The spread of synthetic opioids in Europe is a public health threat – Finland must also be better prepared

Over the past year, more than 100,000 people in the United States have died from drug overdoses. More than 64% of these deaths were caused by the use of synthetic opioids, mainly fentanyl and its derivatives.

Fentanyl is dozens of times stronger than heroin. It is very difficult to dose it correctly, and even a small dose can be fatal.

Illegally manufactured fentanyl and its derivatives are produced in China and India, from where they are then smuggled to the United States via Mexico, often in powdered or tablet form. In Europe, sources of fentanyl include online purchases from China which are then delivered by post.

Although the synthetic opioid situation in Europe is still fairly stable, their availability and use has increased in recent years in certain areas including Nordic and Baltic countries.

Fentanyl and its derivatives have been causing many deaths for a long time already, especially in the neighbouring countries of Estonia and Sweden.

Estonia has been fighting the fentanyl epidemic for nearly 20 years. In recent years, however, it has succeeded in reducing the number of drug-related deaths, which for a long time have been among the highest in Europe.

The decline in deaths has come about in part due to the praiseworthy activities of law enforcement agencies (seizures), but also through the expansion of harm-reduction activities and distribution of the opioid antidote naloxone to people at increased risk of overdose.

Synthetic opioid use could increase rapidly in Finland

Although Finland is, unlike the rest of Europe, a ’Subutex country’, other opioids, such as oxycodone and tramadol, have also caused deaths. These are also synthetic opioids just like buprenorphine, which is known by its commercial name Subutex.

The drug market is changing, with the trend in recent years being a shift towards synthetic drugs.

There are many reasons for this: they are easier to produce and smuggle and, because a small quantity is enough to many doses, they are also profitable to sell.

Alongside darknet marketplaces, there has also been an emergence of social media applications which make it easier to sell and acquire drugs.

In addition, counterfeit medicines sold online or in streets may contain fentanyl. Fentanyl or its derivatives have also been found mixed with other drugs such as heroin, cocaine and methamphetamine.

The risk of an overdose increases if the user does not know the strength or content of the substance they have acquired. Even a small amount of fentanyl can be fatal.

Effective procedures in place to prevent drug-related deaths

In Europe, there are sizeable differences between countries’ preparedness for the spread of synthetic opioids. In general, Finland is considered a model country for crisis preparedness, but there is room for improvement in the prevention of drug-related deaths.

There are a number of effective, well-researched methods for preventing drug-related deaths, but only some of them are currently in use in Finland. Greater impetus is needed for experiments with new methods, such as drug consumption rooms, substance identification services and the distribution of naloxone.

The exchange of information between authorities and other actors should also be speeded up. In this area, new technologies offer better opportunities.

All available means should be brought into use before synthetic opioids arrive in Finland. If our system is not ready, the number of deaths may increase rapidly and the situation may become unmanageable.

The authors have been working for two years within the joint European SO-PREP project, which aims to strengthen the capacities and preparedness of European Union Member States for the spread of synthetic opioids and related health risks and harm.

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