disaster,” Villabí said.
Universal medical care may have also protected Europe from a U.S.-style fentanyl crisis. In the United States, many people addicted to fentanyl began with prescription opioids, got hooked, and then when their prescriptions ran out, turned to the illegal market, where criminal rings provided them with the drug.
In the European Union, however, regulated and publicly funded health care systems have maintained a more limited access to prescription opioids, says Esther Gramage, a lecturer at the CEU San Pablo University in Madrid. The access to other procedures to alleviate pain also may have helped keep European patients away from painkillers. But there are growing reasons to fear that public health care won’t be sufficient to shield Europe.