Concerns in Central Europe are mounting over the increased availability of opioids and an associated rise in deaths. Better monitoring is key to preventing a US-style epidemic, say experts.
“Fentanyl, Duch, Zuromin – these are word symbols… of this poison of the 21st century that is fentanyl and other narcotics, which are taking a deadly toll around the world and are starting to do so in Poland also,” Donald Tusk said in a video posted on the X platform on June 25.
“Nobody who is involved in this accursed business of narcotics will be safe. We will get them. I guarantee you that,” the Polish prime minister vowed.
Tusk’s video followed the arrest of five people, including a notorious drug dealer nicknamed Duch (“The Spirit”), in the small town of Zuromin in Mazowsze county, central Poland.
Interviewed by Polish media like Gazeta Wyborcza, locals in Zuromin would only speak on condition of anonymity about Duch, the drug dealer who had been active in the community for the past 15-20 years, allegedly with the knowledge or even complicity of the local police.
The town of 8,500 had, in the previous months, become a symbol of Polish society’s problems with illegal drugs, after a 36-year-old man died in February of an overdose, with his family claiming the synthetic opioid fentanyl was the culprit. After the death of the 36-year-old man, police from other cities in Mazowsze were brought in to help deal with the situation in Zuromin, leading to two arrests in May and these further five on June 25.
For years, Adam Ejnik, a local teacher and journalist, has been documenting deaths associated with narcotics in the small town, with his count, quoted widely by Polish media, reaching 100 to date.
The spread of fentanyl on Poland’s illegal drug market has been observed for months, with the first death attributed to its abuse, that of a 19-year old woman, occurring in November in the western city Poznan. The Main Sanitary Inspectorate has counted 48 cases of overdosing with the substance this year alone.
That’s tiny compared to America’s epidemic of powerful synthetic opioids that is killing 75,000 people a year and devastating communities. Yet experts and government officials in Poland, the Czech Republic and Slovakia warn that the number in this part of Europe is likely to keep rising as heroin supplies dwindle and fentanyl’s relative cheapness, strength and increasing availability takes its toll.
“While the estimated death rate from drug overdose is around 15 times less in Europe compared to the US, we should not leave any signals unseen or unreacted to,” warns Isabelle Giraudon, principal scientist at the EU Drugs Agency (formerly the European Monitoring Centre for Drugs and Drug Addiction).
Smack, bang, wallop
The arrests in Poland followed a report by the EU Drugs Agency, published on June 11, which warned that while synthetic opioids like fentanyl currently play a relatively small role in the drug market in Europe overall, “they are a significant problem in some countries and there are signals that they could have the potential to play a larger role in Europe’s drug problems in the future.”
The agency noted that in 2023 seven new synthetic opioids were detected by the EU Early Warning System on new psychoactive substances in at least 16 EU member states, Norway and Turkey, with six of them belonging to the highly potent group of nitazene opioids. Fentanyl is up to 50 times stronger than heroin, but nitazenes can be 40 times more potent than fentanyl. In 2023, outbreaks of poisonings and overdoses involving nitazenes were reported in five European countries.
Much of the mounting concern centres on the reduced availability of heroin in Europe as a result of the Taliban’s ban on opium production in Afghanistan, which could create the conditions for greater availability and use of synthetic opioids as either a substitute for heroin or for cutting it with heroin. Latest figures from the United Nations Office on Drugs and Crime for 2023 show an estimated 95 per cent decline both in cultivation and in illicit opium production in Afghanistan compared to 2022.
“Fentanyl can be added to heroin due to reduced opium poppy production in Afghanistan,” explains Dominika Jasekova from the Slovak civic association Odyseus, noting that she has already encountered one such death due to a fentanyl overdose.
For now at least, there still seems to be a steady supply of heroin into Europe despite the Taliban’s poppy ban. Max Daly, a journalist and author specialising in writing about drugs and crime tells BIRN that is due to the existence of large amounts of stockpiled opium and heroin, mainly in Afghanistan.
Daly says another reason why drug trafficking gangs who supply Europe’s heroin markets have so far refused to follow the Mexican cartels in swapping out heroin for cheaper synthetic opioids is the nature of the drugs market in Europe, which is dominated by ethnic groups and clans based in the Balkans who have been smuggling drugs for generations. By contrast, heroin supplies to North America have typically been more sporadic, coming via the Mexican cartels or Southeast Asia’s Golden Triangle 6,000 miles away.
“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,” Daly says.
Furthermore, there are few signs that synthetic opioid production laboratories are being set up in a major way in Europe. Fentanyl for the US market is made in Mexico using precursor chemicals imported from China via a network of brokers. And while the Economist reported recently that “Mexican cooks versed in fentanyl production have set up in Europe”, there is little sign of that happening in Central Europe.
A new movie called Fentasy, based on a book by the former Slovak police investigator and writer Michal Cierny, depicts the story of a fentanyl manufacturer in Bratislava, but the last bust of a fentanyl laboratory in Slovakia was back in 2011, when police seized 4.3 kilos of fentanyl valued at 240,000 euros. There have so far been no reports of labs operating in Czechia or Poland.
However, Daly says it seems that some localised suppliers in Europe rather than organised crime groups are trying out synthetic opioids in their product, “so you get occasional local rises of synthetic opioids found in heroin and sometimes in black market opioids or benzo pills, and this is noticed via a rise in ODs, sometimes deaths.”
“Synthetic opioids – plus ‘benzo dope’, which is a mix of benzodiazepines such as xylazine plus opioids – have been popping up more often in Latvia, Lithuania, Poland, France, Ireland and the UK,” he adds.
The EU Drugs Agency said that at least 163 deaths were associated with fentanyl and its derivatives in Europe in 2022, but most of them were associated with fentanyl diverted from medical use as opposed to fentanyl produced for the illicit drug market.
Patched up
When the Polish police arrested Duch and his accomplices on June 25, they seized 300 medical fentanyl patches.
Those patches, like other forms of medical fentanyl, are only available on prescription, and are normally meant for oncological patients in palliative care. In their case, the high addictiveness of fentanyl is considered worth the benefit of the pain relief. But in most other cases, doctors do not think the addiction risk warrants prescribing the drug.
Fentanyl users typically boil the patches and inject the extract. In early March, the youth-oriented Slovak website refresher.sk featured an interview with a man named Marek who had tried fentanyl with a friend. They mixed the extract from a fentanyl patch with marijuana and smoked it using a bong.
“I’d say that the heavy body was separated from the consciousness, which was like on a cloud,” Marek recounted, adding that his friend then got into his car and crashed it. “The effects lasted several hours.”
In 2019, the Slovak authorities dismantled an organised group that had two doctors prescribing fentanyl patches in excessive amounts. In Czechia, too, fentanyl patches have long been found on the black market. “These [fentanyl] patches come from pharmaceutical distribution,” explained Jakub Frydrych, head of the national anti-drug centre. “It is either a resale from authorised patients, or a leak from the sales chain.”
It is also apparent that one of the main avenues for procuring opioids in Poland is by abusing the system of issuing online prescriptions that developed during the COVID-19 pandemic.
For example, in June the police arrested an oncologist working at one of the main hospitals in Poznan, whom authorities found had issued 800 prescription for synthetic opioids, including fentanyl, to one of her patients who had never used them. Along with the doctor, the police arrested a man that allegedly bought the prescriptions from her and later used them to obtain the drugs at the pharmacy.
The media and other observers in Poland have for years been warning about how online receptomaty (“prescription vending machines”) are issuing prescriptions for opioids or benzodiazepines (depressants) without any doctor properly checking the medical history of the patients or doing any physical exam. Typically, a user in Poland can easily find such an online clinic that requires only filling in a questionnaire and, in some cases a short phone call, to issue such prescriptions.
Polish doctors also too readily prescribe large quantities of such drugs at the request of patients, who end up using them for much longer than advisable or even sharing them with others.
“When the regular Pole thinks about fentanyl, they think about the black market, dealers and organised crime,” Eryk Matuszkiewicz, a toxicologist from a Poznan hospital, told oko.press. “But I see another problem: in Poland, fentanyl is available practically to anyone.”
“Among us doctors, there are also black sheep who would do anything for money,” he added. “If the patient insists, they’ll write up a prescription, going beyond what is recommended.”
The media have also reported cases where users can purchase opioids, including fentanyl, on websites or social media channels, with pickups possible at specific locations and without physical contact with the dealer.
According to the EU Drugs Agency, in March 2023 Polish police and several US law enforcement agencies shut down an operation based in Poland that supplied wholesale quantities of psychoactive medicines, including fentanyl and oxycodone, to the US and the UK. “These medicines were traded on the surface web. The vendor obtained legitimate products and then repackaged them for sale online,” the agency said. “Over 25,000 tablets were estimated to have been traded, and authorities seized over 12,500 tablets ready to be shipped.
In mid-June, Polish Health Minister Izabela Leszczyna announced that the authorities would intensify controls over all prescriptions for opioids, including fentanyl, issued in Poland.
Lack of data
While it’s clear the illicit trade in fentanyl patches and other synthetic opioid pills in Central Europe is a growing problem, there seems to be little understanding, even among experts, as to whether their use as an illicit drug is just marginal in these countries or, whether, on the contrary, the publicised cases represent just the tip of the iceberg.
A lack of official data is hampering efforts to combat it. David Pesek, head of the Czech drug addiction prevention non-profit Sananim, said there is no official data available, but fentanyl is estimated to claim a few dozen lives every year. In 2022, Czech police launched 15 criminal proceedings for distribution or possession of the synthetic opioid.
“For Poland, there is only one source of data used, the general mortality register, and no other data is reported from other sources such as forensic or police laboratories,” Giraudon, the principal scientist at the EU Drugs Agency, tells BIRN, meaning it is difficult to assess whether the information is complete or whether the number of drug-related deaths is being underestimated.
The Polish police did not respond to a BIRN request about the number of fentanyl-related deaths and arrests countrywide.
“It is crucial to build a better system of monitoring and early warning, using multiple sources of information, so as to be able to anticipate and react fast when there are signals of a serious health threat related to drugs,” Giraudon says. “A crisis related to fentanyl or another potent opioid can develop very quickly.”
Although an opioid epidemic like in the US is less likely because the context in Europe is different in so many ways, the journalist and writer Max Daly says there is still a chance it could happen if a major supplier decides to swap out heroin for synthetic opioids, maybe with the help of Mexican chemists, regardless of what happens in Afghanistan.
“The key thing is to have very good monitoring in Europe, testing drugs seized and in the body post mortem, so we know what’s going on,” he says.
