Will synthetic opioids become a bigger drug problem in Europe?

Synthetic opioids have caused a major public health crisis in North America, prompting growing concern in Europe that they could play a larger role in future drug‑related harm. This concern is driven less by fentanyl, which has been central to the North American experience but does not currently feature prominently in Europe. Instead, it reflects recent outbreaks of overdose and death in a growing number of European countries linked to highly potent benzimidazole (“nitazene”) opioids. It also relates to a longer‑established but evolving problem associated with synthetic opioids in the Baltic region.

All seven new opioids reported to the European Union’s (EU) Early Warning System in 2024 belonged to the nitazene group, which is now the class of synthetic opioids generating the greatest public and policy concern, with confirmed detections in at least 21 countries. The emergence of this novel class of highly potent opioids coincides with speculation about potential disruptions to heroin supply in Europe, raising the possibility of increased demand for synthetic substitutes. However, this outcome remains speculative. Future opioid trends remain difficult to predict within a highly dynamic drug market currently oriented toward other substances. Yet, synthetic drugs of all types, including novel synthetic and pharmaceutical opioids, have the potential to play a more prominent role.

The North American experience provides a cautionary example of how opioid use patterns can change rapidly, with serious implications for public health. However, future opioid trends in Europe are unlikely to mirror the trajectory seen in the United States, where liberal prescribing of pharmaceutical opioids helped create the conditions for an expanded heroin market that was later supplanted by synthetic opioids such as fentanyl. The European drug market operates under markedly different dynamics, with distinct patterns of use, supply chains, and policy responses. As a result, lessons drawn from North America may be of limited value in predicting the future trajectory of synthetic opioid harm in Europe. An important caveat is that opioid-related harm in both regions has disproportionately affected socially marginalized populations. Any future deterioration in Europe’s economic situation may therefore create conducive conditions to increased opioid use and associated harm.

Heroin still defines opioid problems in Europe, but its use has been declining 

The EU typically reports around 6,000 to 7,000 “drug-induced deaths” a year, with an opioid being implicated, usually alongside other substances, in around two-thirds of these. Even accounting for the higher rates reported by the non-EU countries like the U.K., and underreporting issues in some countries, overall opioid mortality clearly remains much lower in Europe than in the United States, as evident from the dramatic differences found in age-adjusted estimates of overdose risk.  

The disparity in opioid mortality rates is partly driven by variations in underlying opioid use, which is much more widespread in North America than in Europe. However, different patterns of opioid consumption are also a factor. Since the 1990s, when many countries experienced a surge in opioid use, heroin has traditionally played a central role in Europe’s drug landscape. This remains the case today, but the population of heroin users in Europe is aging, rates of injecting drug use have declined, and there is little evidence of substantial new recruitment into this behavior. These developments have occurred even though heroin availability has remained relatively high, suggesting that demand-side factors, rather than supply constraints, are likely to be important drivers of change here.

In contrast to the North American experience, European opioid problems appear to either be stable or diminishing. Yet there has been a marked increase in the availability and use of cocaine, and various non-opioid synthetic drugs have become more important. These changes are mirrored in European policy priorities toward drug supply, which in recent years have placed greater emphasis on tackling large-scale cocaine and other drug imports via maritime ports, addressing the growth of synthetic drug production in the EU, and responding to rising organized crime and violence linked to these developments.

Nonetheless, heroin‑related problems persist in Europe, reflecting the chronic nature of opioid dependence. Many countries continue to grapple with the needs of a long‑established and aging population that developed dependence through heroin use and is becoming increasingly vulnerable over time. In overall terms, heroin likely remains the substance most frequently associated with fatal opioid overdose, although it is rarely reported in isolation. However, examination of national data indicates that methadone and other synthetic opioids used in opioid agonist treatment are now as commonly—and in many countries more commonly—implicated in drug‑related deaths as heroin. This highlights both the need to strengthen measures to reduce diversion of opioid substitution medicines and, given the protective effect of treatment engagement, to expand access to opioid agonist treatment for those in need. More broadly, this pattern may also reflect the long‑term impact of widespread opioid substitution treatment in displacing illicit heroin use and dampening demand. Estimates of treatment coverage vary widely across Europe, ranging from around 10% to 80%; overall, approximately half of people with opioid problems receive some form of opioid agonist treatment within the EU, a level that is high by international standards.

Other than heroin and the opioids used for agonist treatment, synthetic opioids do not figure predominantly in the available European data on overdose toxicology, prevalence, or availability. There are ongoing concerns that problems associated with the diversion of opioid pain medications may be increasing in some countries; however, the overall level of harm still appears relatively low. That said, these substances are still more prominent in the data than fentanyl and other highly potent, newer synthetic opioids, for which all the available data suggest lower levels of use and associated harm. It is striking to note, for example, that while fentanyl in North America is associated with many tens of thousands of annual overdose deaths, typically in the EU, only around 160 fentanyl related deaths are recorded annually. Moreover, a significant proportion of these are associated with fentanyl diverted from medicinal sources, a small but long-established problem in parts of Europe.

Synthetic opioid problems may rise

Available data suggest that Europe continues to face residual challenges in responding to heroin‑related problems and in more effectively addressing the diversion of opioids intended for therapeutic use. Overall, however, there are grounds for cautious optimism regarding the effectiveness of existing approaches. The relative stability—and in some cases decline—of opioid‑related harm in Europe can reasonably be attributed to a combination of robust supply‑reduction measures, widespread availability of harm‑reduction interventions, and high levels of access to opioid substitution treatment, supported by ongoing monitoring of drug markets and associated risks. While underinvestment in treatment and related services remains a concern in some countries, the broader picture suggests that, with continued investment, future opioid trends in Europe are more likely to decline than escalate in terms of harm. Nevertheless, there is growing concern that this optimistic assessment may have been premature.

Could heroin shortages potentiate market adaptation?

An important caveat to the relatively positive European picture presented above is the atypical situation observed in the Baltic region. After 2000, when the Taliban banned opium production in Afghanistan—the principal supplier of heroin to the European market—there was a short yet significant disruption in heroin supplies. While most European countries saw their heroin markets recover relatively quickly, this was not the case for the Baltic states and some Nordic countries. Estonia experienced a notable shift from heroin toward fentanyl; subsequently, a range of fentanyl analogues became the predominant opioids available in the illicit market. Over time, this transition impacted other regional countries and was linked to a significant rise in opioid-related harm. From 2019 onward, nitazenes, sourced from China, replaced fentanyl on the Estonian market, and this class of opioids has since become established in both Estonia and Latvia. In Lithuania, nitazenes are reportedly available; however, carfentanil—likely originating from Russia—has emerged as the most frequently encountered opioid.

Although fentanyl and other synthetic opioids have caused significant harm in the Baltic region, these markets are relatively small and thus have a limited impact in numerical terms on broader European trends. Nonetheless, this region’s experience provides an example of how synthetic opioids can rapidly enter the market, become established, and escalate harm following a reduction in heroin supply.

This observation is causing alarm in Europe for several reasons. First, although high‑potency synthetic opioids have not to date featured prominently in European drug surveillance data in terms of case numbers, this does not imply that they are absent or not causing harm. The emergence of uncontrolled and often highly potent new opioids has been repeatedly reported through the EU’s early warning system on new psychoactive substances. The European Union Drug Agency (EUDA) identifies two distinct waves of synthetic opioids in Europe: between 2012 and 2019, 38 new and uncontrolled fentanyl derivatives, primarily sourced from China, were detected and linked to an estimated 285 deaths; since 2019, following China’s introduction of regulatory controls targeting fentanyl derivatives, highly potent benzimidazole (nitazene) opioids have emerged.

While nitazenes currently only account for a substantial share of national-level drug‑related mortality in Estonia and Latvia, outbreaks of fatal and non‑fatal overdose are increasingly being reported elsewhere. Harm may also be underestimated, as nitazenes are not routinely detected in postmortem toxicology in some European countries. These substances have been sold as heroin, mixed with heroin, or marketed as “synthetic heroin,” but have also appeared in tablet form, including counterfeit opioid analgesics and benzodiazepines, potentially exposing a wider population of opioid‑naïve consumers. Occasional detections of nitazenes combined with xylazine or benzodiazepines, patterns previously observed in North America, further increase toxicity risks and complicate overdose prevention and response.

Even at a low prevalence, the emergence of a new class of highly potent synthetic opioids is a clear concern for European policymakers—especially as some nitazene-related overdose outbreaks have involved multiple cases, threatening to overwhelm local responses and generating considerable public concern. However, since 2023, a dramatic fall in Afghan poppy cultivation after a new Taliban ban has raised concerns that Europe may face a new heroin drought, potentially driving a significant rise in synthetic opioid use, including nitazenes and fentanyl derivatives. While people who use heroin might initially be most vulnerable to transitioning to synthetic opioids, the variety of forms these drugs are available in could make them attractive to a younger generation of polydrug consumers who do not currently use heroin or inject drugs. From a public health perspective, the possibility of this kind of proliferation would be extremely worrying.

At present, most new synthetic opioids identified on the European market are believed to be sourced from China. Yet there are indications that other countries, including India and Russia, may also be playing a role. Although some nitazene supply has been reported to occur via darknet markets, distribution more commonly appears to occur through direct contact with suppliers using messaging services, linked to advertisements placed on legitimate trading and social media platforms operating across multiple jurisdictions. This market dynamic is sustained by suppliers exploiting gaps across national regulatory frameworks to circumvent controls, often routing transactions through intermediary companies and/or countries. These substances’ high potency makes them easy to conceal and transport, with relatively small volumes shipped via commercial parcel and postal services.

China’s introduction of stricter controls may have had some impact on the types of synthetic opioids emerging in Europe. For example, following restrictions imposed on 10 nitazene compounds in 2024, the EUDA reported a “small but significant” increase in detections of benzimidazole “orphine” family opioids in its 2025 analysis. Regardless, there is no strong evidence that recent regulatory measures have resulted in an overall reduction in the availability of nitazenes in Europe, and advertisements that appear to be linked to Chinese companies have continued to appear.

Synthetic opioid production could also occur in Europe should market conditions become favorable. There are relatively low barriers to manufacturing these substances, particularly given the continent’s established capacity to produce a wide range of synthetic drugs for both domestic consumption and export. While synthetic opioid production has occasionally occurred in Europe, it has not become a major component of the overall supply of synthetic opioids to date. Nonetheless, increased demand could plausibly lead to growth in domestic production, and several recent detections of production sites in Europe are concerning in this regard. For example, in 2024, Latvian authorities dismantled a clandestine laboratory producing multiple synthetic drugs, including fentanyl analogues. Similarly, the reported seizure of 195 kilograms of crystal methadone in Poland illustrates the ability of criminal groups involved in synthetic stimulant manufacturing to pivot toward synthetic opioid production. It also highlights the emergence in parts of Eastern Europe of an illicitly produced, high-potency form of an opioid drug more commonly known for its therapeutic uses.

Preparedness is warranted, but the future appears quite uncertain 

Since there is a real threat of increased synthetic opioid use in Europe, with potentially significant impacts, it is prudent to prepare for such an eventuality. Beyond this, highly potent synthetic opioids are now appearing on the European market—a development that demands a response, even if the scale of the problem remains relatively small in most countries compared to other classes of drugs. Moreover, organized crime groups could face incentives to begin supplying synthetic opioids to the illicit market. Supplying these drugs reduces the risks associated with trafficking bulky cargoes along long supply routes and across multiple national borders, and it also creates opportunities for new players who don’t possess the capabilities to import plant-based drugs from distant countries to enter the market.

These arguments also apply to other synthetic substances, particularly those that currently dominate European consumer demand. Synthetic cathinones, ketamine, synthetic and semi-synthetic cannabinoids, high-potency MDMA, and even methamphetamine are all arguably equal concerns in respect to the current European drug landscape. More generally, Europe is also experiencing what appears to be an ever-escalating problem with respect to the availability and use of cocaine, and harms associated with this drug are becoming both more apparent and more widespread.

It is also far from clear that a heroin shortage will expand the market for synthetics. The European heroin market is long-standing and has proven resilient in the past. Although there may have been some minor local disruption, Europe has thus far escaped a heroin drought, and this outcome may be becoming less likely. Up until now, it is thought that opium stocks have sustained the European market, even though production restrictions have been rigorously enforced. However, there are signs that a combination of external and internal factors is increasingly straining the Taliban’s opium ban. Production appears to be increasing in more remote areas and would have increased further if not for a recent drought. In addition, there is also growing evidence of a diffusion of poppy production to neighboring countries, most notably Pakistan. And while logistical and other factors make Myanmar an unlikely source of heroin for the European market—despite U.N. Office on Drugs and Crime estimates that opium production there is increasing—a handful of recent seizures suggest that some heroin sourced from the country is now entering Europe.

The future may be uncertain, but synthetic drugs will play a greater role

The profitability and logistical advantages of producing synthetic drugs close to consumer markets, using a wide range of precursor chemicals and synthesis routes, mean that they are likely to play an increasingly prominent role in global drug problems. Accordingly, harms associated with synthetic opioids, alongside other synthetic substances, are likely to grow in Europe. However, in the absence of a heroin drought, any increase is unlikely to be sudden, and even under worst‑case conditions, it is unlikely to reach the levels observed in North America. Based on the current drug situation, a stronger case can be made that other synthetic drugs, particularly stimulants, together with the unprecedented availability of cocaine, are more likely to drive increases in drug‑related harm in Europe in the short to medium term. Looking further ahead, and considering the cyclical nature of past opioid epidemics, it would be prudent to expect synthetic opioids to play a growing role in Europe’s drug market. Policymakers must remain vigilant for signs of increasing interest in this group of substances, particularly among younger-age cohorts or within other groups or settings not previously associated with their use.