2. Fentanyl related deaths and fentanyl acute toxicity presentations at emergency Departments in Europe, 2010-2020

An estimated 5200 fatal drug overdose occur in Europe every year and three quarter involve opioids. We examine the most recent data on fentanyl-related harm (fentanyl-related deaths and acute fentanyl toxicity presentations) across Europe, in particular since the beginning of the COVID-19 pandemic.

We reviewed the data reported by the 27 EU Member States, Norway and Turkey to the EMCDDA, on drug-related deaths, including those related to fentanyl from 2010 to 2021. We analysed acute fentanyl toxicity presentations at Emergency Departments (EDs) in the Euro-DEN Plus sentinel hospitals since 2014 in 20 European countries. We analysed the availability of opioid substitution treatment, take home naloxone programmes, safe consumption rooms, and drug checking services across Europe.

Fentanyl deaths have been reported in a minority of countries, although outbreaks have occurred in the past. Consistent with the mortality data, the highest shares of fentanyl toxicity presentations in all presentations at sentinel hospital emergency services were seen in the Baltic countries: 15.8% in 772 presentations in Estonia, 5.4% in 708 presentations in Lithuania and 3.5% in 231 in Latvia, as compared to an average of 0.2% fentanyl in 51265 total presentations in the rest of the network. Fentanyl presentations decreased after 2016, while responses targeting opioid users were scaled up across Europe.

Access and coverage of harm reduction and drug treatment vary but overall, adaptation, and no major disruption was observed since the beginning of the Covid-19 pandemic. Available data suggest no signals of increase in the deaths or acute toxicity presentations related to fentanyl in Europe.