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Fentanyl Crisis and Overdose Prevention Guide for European Families and Communities

Fentanyl Crisis and Overdose Prevention Guide for European Families and Communities

Europe hasn’t experienced the same fentanyl-driven death toll seen in the United States, but overdose risk is shifting and should be taken seriously. Heroin remains the primary drug of concern in many European countries, but overdoses increasingly involve multiple substances and drug markets vary considerably by region. These shifts create new and unpredictable risks for individuals, families and communities, and increasing knowledge on overdose prevention has become more important than ever.

This comprehensive guide explains fentanyl’s impact in Europe, why nitazenes are an emerging concern and how polydrug use raises risk. It also covers how to recognise an opioid overdose and how naloxone fits into a Europe-wide response.

Europe vs the United States: What’s Different and Why It Matters

According to the latest European Union Drugs Agency (EUDA) estimates, nearly 7,500 drug-induced deathsinvolving one or more illicit drugs occurred in the European Union (EU) in 2023, rising to over 8,100 deaths when including Norway and Türkiye. While many large-population countries hadn’t reported their numbers yet, the estimated values already represented a slight increase over 2022’s findings. Opioids were involved in about two-thirds of these deaths.

It’s tempting to assume Europe is simply behind the United States and will inevitably follow the same path leading to high numbers of fentanyl-related deaths. However, the data doesn’t seem to support this track and making assumptions based on what’s previously occurred in the U.S. can lead to the wrong focus in Europe.

Widespread illicitly manufactured fentanyl in the drug supply and very high mortality define North America’s crisis. Europe has serious risks, but its opioid situation is more mixed. For example:

  • Heroin remains the most commonly used illicit opioid in the EU, even as synthetic opioids become more available.
  • The EU Council estimates about 1 million high-risk opioid users in the EU, indicating a substantial population at risk even without high-level fentanyl penetration.
  • Europe’s opioid market involves internationally controlled substances, diverted medications and highly potent synthetics new to the illicit drug market.
  • Fentanyl is still relatively specialised in most places but increasingly available.
  • Polysubstance use is the norm, as EUDA notes that most drug-induced deaths involve multiple substances, with benzodiazepines detected in a large portion of deaths in many countries. 

Europe’s challenge is partly about preventing a larger synthetic-opioid wave, and partly about reducing deaths that already occur through polydrug use. Opioid plus depressant (alcohol or benzodiazepines) or opioid plus stimulant combinations are prime examples of polydrug use driving fatal outcomes.

What Is Fentanyl and How Has It Shown Up in European Drug Markets

Fentanyl is a synthetic opioid prescribed for pain management and anaesthesia, so it has legitimate medicinal applications. However, illicit fentanyl and fentanyl derivatives create a significant overdose risk because tiny differences in a dose can be life-threatening. Also, people can be exposed without knowing it when fentanyl is mixed into other drugs, such as heroin, or when counterfeit pills contain unexpected opioids.

In Europe, EUDA notes that fentanyl and fentanyl derivatives currently remain far less dominant than in the U.S., but they’re not absent. Furthermore, they were linked to 153 overdose deaths in 2023 across 16 reporting EU Member States. While this number is down compared to 159 deaths in 2022, some fatalities may be due to diverted medicines rather than illicit fentanyl, potentially giving people a false sense of safety because they’re prescriptions, not “street drugs.”

From a prevention standpoint, reduced counts don’t mean low risk. High potency creates tremendous harm when fentanyl appears in inconsistent concentrations, when it’s mixed with other depressants or when it appears in markets where people don’t expect it.

Nitazenes: A Primary Emerging Threat in Europe

In addition to a potential fentanyl crisis, EUDA highlights that nitazene opioids (benzimidazole opioids) are a major emerging concern. Nitazenes are particularly concerning because they can appear unexpectedly. EUDA reported localised poisoning outbreaks and clusters of deaths across Europe in 2023 and 2024.

  • Baltic and Nordic impacts: EUDA reported nitazenes involved in over half of drug-induced deaths in Estonia in 2023, and identified in 66% of Latvia’s 2023 cases (among people between ages 15 and 64).
  • Outbreak pattern: Clusters of deaths linked to nitazenes were reported in multiple countries, including France in 2023, Sweden and Norway in 2023 and 2024, and Germany in 2024.
  • Market shift: The EU Council reports that in the last five years, highly potent nitazenes have taken precedence over fentanyl derivatives in new synthetic opioids reported to the EU Early Warning System.

For clinicians and public health teams, the emergence of nitazenes strengthens the case for a Europe-wide prevention message that doesn’t just focus on a single drug. Instead, communities and healthcare teams must be prepared for opioid potency shocks and elevated overdose risk.

Why Europe Hasn’t Seen a U.S.-Style Fentanyl Wave and What Could Change

Europe’s relative insulation from a U.S.-scale fentanyl catastrophe likely reflects a mix of factors, including lower rates of opioid prescribing in many settings and, in some parts of the continent, more established harm reduction and treatment networks. There are also different market dynamics at play. However, none of these factors is a guarantee that Europe won’t see a fentanyl wave, and the differences between countries are substantial.

One helpful case example comes from a Dutch-focused analysis by the Netherlands Institute for the Study of Crime and Law Enforcement. It notes that fentanyl receives far less attention in the Netherlands because indicators suggest a much smaller presence than in the United States.

That same analysis stresses a prevention guideline relevant continent-wide, which is that the best time to tackle fentanyl is before it becomes widespread, not after. It further argues that maintaining the status quo requires vigilance, strong monitoring and responsiveness to market changes.

What could change Europe’s fentanyl risk? Market disruption is a recurring concern. The Netherlands analysis discusses how reduced heroin availability can increase vulnerability to new synthetic opioids. It explored prior times when specific regions saw shifts toward fentanyl when the heroin supply dropped.

Recent market disruptions, according to the EUDA, include the Afghan government’s collapse and takeover by the Taliban in late 2021 and the subsequent ban on opium cultivation in early 2022. These changes could impact the production and trafficking of opiates, including heroin. Furthermore, it points out that Russia’s war on Ukraine, which began in early 2022, could also disrupt heroin trafficking through three out of four commonly used routes. As previously seen, heroin supply shortages could cause an uptick in the production of synthetic opioids such as fentanyl.

While Europe hasn’t had a North American-style fentanyl wave, changes in drug supply, increased polysubstance use and the emergence of potent synthetics like fentanyl and nitazenes mean overdose readiness still needs to improve. Families and communities must be prepared to respond should the need arise.

Recognising and Responding to a Suspected Opioid Overdose

Recognising fentanyl overdose symptoms early can mean the difference between life and death. Overdoses involving fentanyl progress faster and are harder to reverse than those caused by many other opioids. Learning how to spot overdose emergency signs and respond quickly is critical for parents, peers and anyone who may encounter someone in distress.

Common Signs of Opioid Overdose

Fentanyl overdose symptoms can escalate rapidly due to the drug’s potency. Look for these common warning signs if you suspect an overdose:

  • Unresponsiveness or severe drowsiness
  • Slow, irregular or absent breathing
  • Blue or grey lips and skin (or extremely pale)
  • Snoring, gurgling or choking sounds
  • Pinpoint pupils (not always reliable with polydrug use)

If breathing is compromised or you can’t wake someone, treat it as an emergency, even if you’re unsure whether it’s actually an opioid overdose. Waiting for certainty costs precious time. In Europe, polydrug exposure is the norm, not the exception. Symptoms can vary in polysubstance use, and taking action is even more critical.

What to Do Immediately

  1. Call emergency services right away. In the EU and many neighbouring countries, 112 connects you to emergency services, but some countries also use other emergency numbers.

  2. Check responsiveness and breathing. Call the person’s name loudly, rub your knuckles firmly across their upper lip or into the sternum (breastbone) and lightly pinch them to see if they respond. If they don’t, check to see if they’re breathing.

  3. Start CPR if they’re unconscious and not breathing normally. If the person isn’t breathing normally, this is an emergency. Begin chest compressions and rescue breathing, and follow dispatcher instructions.

  4. Place in recovery position. If they’re breathing but unresponsive, place them in the recovery position to prevent choking and keep monitoring until help arrives.

  5. Give naloxone if it’s available. Naloxone can temporarily reverse the effects of an opioid overdose. Because fentanyl is so potent, one dose may not be enough. Follow the instructions on the package carefully, then keep monitoring.

  6. Be ready to give additional doses if symptoms return. If they don’t respond to the first naloxone dose within 2 to 3 minutes, give another dose. If they respond, but overdose symptoms return while waiting for emergency care, give another dose. However, always follow the product instructions and dispatcher guidance.

  7. Stay with the person until help arrives. Never leave a person once they’re responsive. They may become confused or agitated, and overdose symptoms can return. Reassure them calmly and monitor them until help arrives.

The International Liaison Committee on Resuscitation (ILCOR) released a “good practice statement” in its 2025 International Consensus on First Aid Science with Treatment Recommendations related to the use of naloxone during resuscitation for suspected opioid-associated emergencies. It states that you should start standard CPR immediately on anyone who’s not breathing normally and unconscious. Furthermore, lay rescuers (bystanders) should administer naloxone (nasally or through injection if allowed) in respiratory or circulatory arrest related to suspected opioid use.

Important Note: Protocols vary by country. Always utilize local training when available, follow the instructions that came with your naloxone product and follow emergency dispatcher guidance. 

Naloxone Across Europe: What Is It, Who Should Carry It and How to Get It

Naloxone works by binding to the same receptors in the brain that opioids like fentanyl attach to. By displacing the opioids, naloxone can reverse respiratory depression, restore normal breathing and revive the person temporarily until medical help arrives.

Naloxone begins working within 2 to 3 minutes of administration, but it’s not a permanent cure. Opioids, especially fentanyl, can remain active longer than naloxone’s effects. Also, it doesn’t work on non-opioid drugs. 

Naloxone doesn’t have any potential for dependency and has a high safety margin, making it widely used in emergencies and promoted for take-home use in many European countries.

Who Benefits From Having Naloxone Nearby

Naloxone access is most useful when it’s in the hands of people most likely to witness an overdose, including:

  • People using opioids, whether prescribed or illicit
  • Friends, partners and family members
  • Outreach teams, shelter staff and peer support workers
  • Staff in nightlife settings and other community environments where drug use may occur

Because polydrug exposure is common, naloxone is a practical safety tool that reduces preventable deaths and shouldn’t be viewed as a moral judgement. 

What Naloxone Looks Like in Europe

Europe doesn’t have a single, uniform system, so naloxone availability varies by country, setting and programme. EUDA notes that nasal formulations allow use by laypeople. France was the first country to license a nasal naloxone spray (Nalscue) in 2016 and authorised distribution through drug treatment centres, hospitals and harm reduction facilities without a prescription in 2017. 

In November 2017, the European Commission authorised a nasal naloxone (Nyxoid) for marketing EU-wide. Since early 2018, it’s been introduced in several European countries. 

Different Forms of Naloxone

Intranasal Naloxone Sprays:

  • Nyxoid® (1.8mg/0.1mL)
  • Nalone® (specific to some countries)
  • Nalscue® (0.9 mg/0.1mL – France) 
  • Pre-assembled, single-use devices
  • No assembly required
  • Designed for non-medical users

Injectable Naloxone

  • Pre-filled syringes
  • Intramuscular or subcutaneous administration
  • Faster onset than intranasal
  • Used by medical services
  • Included in take-home programmes with training in some countries

How People Get Naloxone

Access pathways differ among countries, but common routes include:

  • Take-home naloxone programmes through harm reduction services
  • Distribution through some pharmacies
  • Provision through drug treatment services and community health programmes
  • Targeted distribution in high-risk settings, including some prison-related services

EUDA’s harm reduction reporting noted that 15 European countries had implemented take-home naloxone programmes as of 2023, including:

  • Austria
  • Cyprus
  • Czechia
  • Denmark
  • Estonia
  • France
  • Germany
  • Ireland
  • Italy
  • Lithuania
  • Norway
  • Portugal
  • Slovenia
  • Spain
  • Sweden

Croatia and Finland initiated pilot take-home naloxone programmes in 2024.

Also in 2023, seven countries reported that naloxone provision in prison was available for people to take home once released. These countries included Estonia, France, Germany, Ireland, Italy, Lithuania and Norway. Luxembourg implemented a similar program in September 2024.

Prevention that Fits Europe’s Risk Profile

Overdose prevention works best when it matches the most common pathways to harm. In Europe, that means focusing on polydrug risk, unknown contents and variable potency.

Reduce Risk From Dangerous Combinations

Mixing opioids with other depressants significantly raises the risk of overdose. EUDA highlights the frequent presence of benzodiazepines and alcohol in drug-induced deaths in many countries, supporting prevention messaging that targets drug combinations, not just single substances.

If someone is using any opioid, the safest guidance is to avoid alcohol and benzodiazepines unless medically directed. Also, never assume you know what’s in an illicit supply.

Assume the Contents Aren’t What You Think

Counterfeit pills and adulteration create risk even for people who don’t identify as opioid users. This risk is one reason overdose education should be community-wide and non-stigmatising, especially for young adults and social settings.

Where available, drug checking services can help detect unexpected substances, though they’re not a guarantee of safety. A “found nothing” result doesn’t translate to a “safe dose” when potency can vary inside the same batch.

Make Overdose Response Easier Before It Happens

Planning beats panic. These aren’t hypothetical suggestions. They’re practical steps that can help you stay calm and act fast to keep someone alive until help arrives. Helpful steps include:

  • Keep naloxone accessible, not locked away.
  • Make sure more than one person in a household or setting knows where it is and how to use it.
  • Agree on a response plan and roles:
    • Call for help.
    • Check breathing.
    • Start CPR.
    • Give naloxone.
    • Stay until help arrives.
  • Encourage people not to use opioids alone and to have someone with them who can respond quickly.

Use Evidence-Based Harm Reduction Services Where They Exist

Harm reduction is part of Europe’s public health response, though availability differs widely. EUDA notes that supervised drug consumption facilities exist in some European countries, with numbers increasing in several countries over the last decade.

Treatment and Recovery: What Works and What Access Gaps Remain

Opioid use disorder is treatable, and recovery is realistic. In Europe, core evidence-based treatment usually combines medications for opioid use disorder (MOUD) and psychosocial support, with care tailored to the person’s needs and risks.

Europe’s challenge isn’t necessarily about whether treatment works. It’s about whether people at the highest risk can access it quickly and consistently. The Council of the EU estimates that there are about 1 million high-risk opioid users in the European Union. This data helps measure the population most likely to benefit from sustained treatment access and overdose prevention tools.

Polydrug risk also changes treatment needs. When a person habitually combines opioids with benzodiazepines, alcohol or stimulants, treatment planning should include medication safety, mental health care and practical harm reduction supports.

For families and communities, getting into treatment can lower overdose risk, especially when they also have naloxone, safer-use support and steady care during big transitions like discharging from hospital, leaving prison or changing medications.

What to Focus On in Europe

Europe’s opioid situation is distinct from that of the United States, and prevention strategies should reflect European data and systems. EUDA’s current surveillance shows opioids remain heavily involved in drug-induced deaths. However, fentanyl-linked deaths are far lower in the EU compared to U.S. levels and relatively stable in the latest reporting.

 

To keep fentanyl overdose risk in check, the goal shouldn’t be to copy the United States’ playbook, but to prioritise prevention strategies that match Europe’s drug landscape. Practical priorities include: 

  • Plan for polysubstance overdoses, not single-drug scenarios.
  • Expand naloxone access and training so people can act before emergency services arrive.
  • Strengthen early warning and toxicology capacity so new threats are identified quickly and shared clearly.
  • Improve treatment access and continuity, especially during high-risk transitions.
  • Keep local protocols clear and practiced so families, staff and clinicians know what to do in the moment.

The goal is for European families and communities to stay alert without alarm, respond fast when it matters and keep people connected to care that works. By working together, everyone can help sustain Europe’s comparatively lower rates of fentanyl-related mortality.

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