Fentanyl& Nitazenes: Who is at risk?

It is important to highlight that most people are not intentionally seeking out fentanyl or nitazenes. They purchase drugs like heroin or painkillers like oxycodone, without knowing these are laced with or substituted by fentanyl or nitazenes and thus consume fentanyl and nitazenes unknowingly. This heightens the risk of overdose, as individuals are unaware of the highly potent drugs they are consuming.

But there are definitely also people that want to consume fentanyl. When people develop tolerance to weaker painkillers or heroin, they may start actively seeking out fentanyl to achieve the same effects. In the Netherlands there haven’t been reports of fentanyl as a stand alone substance on the drug market, but there have been cases of people ingesting or smoking fentanyl that was medically prescribed.

In the Netherlands, Individuals obtaining painkillers like Oxicodon online or through a dealer are at risk of unintentionally ingesting fentanyl or nitazenes. However, the Dutch Drug Incidents monitoring system is likely to quickly identify cases of poisoning or overdoses, allowing quick emergency responses. The Drug market monitoring through drug testing is also likely to identify laced pills or other substances quickly and send out a red alert to warn the public.

Marginalized people who use drugs at greatest risk

People who use drugs while living on the streets or in homeless shelters are at a heightened risk of exposure to fentanyl and the even stronger nitazenes. Their drug choices shift rapidly with changes in price and supply.

Mainline’s recent study on flakka (alpha-PVP) shows how fast these shifts can happen: when flakka was banned, users in West Brabant and Zeeland immediately searched for substitutes. And many of the people who were using Flakka problematically had a history of problematic GHB use. For this marginalized population, cost, availability, and potency drives consumption. If a substance is cheap, easy to find, and powerful, it will be adopted, whether it is another stimulant or a depressant, because stronger drugs offer a quick escape from harsh daily realities.

At the moment, many are also purchasing heroin and diverted prescription medications, both of which can be—or already are—adulterated with fentanyl or nitazenes. Field workers have also seen people obtaining fentanyl patches. Regular exposure to these opioids raises the risk of dependence, tolerance, and a progression toward even stronger synthetic opioids whenever they appear at low prices.

In cooperation with GGD Amsterdam, Mainline made a flyer for professionals, working with marginalized people who use drugs, to alert them of the risks of fentanyl and nitazens.