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The drug-overdose capitals of Europe – The Economist – 12.06.24

Will synthetic opioids take root across the region?


FOR YEARS European authorities have worried that a drug epidemic on the scale of America’s opioid crisis would arrive at the continent’s shores. Drugs like fentanyl, a synthetic opioid 50 times more powerful than heroin, are estimated to kill around 70,000 Americans every year. Europe has, so far, managed to escape fentanyl’s grip. Universal health care throughout much of the region means that most patients are able to treat the source of their pain, instead of turning to addictive medical opioids for a quick fix. But their uptake is greater in some European countries than others. This year’s report by the EU’s European Monitoring Centre for Drugs and Drug Addiction shows where drug overdoses are estimated to be happening most frequently, and the extent to which opioids are responsible.



Map: The Economist


The report found that Ireland faces the deadliest drug problem, with fatalities around three-times higher than the region’s average. Estonia, which has been ravaged by opioids and other drugs, is close behind (see map). Drugs are estimated to have killed around 6,400 people in the EU in 2022, the latest year for which data are available, though the true number will be higher. (Some countries, including France, have not reported their data for several years, and the report does not include deaths where drugs may have been a factor, such as in traffic fatalities.)


Assessing the specific role of opioids is harder still. Some newer classes of the drug, such as nitazenes, may not be detected in routine post-mortems in some countries. Provisional data from Estonia, for example, show that nitazenes were present in almost half of all drug-related deaths in 2023, up from 39% in 2022. The country did improve its testing methods over this period, which probably helps to explain the rapid increase. The way in which countries study data on drugs can differ across the region, limiting the opportunity for cross-country comparisons. (The EU is launching a new drugs agency this year, tasked with better assessing and managing the situation.)


Map: The Economist


Based on the information available, the report found that opioids (usually taken with other substances) are the most common cause of drug-induced deaths in the EU. In 2022 they were responsible for more than three-quarters of fatal overdoses. In Denmark, Austria and Bulgaria, opioids—including heroin and synthetic forms—made up more than 90% of all drug-related deaths. Where the data can be broken down by the type of opioid that was used, Germany had the largest number of deaths from fentanyl and its derivatives, followed by Lithuania and Denmark.


The good news is that the situation appears stable: the report found that the number of deaths that involve opioids has changed very little year on year. Mortality from all drugs has also barely budged, although the demography of the dead is shifting: between 2012 and 2022 the number of overdoses among those aged 50-64 increased by two-thirds. Ageing addicts are now the most affected group across the region (see chart).



Chart: The Economist


Europe could still face its own opioid crisis. The region’s taste for heroin may be a harbinger. Nearly all of Europe’s supply originates from poppies in Afghanistan. Production cuts by the Taliban are expected to severely limit the availability of cheap heroin in Europe this year.


Drug gangs are expected either to mix fentanyl into their remaining supply of heroin, or sell the synthetic drug as a replacement. In the early 2000s a similar shortage of heroin led to an uptick in fentanyl use in Estonia.


Last year Antony Blinken, America’s secretary of state, warned his European counterparts that either they already had a problem with fentanyl-like drugs but had not woken up to it yet, or they would soon have one. The switch from one type of opioid to another can be sudden, and the EU’s patchy data will make it harder to track and trace new pockets of addiction if the drug spreads through the bloc. ■



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