Germany grapples with a lethal opioid predicament
Fentanyl poses a significant threat, claiming numerous lives in the United States. While it's less prevalent in Germany, there's a possibility that its influence might escalate. One factor contributing to this could be linked to Austria.
Heroin has been a popular recreational drug for decades in Germany, with many drug-related fatalities involving heroin. However, newer, potentially harmful substances are making their way into the market. One such substance is fentanyl, a powerful opioid that psychiatrist Norbert Scherbaum explains, is about 50 times more potent than heroin. A lethal dose is as minimal as 2 milligrams. In 2021, 2227 individuals in Germany lost their lives due to the consumption of illicit substances, with heroin contributing to 712 fatalities, closely followed by cocaine (610) and crack (507). Mixed usage was often detected.
Similarly, fentanyl has sparked a major drug issue in the United States, leading to thousands of fatalities. As per the United States' National Institute on Drug Abuse, over 70,000 individuals succumbed to a fentanyl-induced overdose in 2021 solely.
Fentanyl belongs to a class of newer drugs: synthetic opioids such as tilidin, tramadol, and oxycodone, which are licensed medications used to alleviate severe pain. Fentanyl functions similarly to morphine but is synthesized artificially. In the medical field, it's utilized for treating conditions like cancer.
Fentanyl can be consumed orally, injected, snorted, smoked, or applied as a patch. In Germany, fentanyl doesn't appear to play a significant role compared to the United States, as per Scherbaum, who serves as the chairman of the German Main Board for Addiction Issues (DHS). The opioid crisis in the United States was primarily triggered by overly permissive and careless prescription of strong painkillers. While such medications are also prescribed in large quantities and more frequently in Germany compared to the past, it's not at the same level as the United States, asserts Scherbaum.
Consumers Remain Wary
Long-term surveys of opioid-dependent patients in detoxification clinics in North Rhine-Westphalia reveal that fentanyl plays a minimal role in Germany, as per Scherbaum. Rüdiger Schmolke from the Berlin emergency service for drug-endangered and -dependent individuals confirms that fentanyl isn't yet a major issue in Berlin's open drug scene. "We've found traces of it in tests, but it's not the drug that our clients seek."
From the perspective of consumers, heroin is perceived to be safer and provides a longer high, claims Schmolke, who is responsible for prevention and counseling. Many are also aware of the increased risk of overdose with fentanyl. "That's why our clients are skeptical or even reject fentanyl."
Scherbaum speculates that the drug's reach could expand and potentially spark a crisis in Germany as well. "Of course, we can't predict the future, but the risk is certainly there," the addiction expert estimates. One reason for this is Afghanistan, a world leader in opium production, the raw material for heroin, derived from poppies. Following the Taliban's ban on poppy cultivation in 2022, global opium production plummeted by 74 percent, according to the UN Office on Drugs and Crime (UNODC).
Though the immediate effects may not be noticeable due to existing stockpiles, a deficit is anticipated in the near future. Another possible reason, as per the psychiatrist, is the potential change in the global drug market. "Drug cartels are realizing that synthetic products are much more profitable and less risky in terms of law enforcement." The production of Fentanyl is less expensive than that of Heroin as it can be synthesized in a lab. Already now, there's a risk that individuals purchasing Heroin may be unknowingly ingesting Fentanyl, leading to an underestimation of dosage and an unintentional overdose. The risk of fatal heart rhythm issues or respiratory arrest is significantly higher with synthetic drugs compared to Heroin, explains Scherbaum. With the rising prevalence of synthetic opioids, drug-related deaths are expected to surge.
Schmolke also believes that a drop in Heroin availability for addicts would trigger "a foreseeable catastrophe." The drug help services are preparing for a surge in Fentanyl, although there isn't a need for a "Fentanyl panic" yet.
Education and extensive therapy and substitution offers for addicts are considered essential. For instance, Berlin offers four drug consumption rooms and three mobile consumption units. Yet, this is not sufficient.
Despite the minimal role of fentanyl in Germany's drug scene at present, its potency and potential profitability for drug cartels could lead to an expansion of its influence, potentially sparking a crisis. Many consumers remain wary of fentanyl due to its increased risk of overdose compared to heroin.
As the global opium production decreases and drug cartels turn to synthetic products like fentanyl due to their profitability and reduced risk, there's a rising concern about an unintentional overdose among heroin users who unknowingly ingest fentanyl.
