Fentanyl and Nitazenes: are we ready?

For the media, fear of fentanyl and nitazenes has become the talk of the town. This time, though, the fearmongering is not entirely unjustified. What are fentanyl and nitazenes? Have they reached the Netherlands? If so, who is at the greatest risk? 

What are fentanyl and nitazenes? 

Fentanyl and nitazenes are synthetic opioids. This means they are artificially produced but act similarly to traditional opiates like heroin. However, fentanyl and nitazenes are significantly more potent. Being at least 50 times stronger than heroin makes dosing extremely difficult, as an extra microgram can lead to a fatal overdose. 

Synthetic opioids in the Netherlands 

Fentanyl has been used in the United States for some time already. In the U.S., fentanyl overdoses are the leading cause of death for adults aged 18 to 45. On the European drug market, synthetic opioids began to circulate only recently. Organizations monitoring drugs in the Netherlands, including Mainline, have reported initial signals of individuals misusing commercially produced fentanyl patches, either by sucking or scraping them to smoke the substance. However, for now, synthetic opioids have not yet been widely found in the Dutch drug scene. Only occasionally have batches of fentanyl been intercepted in transit from the Netherlands to other destinations. 

Who is at risk? 

In the U.S., it is predominantly the middle class who uses fentanyl and nitazenes. They were initially receiving opioids from their doctors and transitioned to illicit sources after the prescriptions stopped. In the Netherlands, this scenario is unlikely. Individuals obtaining illegal painkillers are certainly at risk, for example, from possible nitazene contamination.  However, the Dutch monitoring system is likely to quickly identify incidents of poisoning or overdoses, allowing timely intervention. In the Netherlands, the middle class is easily reached via digital channels and stays well informed. On top of that, due to its high purchasing power, it tends to prioritize factors other than low price. In this case, health and safety rank higher.  Similarly, young people generally know the risks associated with synthetic opioids, and we expect them to remain uninterested. 

Marginalized groups at highest risk

Instead, individuals who use drugs while living on the streets or in homeless shelters would be at the greatest risk of using fentanyl and nitazenes. We observe that the practices of marginalized groups of people who use powerful stimulants tend to fluctuate significantly with the availability and price of resources. Mainline’s recent research on the strong stimulant flakka (also known as alpha-PVP) demonstrates this trend. Following the ban on flakka, those who used it in regions such as West Brabant and Zeeland sought alternatives. The legal status of the drug matters little to them. Their choices are based on cost, accessibility, and potency. These groups therefore easily switch to depressants or other strong stimulants. They will choose anything that helps them to escape the harsh reality of their lives. The more powerful the substance, the better it fulfils that goal. This leaves us with a highly vulnerable group likely to transition to synthetic opioids if they become available at low prices. 

Homeless migrants as a risk group

A substantial part of Mainline’s outreach is targeted at homeless migrants. Our organization has observed a steady influx of Eastern European labor migrants onto the streets. Due to government cuts to social support services, this group is likely to grow. A certain number of its members will use drugs. Unfortunately, having limited knowledge of substances and few or no prospects puts these vulnerable immigrants at a high risk of using synthetic opioids.

Are we prepared for synthetic opioids? 

Mainline’s answer is “no.” Homelessness has been rising in recent years. Groups at risk of using synthetic opioids have grown larger. Meanwhile, significant cuts to social services for the homeless are planned- including funding for Mainline.  

It is Mainline who conducts sample street drug testing, a critical tool for monitoring the presence of fentanyl and nitazenes in the Netherlands. Marginalized drug users rarely find a way to access formal testing services – it is, therefore, of the highest importance that street-based sample testing continues. Additionally, through its magazine, Mainline provides targeted education about new substances for people who live on the streets or in shelters, and use drugs, a target group that is otherwise difficult to reach. Without this magazine, there will be no direct channel to warn these vulnerable populations if fentanyl and nitazenes become more widely available in the Netherlands. 

The effects of fentanyl and nitazenes can be disastrous. It is of utmost importance that we in the Netherlands stay vigilant and prepare for the coming of synthetic opioids. Cutting harm reduction services at this time constitutes a serious backward step.