The (Hypothetical) Scenario of a Fentanyl-Overdose Death Epidemic in Europe: Considering Canada-Based Experiences and Insights

Background: North America has been experiencing an unprecedented public health-crisis from illicit/synthetic fentanyl/fentanyl-analogue (F/FA)-related overdose-deaths (DODs), with speculative warnings for a similar crisis to unfold in Europe. Aim: We summarize key Canada-based experiences relevant for reducing the adverse impacts of a (hypothetical) F/FA-crisis in Europe. Results: F/FA-availability in North America has risen in contexts of major oscillations in pharmaceutical opioid control and supply. Illicit F/FA-products are potent opioids for which correlates of (injection/non-injection) use-modes, adulteration (with other drugs) and use-contexts produce distinct risk environments for DOD. Standard treatment (e. g., OAT) and ‘harm-reduction’ (e. g., supervised-consumption, naloxone, drug-checking) interventions have been widely expanded; however, their overall scope and reach has been limited in curbing the F/FA-related DOD-toll. In response, ‘safer-opioid-supply’ (SOS) programs have been implemented to reduce exposure to illicit F/FA-drugs with promising initial signals for DOD-related outcomes, while requiring more evaluation and ramp-up for possible benefits. Conclusions: The likelihood of a possible F/FA-crisis in Europe is difficult to forecast; if unfolding, Canadian experiences suggest that standard interventions are essential, but likely would be insufficient for effectively containing the consequential DOD-toll; additional, evidence-based intervention strategies should pre-emptively be considered and developed.