Opioid problems are changing in Europe with worrying signals that synthetic opioids may play a more significant role in the future

Since 2009, a total of 78 new uncontrolled opioids have been identified on the European market. These include 13 highly potent benzimidazole (nitazene) opioids. The appearance of this group is likely to have been potentiated by of a number of national and international actions aimed at reducing the availability of fentanils. Nitazene opioids have been available in some Baltic countries from around 2019, but their availability appears to have increased since 2022 and they are now contributing to a rapid escalation in the numbers of opioid related deaths. Outbreaks of deaths associated with these substances have also been noted in other countries recently, including the United Kingdom. New opioids have also been found in fake benzodiazepine or opioid analgesic medicines and in mixtures with bromazolam, a new benzodiazepine, and xylazine, a veterinary anaesthetic and sedative. An assessment of the current European situation would suggest that changes in the availability and use of synthetic opioids pose a credible future threat to public health, especially if some of the new forms available prove to be attractive to a wider group of consumers.