Fentanyl as a starting point in the opioid crisis. Current situation and retrospective view in Europe and the USA

Fentanyl, an opioid drug synthesized in 1960 with high analgesic potency and broad therapeutic
utility, has become the leading cause of drug overdose death in the United States. Provisional
data on drug overdose deaths in 2021 offer the chilling figure of 108.000 deaths, in a strongly
upward trend for a decade. In Europe, drug overdose deaths in 2020 (6.400) also increased
slightly compared to 2019, although not specifically related to fentanyl. In both Europe and the US,
approximately 75% of fatal drug overdoses are related to opioids. In the US particularly with illicitly
manufactured fentanyl and fentanyl analogues, and in Europe with heroin. Although with different
epidemiological nuances, the opioid crisis is a global phenomenon that has been superimposed
as a pandemic on the recent global health crisis due to COVID-19. The mortality rate related to
synthetic opioids (particularly fentanyl) is growing exponentially and unstoppably. This has occurred
in a very pronounced way in the US since 2013, but also in Europe since 2017, although with less
impact. In some way we could understand fentanyl as a starting point in the opioid crisis, since the
phenomenon is dynamic and changing. To better understand the opioid epidemic, it is necessary to
know that as substances related to fentanyl are controlled, new synthetic opioids (NSO) without
approved medical use (such as the so-called ‘nitazenes’) are detected with increasing frequency. in
drug seizures and forensic and toxicology reports worldwide.