- Fentanyl-related fatalities at two-milligram levels: Is an escalating amount of this potent opioid entering Germany?
In the vibrant illicit drug scene, heroin has been a prominent recreational substance for years, with a significant proportion of drug-related fatalities in Germany attributable to it. However, more lethal drugs like Fentanyl are making their way onto the market. Dr. Norbert Scherbaum, a renowned psychiatrist, highlights that Fentanyl is remarkably addictive and approximately 50 times stronger than heroin, leading to a disproportionate number of deaths. As little as 2 milligrams can be fatal.
In 2021, 2227 individuals lost their lives in Germany from illegal substance consumption, with heroin involved in 712 cases, followed closely by cocaine (610) and crack (507). Often, mixed consumption was detected.
Thousands of Fentanyl Overdose Deaths in the USA
In the USA, Fentanyl has escalated into a major drug issue with tens of thousands of deaths. The American national institute researching drug abuse reports that more than 70,000 individuals died from an Fentanyl overdose in 2021 alone, primarily from synthetic opioids.
Fentanyl belongs to a category of relatively new drugs: synthetic opioids such as Tilidin, Tramadol, and Oxycodone, which are used as medications for managing severe pain. Fentanyl functions similarly to morphine but is entirely synthesized. In medicine, it's employed for treating conditions like cancer pain.
The drug can be consumed orally, injected, inhaled, smoked, or applied using a patch. In Germany, Scherbaum, who heads the German Main Office for Addiction Issues (DHS), suggests that Fentanyl has not yet had a substantial impact compared to the USA. The USA's opioid crisis was predominantly driven by the overly liberal and careless prescribing of potent painkillers.
In Germany, such medications are indeed prescribed in large quantities and more frequently than in the past, according to Scherbaum. However, it's not at the same level as in the USA. Furthermore, repeated surveys among opioid-dependent patients in detoxification clinics in North Rhine-Westphalia have revealed that Fentanyl has had a minor role in Germany so far.
In Berlin, Rüdiger Schmolke from the emergency service for drug-endangered and drug-dependent individuals reports that Fentanyl has not yet played a significant role in the city's open drug scene. "We've found it in tests, but it's not the drug our clients are pursuing."
Heroin is considered safer and provides a longer high by consumers, states Schmolke, who is an advisor for prevention and counseling. Moreover, many are aware of the higher risk of overdose with Fentanyl. "That's why our clients are rather cautious or reject Fentanyl."
The Opioid Crisis Could Also Affect Germany
Scherbaum anticipates that the spread of the drug could escalate and trigger a crisis in Germany as well. "We can't predict the future, of course, but the risk is undeniably there," says the addiction expert.
This can be attributed to several reasons, including Afghanistan. The country is a major producer of the heroin precursor opium, derived from poppies. In 2022, the Taliban banned opium cultivation, resulting in a 74% decrease in global opium production, according to the UN Office on Drugs and Crime (UNODC).
Scherbaum acknowledges that this isn't likely to have immediate consequences, as stocks are presumably still plentiful. Nevertheless, a shortage is probable sooner or later.
Fentanyl is More Profitable and Less Risky for Drug Cartels
Another reason, as per Scherbaum, is that the international drug market may undergo significant changes in the future. "Drug cartels are realizing that synthetic products are considerably more profitable and less risky in terms of law enforcement." The production of Fentanyl is considerably less expensive than that of Heroin, as it can be manufactured in a lab.
Currently, there's a risk that individuals purchasing Heroin are unknowingly ingesting Fentanyl mixed in. This can result in users underestimating their dose and inadvertently overdosing, says Scherbaum.
The risk of fatal heart rhythms or respiratory failure is significantly higher with synthetic drugs than with Heroin, explains the addiction expert. As synthetic opioids become more prevalent, so will the number of drug-related deaths.
Drug Assistance Services Prepare
Schmolke also expects a reduced availability of Heroin for addicts to be "a foreseeable catastrophe." Drug assistance services are vigilantly preparing for an increase in Fentanyl, although there's no reason for a "Fentanyl panic" at this point.
Important are education and a comprehensive and expanded therapy and substitution program for addicts. In Berlin, for example, there are four drug consumption rooms and three mobile consumption units. However, that's not enough.
The escalating use of Fentanyl in the USA has resulted in over 70,000 overdose deaths in 2021 alone, a stark reminder of its deadly potential. In Germany, Dr. Norbert Scherbaum cautions that while Fentanyl has not had a significant impact yet, its addictiveness and lethality make it a looming threat.
