Commentary
Fentanyls: Are we missing the signs? Highly potent and on the rise in Europe

https://doi.org/10.1016/j.drugpo.2015.04.003Get rights and content

Abstract

Fentanyl is a synthetic opioid analgesic historically used as a pain reliever and an anaesthetic. Recent concerns have arisen around the illicit use of fentanyl and its analogues in a number of European countries, linked to their high potency and associated risk of fatal overdose. Evidence has been emerging from Estonia for over a decade of entrenched patterns of fentanyl use, including injection of the drug and hundreds of overdose deaths. More recently, reports indicate that both fentanyl and 3-methylfentanyl (TMF) have been marketed as a replacement for heroin in European countries (e.g. Bulgaria, Slovakia) affected by heroin shortages. In addition, Germany, Finland and the United Kingdom, reported new outbreaks of fentanyl-related deaths. This combination of increasing mortality data alongside law enforcement intelligence suggesting both diversion and illicit production of fentanyls, prompted wider investigation using a targeted multi-source data collection exercise and analysis. This identified that in the European context, fentanyls are ‘low use but high risk/harm’ substances. Evidence shows that Estonia stands out as having an endemic problem, while the use of fentanyls in other European countries appears to be geographically localised. Developments in illicit supply of fentanyls reflect the complexity of Europe's contemporary drug market: manifesting illicit production and use, the diversion and misuse of medicines, and the online sale of non-controlled new psychoactive substances. Likewise effective and integrated responses will need to address fentanyl production, diversion as well as ensuring the availability of harm reduction measures to users.

Section snippets

Key points

  • Fentanyl is a synthetic opioid analgesic historically used as a pain reliever and an anaesthetic.

  • Recent concerns have arisen around the illicit use of fentanyl and its analogues in Europe, linked to their high potency and associated risk of fatal overdose.

  • The illicit supply of fentanyls onto Europe's drug market includes illicit production, the diversion of medicines, and the online sale of non-controlled new psychoactive substances.

  • In Europe, Estonia stands out as having an endemic problem,

Fentanyl in Europe

Fentanyl is a synthetic opioid analgesic acting predominately at the μ-opiate receptor. It has historically been used as a pain reliever and an anaesthetic in both human and veterinary medicine and in terms of analgesic activity it is at least 80 times more potent than morphine. Fentanyl was first synthesized by Paul Janssen in 1960 and marketed as a medicinal product for treating pain. Subsequently, many fentanyl analogues were developed including sufentanil, alfentanil, remifentanil, and

Acknowledgements

The authors would like to thank the many contributors to the EMCDDA Trendspotter study and meeting on Fentanyl in Europe which this article in part summarises. This includes the invaluable contributions made by external experts, EMCDDA scientific staff and the Reitox network of National Focal Points.

Conflict of interest statement: The authors confirm that there are no known conflicts of interest.

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