The European opioid crisis is playing out differently from the North American one — so far without broadly available pharmaceutical opioids as an entry point. But: synthetic opioids from online sources (often Chinese or Indian supply chains) have been increasingly present since 2020.
What is found in the current market:
- Nitazenes (isotonitazene, etonitazene, metonitazene): up to 1000× stronger than morphine, often in supposed heroin or counterfeit “Oxycontin” tablets
- Fentanyl adulterants in heroin
- Tilidine and tramadol misuse with mixed-use risks
- “Painkillers” sold online of unclear identity
Protective measures:
- Naloxone nasal spray (Nyxoid, OTC at pharmacies since 2024). Keep it on hand if opioid use is suspected or if you are around people who use them.
- Drug checking in Berlin: drugchecking.berlin (vista, Schwulenberatung, Fixpunkt) and Eclipse e.V. Get every new substance tested.
- Never use opioids alone — respiratory depression is the leading cause of death.
- Fentanyl test strips as an additional check (not reliable for nitazenes, but useful for heroin).
The naive assumption “fentanyl doesn’t exist here” has led to several deaths in major German cities in recent years.