Lisa Hillman

Are synthetic opioids Europe’s next epidemic?

15 January 2025

In 2020, governments were slow to react to an epidemic as it crept westward. Now, potent synthetic opioids are coming to Europe – and, as before, playing catch-up could have deadly consequences.

Last October, the New York Times reported a shocking statistic: fentanyl and other synthetic opioids killed more Americans in 2022 than the 77,000 killed in the wars in Vietnam, Iraq and Afghanistan. That’s more fatalities than guns and automobile accidents caused in their deadliest years.

Fentanyl is between 50 and 100 times stronger than heroin, and much easier to manufacture and distribute. When the Taliban outlawed the growth of opium poppies in Afghanistan – once the source of 90% of the world’s heroin – nimble producers of synthetics quickly filled the vacuum. And business is booming, with one kilogram of fentanyl potentially generating profits of $1 million.

Now, an even stronger class of drugs is on the rise: 2-benzyl benzimidazole opioids, or nitazenes. Hundreds of times more potent than heroin and tens of times more potent than fentanyl, nitazenes are a cheap way to increase the strength of illegal drugs.

Nitazenes have been found in pills sold as anti-anxiety medication (including diazepam), cannabis and even vape liquid. Because of nitazenes’ potency, and because users are not aware that they are consuming them, there has been a recent spike in deaths from the drugs in the UK. Similar overdose patterns have also been identified in Estonia, France, Ireland and Latvia.

One overdose occurred in 2020 when a 19-year-old man from the UK took two pills he’d purchased on the dark web. He believed them to be oxycodone, but they were metonitazenes.

One such overdose occurred in 2020 when Will Melbourne, a 19-year-old man from Cheshire in the UK, took two pills marked M30 that he’d purchased on the dark web. He believed them to be oxycodone, an addictive opioid and anti-anxiety medication, but they were metonitazenes. The coroner’s findings stated that the pills probably shut down his respiratory system and killed him within an hour.

Can Europe prevent an influx of synthetic opiates?

In an effort to combat the use of synthetic opioids, the European Commission announced an anti-drug trafficking action plan in November 2023. The plan aims to ramp up drug-detection technology and equipment at ports, and increase efforts to find and destroy labs that process and manufacture the drugs.

In March 2024, 14 nitazenes were classified as Class A drugs (the most dangerous category) in the UK, with production or distribution of the drug potentially carrying a life sentence. UK officials are also enhancing surveillance and early-warning systems, including analysing wastewater. They hope that deaths can be prevented by tracking opioid use, and distributing naloxone – a medicine that reverses opioid overdoses – to police, paramedics and emergency departments in areas where the drugs are detected.

Because of nitazenes’ potency, and because users are not aware that they are consuming them, there has been a recent spike in deaths from the drugs in the UK.

But changing the class of illegal substances does nothing to keep pace with the rapidly evolving drug market. In the UK, the National Health Service is in critical condition, social determinants of health are moving in the wrong direction, and more than 1 million people are waiting for mental health services. The UK is not alone in this, with many health systems in Europe similarly overwhelmed. So there is every reason to believe that more people will use and abuse drugs – and overdose.

No quick solutions

The most enduring and cost-effective solution to opioid problems is prevention. However, in every country, the causes of addiction are entrenched and complex; addressing them means addressing generations of social and economic ills. There is no silver bullet.

There is some hope that European countries – with their more generous health systems and stronger social safety nets – will be able to avoid death and overdose rates on the scale of the US’s. However, the EMCDDA predicts an EU heroin drought in the next year, which could well lead to a rise in demand for nitazenes and their inevitable successors.

In the face of a rapidly evolving drug landscape, the urgency for policies that are long-term, root-and-branch and forward-thinking has never been greater. Failure to help the most vulnerable will lead to more desperation, more addiction and another epidemic with devastating consequences – but this one will be of our own making.

Are synthetic opioids Europe’s next epidemic?

In 2020, governments were slow to react to an epidemic as it crept westward. Now, potent synthetic opioids are coming to Europe – and, as before, playing catch-up could have deadly consequences.

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Can Europe prevent an influx of synthetic opiates?

No quick solutions

The opinions expressed in this blog are those of the author and do not necessarily represent the views of The Health Policy Partnership.