Will Europe Escape America’s Opioid Death Crisis?

On Friday July 7 in Evesham, a quiet English market town south of Birmingham, ambulances were called after two men were found collapsed in the public toilets of a local park. Dying from what paramedics presumed was heroin, the men were jabbed with naloxone, the opioid overdose antidote, with no success. It was only after multiple doses of naloxone that they started breathing again. Two days later, on Sunday morning, another man, in his 30s, was found in a playground in the same park, but this time it was too late. He had overdosed and died. 

All three people had unwittingly taken nitazenes, a group of synthetic opioids more potent than fentanyl which have already hit America but which are now on the rise in the U.K. and Europe. The cases were part of a bubble of 20 overdoses in the area after dealers travelling from Birmingham sold a batch of heroin containing nitazene, a drug developed in the 1950s as an opioid analgesic but which was never approved to market. 

Health experts told VICE News that nitazenes have been linked to at least 100 deaths so far this year in the UK, and that there could have been many more without the swift use of naloxone. The U.K.’s National Crime Agency (NCA), which is “proactively monitoring” the threat posed by synthetic opioids, this week confirmed 57 deaths from nitazene over the last six months. There have been regional overdose spikes – where heroin has been cut with the drug – in the West Midlands and Belfast, alongside sporadic deaths around the country.

Michael Linnell, a drug expert who co-ordinates DrugWatch, a network which monitors drug trends, said indications at the moment are that the adulteration of heroin is “sporadic and has involved a range of different nitazenes, indicating adulteration and cutting has taken place at a local level.”

Nitazenes have also been popping up in black market opioid and benzo pills., sometimes mixed with the potent tranquilliser xylazine, which has been connected to a significant spike in overdoses in the U.S.. In October, police unearthed  150,000 nitazene pills, the largest ever seizure of synthetic opioids in the U.K., at a home drug production lab in north London. They believe the gang were importing the opioid before mixing it with cutting agents, pressing and repackaging it into pills and selling it on as other drugs.

This is not just happening in the U.K.. In November heroin laced with nitazene sparked a wave of 57 overdoses in just three days in Dublin before dealers pulled the product off the streets. Last week there were eight overdoses linked to the drug in Cork. A spate of nitazene poisonings were recorded in the spring in the Occitania region of southwest France. 

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These drugs have been on the rise in in Europe’s northeast corner – in Estonia, Latvia and Lithuania – since 2021. Preliminary data from the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) suggesting that in 2023 nearly half of all opioid deaths in Estonia were linked to nitazene, compared to around 10 percent just two years ago. The EMCDDA said a mobile lab making fentanyl and carfentanil, one of the most potent opioids around, was unearthed in Latvia earlier this year.    

Public health experts in the U.K. and across Europe are nervously looking west, at the massive death toll from North America’s opioid crisis, and east towards Afghanistan, where the Taliban is doubling down on its promise to stamp out the largest heroin production industry in the world. They fear that if Afghanistan’s heroin trade is effectively shut down, drug traffickers to Europe will be forced to supply far more deadly synthetic opioids instead, opening the door to a North American drug poisoning epidemic.  

But, despite the jump in the presence of synthetic opioids in the U.K. and Europe, so far the continent has a long way to go to reach the level of carnage being caused by such drugs across the Atlantic. 

In the United States 75,000 deaths, almost three quarters of all drug deaths, were linked to synthetic opioids in 2022. In Canada 1,060 people died due to fentanyl in the first three months of 2023. But in the U.K. and Europe, an area with roughly twice the population of North America, there were around 200 confirmed fentanyl deaths in 2021. In the U.K. deaths from heroin and methadone (1,876) dwarfed deaths from fentanyl (58). 

Yet with the long-standing source of all of Europe’s and most of the world’s heroin now under threat in Afghanistan – coupled with a steep rise in the production of powerful synthetic drugs in underground labs and unregulated factories across the planet – two questions arise. 

Why have the drug trafficking gangs who supply Europe’s highly lucrative heroin markets so far refused to copy what the Mexican cartels began doing in America 10 years ago by swapping out heroin for far cheaper synthetic opioids? 

And what are the chances that Europe – and the wider world – will escape a global opioid death epidemic involving hundreds of thousands, and potentially millions of fatal overdoses? 

To understand why Europe has not followed the U.S. so far you have to look at the difference between the criminal gangs supplying drugs in these areas, according to Ruggero Scaturro, senior analyst at the Global Initiative against Transnational Organized Crime (GI-TOC). 

“You ask why heroin traffickers from this side of the world haven’t followed the example of the Mexican cartels. But my question is, why should they? Because the way North America is supplied with drugs is totally different from how it works in Europe, and the traffickers, the criminal actors involved, they're also totally different.” 

Scaturro says the key players in the supply of heroin from Afghanistan into Europe and Russia are ethnic groups and clans based in the Balkans in south eastern Europe, mainly from Albania, North Macedonia, Bulgaria, Serbia and Turkey, who have been smuggling drugs for generations.

“To these criminal networks, smuggling heroin has always always been their business and it's always going to be their business, simply because it's a very well functioning machine. There is no need for these traffickers to find alternative ways. The heroin is there, the demand is there. They use a heroin trafficking corridor which has resisted all attempts to police it. Why upset the equilibrium?”

Heroin supply to North America has historically been much more sporadic, either supplied via Southeast Asia’s Golden Triangle 6,000 miles away or via the Mexican cartels, for whom heroin trafficking has become rapidly declining interest.

Scaturro says the decision, or not, to shift to synthetics is also about logistics. For the Mexicans, fentanyl or its precursors are easy to ship from China. For Europe’s traffickers, all the heroin they need comes into Turkey, which sits on the edge of Europe. And, just because Mexican chemists are adept at synthesising and dealing with opioids such as fentanyl, does not mean Europe’s heroin trafficking gangs have the know-how. 

What could jolt this status quo is the Taliban, who are in the process of stamping out the livelihoods of hundreds of thousands of Afghans involved in the country’s opium economy. These opium farmers and traders are, bizarrely, the biggest barrier to Europe being assailed with deadly synthetic opioids. But this month the UN announced the Taliban’s increasingly strict drug trade clampdown has reduced opium cultivation in the country by 95 percent in less than a year.

Traffickers are not panicking yet. There are huge stores of opium and heroin, from the fields of Afghanistan all along the trail to Europe, in Pakistan, Iran, Turkey, and in the Balkans. And at the moment the Balkan heroin route is something of a safe space for smugglers to operate within. 

“All the attention is towards the wars in Ukraine or the Middle East. With Turkey, Bulgaria and Albania, there is a natural corridor in between wars, which is ideal for traffickers,” says Scaturro. 

In fact, according to Scaturro’s research, Russia’s war in Ukraine has indirectly resulted in fresh supplies for Europe. The heroin which would usually end up being shifted north to Ukraine to supply its 350,000 heroin injectors, and into Russia, has either been diverted to Western Europe or remains in the Balkans, Turkey and Iran. As a result of the war, street heroin prices in Ukraine have rocketed, and drug users have pivoted to black market opioid addiction medicines such as methadone and buprenorphine. Meanwhile, heroin prices in the Balkans and Europe are stable. In the U.K., where a 0.1 gram bag of heroin costs as always £10 ($12.55 US), purity has been gradually falling over the last 5 years, but this is independent of the Taliban’s policy changes.

However, stores of heroin are finite, and the wholesale price of opium in Afghanistan has been increasing rapidly since the ban. If the Taliban continues its opium clampdown, a major worldwide heroin drought is a possibility within the next two years. 

How the big drug suppliers, heroin users and governments will react is hard to predict, although a wholesale swap of heroin for synthetic opioids in Europe, as is happening in North America, is not inevitable.

Of course, some trafficking gangs, with the help of imported Mexican chemists, could follow the U.S. model and start pumping out synthetic opioids to heroin users in order to fill the gap in supply. Others may opt to stick with the real thing, and look towards the rejuvenated opium trade in the Golden Triangle - where the jungle borders of Myanmar, Thailand and Laos meet – for a fresh source of heroin. In this lawless zone, also the world’s biggest producer of methamphetamine, poppy cultivation, once its biggest trade before the rise of jungle meth labs, is already back and booming.  

It could also be the case that, faced with a serious shortage of their usual drug and without a regular supply of synthetic opioids, heroin users may switch to an array of other drugs such as illicit tranquillisers, opioid medicines, methamphetamine and crack cocaine, as they did in previous heroin droughts in the U.K. in 2010 and Australia in 2001. 

Experts say that countries in Europe, particularly the U.K., are much better firewalled against a synthetic opioid death epidemic than the U.S., and this is not just because they have learned lessons.

“The U.K. and U.S. contexts are very different,” says Charles Yates, deputy director of the NCA. “The opioid crisis in the U.S. was initially caused by widespread overprescription of opioids for chronic pain, which substantially increased the numbers of people exposed and addicted to opioids. This is not a major concern in the U.K.”

Bryce Pardo, a drug trends expert at the UN’s Office on Drugs and Crime, says Western Europe generally has better health and social services than in the US, meaning better treatment for drug users. 

And, unlike the Mexican cartel-run fentanyl labs, there are currently no big producers of synthetic opioids in or near Europe. “Whereas the U.S. is right next door to Mexico, Europe lacks a major producer with sufficient continent-wide distribution networks on its borders that is capable of rapidly scaling up production,” says Pardo.

What’s more, North America’s opioid using market is much younger than Europe’s, so the drug dealers’ rule of ‘don’t kill your customer’ becomes more of a dilemma in Europe, where heroin users are older and more vulnerable. Lastly, Europe is a powder heroin dominated market, and less accustomed to opioid tablets compared to North America, so the spread of synthetic opioids in pills would, it is hoped, be restricted to a much smaller population.

Worryingly though, in the last two years in the U.K., there has been a rise in people dying after experimenting with online bought oxycodone and valium pills which contained nitazene, causing 24 deaths in 2021. One of them, 18-year-old Will Helstrip, bought what he thought was valium on the dark web to help him get to sleep, but the pills contained a nitazene.  

What could prove to be a crucial tipping point in the expansion of synthetic opioids in Europe, is a generational shift in opioid users, says Paul Griffiths, Scientific Director at the EMCDDA. 

“We're not seeing much new initiation of heroin use in Europe. So in 5 to 10 years from now, simply due to ageing, as heroin users get older and more vulnerable, we're not going to have much of an opiate problem left, and in some ways that could be viewed as a protective factor, because there will be no market for synthetic opioids,” says Griffiths. “We know we have labs in Europe making amphetamines and methamphetamine, but the reason they are not making synthetic opioids is because there is no market for them among Europe’s ageing heroin using population. 

“The nightmare scenario is that if we start seeing more synthetic opioids around because of a heroin drought. This first wave of synthetic opioids could hit the established heroin using population. But down the line, you might then see opioids appearing in other forms and preparations, such as pills, that could then potentially become popular among younger age groups who are currently do not appear attracted to injecting heroin. The lesson we learned from the US is that these markets can be dynamic and change rapidly. We really wouldn't want to be blindsided by a new opiate using population in two, three or five years time. That could have disastrous consequences for public health.” 

Griffiths admits there needs to be more forensic testing of drugs being carried out in Europe. “We need to be prepared to mitigate the threat of synthetic opioids such a nitazenes and fentanyl. We don't monitor them sufficiently well. We need to get better at more quickly working out what's going on in the opioid market,” he says.

This is why, as part of the EMCDDA’s relaunch next June as the newly formed European Union Drugs Agency, which will include some of the functions that exist in the U.S. Drug Enforcement Administration, with a new forensic toxicology laboratory network planned that will provide greater capacity to track trends in the synthetic opioid market

But Griffiths warned that the threat of synthetic opioids replacing heroin goes wider than Europe. A heroin drought could have big ramifications for large heroin-using populations in Asia, such as Iran, Pakistan and India – a country with an estimated 28 million opioid users.

As VICE News has previously mentioned, the West and the wider world too, faces a dilemma. 

It could well be the case that a thriving Afghan opium and heroin trade – for so long the bete noire of governments across the globe – is the only barrier to a global opioid death epidemic sparked by synthetics such as fentanyl and nitazene. 

Yet, with the shifting tectonic plates of the global drug market indicating a gradual move away from plant based drugs to far cheaper and more potent synthetic substances made in labs, the rise of this chemical soup of Frankenstein narcotics may happen regardless of what the Taliban decide to do. 

On a positive note, says Linnell, the U.K. drug expert, “in nearly 40 years of working in the drugs field, I think this is the most prepared we have ever been to a potential threat of adulteration to the heroin supply”. This, he says, is due to better information collection and sharing, carrying of naloxone by the police and medics, and treatment services providing rapid access to substitute prescriptions. 

Perhaps though, the only barrier to the further proliferation of this plethora of unpredictable substances would be to wrestle the drug market from chancers and organised criminals and regulate it as best we can. Because if nothing is done, the world’s drug menu, especially for the poorest, will only descend into a mire of synthetic highs which will make heroin, mushrooms, cocaine, and weed look like benign friends from a distant past.