It is a harsh and painful human accounting, constant in numbers and extensive in the biographies of those who are victims of it. In the last ten years (period for which data are available), i.e. from 2013 to 2022, Italy has recorded 3,148 deaths from overdose: over 300 every year, almost one per day. But there is also a very specific geography, one that takes shape from the periodic reports of the Central Directorate for Anti-Drug Services (DCSA) of the Ministry of the Interior, which locates the dangers in some recurring segments of the country. They are often provincial contexts, far from the spotlight of metropolises, and which in some way are also linked to the most recent alarms.
In relation to the resident population, the provinces of Fermo, Perugia and Sassari are the areas of Italy that have seen the most overdose victims in the last decade. The province of Fermo has in fact recorded 33 deaths in the decade, i.e. 19.7 per 100 thousand inhabitants; Sassari saw 83 lives lost, with 17.5 deaths per 100 thousand inhabitants; there were 111 deaths in Perugia, equal to 17.4 per 100 thousand inhabitants. On the other hand, for example, Milan had 58 deaths (1.8 per 100 thousand inhabitants), Rome 219 (but equal to 5.2 per 100 thousand inhabitants).
Just in Sassari last summer there were five deaths in three days in July, and there the presence of xylazine – a veterinary anesthetic – to cut heroin was ascertained for the first time, so much so that it triggered an alert from the Higher Institute of Health. The alarm is now for Fentanyl, the synthetic opioid that is causing havoc in the United States and which is still not widespread in Italy, but is at the center of a national prevention plan launched by the government in the spring. On 30 April the National Rapid Alert System for drugs was activated because for the first time in Italy Fentanyl was identified as a cutting substance for heroin: it happened precisely in Perugia, precisely one of the areas of Italy where most people die from an overdose.
As if future drug trends could be intercepted in advance among the folds of data. However, the “classic” substances still remain to cause all the overdose deaths in Italy: «According to data from the Ministry of the Interior, opioids such as heroin and methadone, together with cocaine, are the substances responsible for the majority of overdose deaths in 2023″, explains Luca Pasina, head of the Laboratory of Clinical Pharmacology and Prescriptive Appropriateness of the Mario Negri Institute in Milan.
Looking at the last decade, between 100 and 168 deaths per year are attributed to heroin, depending on the peaks, while cocaine causes between 23 and 71, methadone between 9 and 22, and then a few more minute of other substances, from synthetic drugs to psychotropic drugs. Not yet Fentanyl, whose circulation remains limited so far: compared to the USA, Pasina explains, «in Europe and Italy this phenomenon seems to be much smaller in size, with a limited number of victims per year: in the entire European continent there are around a hundred cases per year, while in Italy the number is even lower, with only a few units reported, one death confirmed last year”.
Now, after the recent report from the National Rapid Alert System for Drugs, attention has turned to the use of Fentanyl to cut heroin, as happened in Perugia. But what are the risks of this “combination”? «Since they are two substances from the same family – explains the researcher -, the main risk is the rapid development of dependence and tolerance, which can more easily lead to a serious and potentially fatal overdose. This risk could be underestimated by those who use it, as they may mistakenly think they are taking a different substance.” The consequence is therefore “the enhancement of the effects of heroin”, because Fentanyl has a “pharmacological potency and very high response speed even at small doses”, moreover with “enhanced effects if combined with psychotropic drugs such as benzodiazepines and alcohol”, adds Pasina.
The Fentanyl “epidemic”, which started in the United States, is the result of a combination of several factors: «It is an extremely powerful substance, much more than heroin, so even small quantities can quickly produce the desired effects, mainly euphoria and sedation – Pasina remarks –. Furthermore, being a synthetic opioid, it is produced in the laboratory with simpler and less expensive processes than other substances such as morphine or heroin, which require more complex steps and the extraction of the active ingredient from opium poppies. Its high pharmacological potency, combined with ease of production, makes it relatively inexpensive and very profitable, as small quantities can generate significant profits.” Also due to its potency, among the consequences of the use of Fentanyl there is “a rapid onset of tolerance, dependence and risk of overdose”.
