For some days Italian newspapers have been publishing numerous articles on fentanyl, a synthetic opioid that has created enormous public health problems in the United States for several decades. It all comes from the fact that they were in Italy for the first time find traces of fentanyl in a dose of heroin seized in Perugia a few weeks ago.
So it was April 30th the national alert system was activated rapid response for drugs, coordinated by the Department for Anti-Drug Policies, which issued aalert to all police forces and competent administrations. The National prevention plan against the misuse of fentanyl and other synthetic opioids, presented on March 12 by the government, which provides a series of actions to prevent and combat synthetic opioids. These are, in fact, prevention and contrast actions to be implemented in the event that the spread of fentanyl represents an emergency, which currently it is not in our country.
What is fentanyl
During the presentation of the Plan in mid-March, the undersecretary to the Prime Minister, Alfredo Mantovano, spoke of fentanyl as a «zombie drugbecause it transforms the users into walking monsters”, a strong but wrong expression, as it was explained by the Higher Institute of Health (ISS). A preparation of heroin or fentanyl cut with xylazine, a veterinary anesthetic and muscle relaxant not very present in Italy but used on the international illegal market, is labeled as a “zombie drug”. So not fentanyl alone.
Fentanyl is a drug first synthesized in the 1960s. It belongs to the opioid family, like morphine and heroin, and is used as an anesthetic and analgesic, therefore for reduce the perception of pain. Together with other drugs it is in fact used to anesthetize patients before surgical operations and to treat cases of chronic pain, such as cancer. AND much more powerful than morphine: One hundred micrograms of fentanyl is roughly equivalent to 30 milligrams of morphine.
How fentanyl works
In a item published in the magazine of the Mario Negri Pharmacological Research Institute, it is explained that, like other opioids, fentanyl acts on particular receptors, the opioid receptors. When stimulated, they reduce the transmission of pain nerve impulses on the one hand and induce one on the other state of euphoria. People who suffer from chronic pain, such as cancer patients, and take fentanyl feel more relaxed and say they experience less pain. Those who take it as a drug seek both a sense of relaxation and euphoria.
How to hire it
Fentanyl is mainly taken through patches, tablets and injections. It’s marketed under names like Actiq, Durogesic and Sublimaze, and it comes distributed exclusively on medical prescription. It is used under strict medical supervision: it is very easy to develop dependence on fentanyl even following repeated short-term use. For this reason, when the decision is made in the clinic to interrupt treatment, a slow and gradual reduction in dosage is advisable to avoid withdrawal symptoms for the person who has taken it.
However, fentanyl has been coming for years produced and traded even illegally: alone or in combination with heroin, counterfeit pills and cocaine, it is the basis of third wave of the opioid epidemic and overdose deaths in the United States, which began in 2013, as Enrico Bucci explains well in this in-depth analysis published in Il Foglio in November.
The side effects
The health harms caused by fentanyl are listed in form published on the Department of Public Safety website. It is a very powerful opioid: it is easy to overdoseeven inadvertently, and a few milligrams can be lethal. Taking fentanyl for a long time increases tolerance, and patients must take larger amounts to get the same effects.
When administration is stopped, typical withdrawal symptoms may occur, such as sweating, anxiety, diarrhea, bone pain, cramps and chills. Side effects, typical of synthetic opioids, are exacerbated when fentanyl is mixed with heroin, cocaine, alcohol or other central nervous system depressants, such as benzodiazepines.
The epidemic in the United States, in brief
In the 1990s the classic perfect storm was created in the United States. Public awareness was growing regarding the need to treat chronic pain and at the same time some pharmaceutical companies began very aggressive advertising campaigns on opioids, praising their benefits and giving little information on the risks they could entail. Among these the Purdue Pharma, which at that time put oxycodone on the market, marketed as OxyContin. This story was recently told in a Netflix mini series that was very successful, «Painkiller».
The strategy worked well and OxyContin began to be widely distributed. Soon it also developed a black market and doctors began abusing oxycodone prescriptions. Many patients began to prolong their intake, but above all many people in their family and friends circle began to take the pills outside of prescription, creating a first pocket of recreational users of prescription opioids. This favored the entry into the market of increasingly powerful and dangerous substances, such as fentanyl.
The pocket has thus expanded, increasing a demand that during the first phase of the opioid epidemic had been satisfied with an excess of prescriptions, explains Bucci.
In the United States the deaths from overdose from drugs began to increase dramatically: it is estimated that more than 800 thousand people have died since 1999. After years of negotiations, Purdue had agreed to pay 6 billion dollars in compensation to settle the thousands of lawsuits brought by families of victims of opioid addiction, adding as a fundamental clause the exemption of members of the Sackler family (the owners) from any responsibility. The agreement was approved by a New York court last May, but a division of the Justice Department blocked it, asking the Supreme Court to review it, which now must speak out.
The situation today
Today the situation in the United States has not improved, on the contrary. That one is underway third wave of opioid addiction, which began in 2013, in which the protagonist is fentanyl. The drug epidemic is driven by illegal production mainly in China and Mexico. Given its ease of production, fentanyl is often associated by dealers with other drugs such as heroin, cocaine, methamphetamine and MDMA. This often means drug addicts they end up consuming fentanyl without knowing they are doing so.
In Europe There is no fentanyl emergency at this time. According to him latest data available from the European Monitoring Center for Drugs and Drug Addiction (EMCDDA), syringes with traces of fentanyl were found in Estonia, Latvia, Lithuania and Prague in 2022. However, attention is high, so much so that the fight against fentanyl has been placed on the G7 agenda by the Italian presidency, whose summit will be held in Puglia from 13 to 15 June. In a joint statement released on April 29, the G7 leaders committed to «leading international efforts to stamp out drug trafficking (in particular synthetic drugs with particularly devastating effects such as Fentanyl)».
Although there is currently no market for fentanyl in Europe, according to an in-depth study published in Euronews and an editorial published in the Economist there is however risk that drugs could take over Europe, as he acknowledged the European Union Agency for Law Enforcement Cooperation (Europol), the agency that assists police authorities in the member countries of the Union.
The numbers in Italy
In Italy, from June 2016 to today, the National Rapid Alert System of the Department for Anti-Drug Policies has released two reports for deaths associated with fentanyl use (one in 2018 and one in 2019), five communications regarding non-fatal intoxications and two reports relating to consumption found by the analysis of biological samples of people being treated at the Serd. Between 2018 and 2023, they were 123.17 grams of fentanyl powder, 28 doses in tablets and 37 other packages seized (patches, medicine bottles and boxes).
