Paris (AFP)

One evening in December 2016 in the south of France, Joseph, 18, never woke up. In question, a fake morphine tablet sold under the coat and containing fentanyl, an overpowered opioid which, after having wreaked havoc in North America, worries Europe.

This kind of drama has become commonplace in the United States and Canada, where fentanyl and other opioids cause tens of thousands of deaths a year. But Europe, hitherto relatively protected against this painkiller drug which has become a deadly drug, is far from waterproof.

This substance, 50 times more powerful than heroin and 100 times more than morphine, circulates more and more on the Old Continent and causes worrying peaks of fatal overdoses.

"Outside of an extremely precise context, like cancer patients at the end of their life, taking fentanyl is worse than playing Russian roulette," said Juliette Boudre, Joseph's mother. "It's impossible to get out of it."

Addicted to anxiolytics (tranquilizers of the Xanax type) which he appreciated "the hovering effect", his son gradually switched to painkillers, codeine in mind. At the end of 2016, the young man went "to go green" in Cannes. But at the funfair, he buys tablets presented as "morphine or a derivative", says his mother.

Counterfeit, the pills contain fentanyl. After the anxiolytics already consumed that evening, the cocktail will be fatal to him: some grains of this drug can be fatal.

"The worrying thing about fentanyl is the consumer profile," said Les Fiander, director of the drug squad at Europol. "They are quite young and do not know what they are taking because fentanyl is often mixed with other drugs, heroin, cocaine, and this represents a great danger for individuals who have no tolerance for opioids".

- Serial killer in the USA -

Joseph's death recalls the fate of Prince, who died of adulterated painkiller, without knowing that he was taking fentanyl. In the United States, the singer's case symbolizes the ravages of a substance that has become a real serial killer.

Legal on prescription, in the form of painkillers, nasal sprays or tablets to be melted under the tongue, it causes abuse in many patients. They die "on prescription" or by misuse of drugs sold under the coat.

Fentanyl can also be synthesized illegally, most often in China or Mexico, and then shipped in simple postal packages after ordering on the darknet. The whitish or yellowish powder which thus arrives on the black market can be smoked, snorted, injected or incorporated into tablets. But traffickers and users are often unable to measure to the nearest milligram.

In 2018, 32,000 Americans died from an overdose involving fentanyl and other opioids, according to still tentative official figures.

This dark scenario started because of certain pharmaceutical companies, which encouraged doctors to prescribe ever stronger painkillers, including medical fentanyl, creating a population of addicts. In response, the authorities restricted the prescriptions: the Americans then turned to heroin and the traffickers took advantage of this to sell illegal fentanyl, which is more profitable and easy to produce.

In Europe, the situation is very different, underline unanimously the experts consulted by AFP.

The continent benefits from several "protective factors", according to the scientific director of the European Monitoring Center for Drugs and Drug Addiction (EMCDDA), Paul Griffiths: the prescriptions for painkillers are better regulated and fentanyl is very little prescribed, the use heroin is less common among young people, and access to substitution treatment is easier.

The American crisis also engenders distrust of heroin users, who are used to using opioids, according to Magali Martinez, research officer at the French Observatory for Drugs and Drug Addiction (OFDT).

"Most consider fentanyl dangerous because of the very high and unattractive risk of overdose: its effect is described as more boring than euphoric," explains the researcher.

- "Descent into hell" -

And yet. Health worker, Jacques (his first name was changed) sank into medical fentanyl, even "knowing perfectly well the risks of addiction".

Thanks to his status and some tricks, this fifties diverted the drug for five years: a real "descent into hell", says the French, "clean" since February 2019 thanks to the daily meetings of Narcotics Anonymous.

Already a cocaine addict, he tries fentanyl after his divorce, and to relieve himself from fractures after a motorcycle accident.

After the first "discharges of pleasure" which give him the illusion of being "happy, connected with people", he quickly finds himself acting "like a basic drug addict": from two to three snif daily, he goes to "five or six bottles of sprays per day".

Dependence and lack take hold of him: drowsiness at work, sweating, malaise, aggression, nausea, constipation, "excruciating pain in the legs" ... Never relieved, he even chews on patches, enough to absorb directly " a dose designed to be spread over three days. "

Despite two overdoses, which he survived thanks to the intervention of friends, nothing stopped him. "I was trapped: I could no longer have fun, I only had pain," he says. "The last two years, every three days I said to myself:" I stop. "But my whole life revolved around my next dose."

- Strong increase in seizures -

The EMCDDA has no overall figure for deaths directly related to fentanyl in Europe. It simply records 8,200 overdose deaths (all types of drugs combined) in Europe in 2017.

"About 70% of them are related to opioids and among these 70% are due to heroin," explains Mr. Griffiths.

But an overdose death is rarely due to a single drug. And for lack of precision in European toxicological analyzes, the role in recorded deaths of fentanyl and its multiple derivatives (there are dozens of them) could be underestimated, according to the organization.

A fear supported by Juliette Boudre. She only identified fentanyl several weeks after the tragedy, by having one of the pills hidden by her son analyzed by a police friend in Paris. At the time of death, there had been no investigation.

Seizures of this drug are rapidly expanding in Europe. According to the latest available data, around 15 kg were intercepted in 2017, compared to just one the previous year. Enough to make "millions of doses", explains Mr. Griffiths to the EMCDDA.

As a sign of this new availability, some European countries have recently experienced occasional peaks of fatal overdoses.

In 2017, the United Kingdom recorded 75 deaths directly linked to fentanyl (+ 29% over one year). The drug was used to cut heroin, mainly in the north of the country, authorities said.

In Sweden, fentanyl and its derivatives have become more deadly than heroin, causing at least 370 deaths since 2014, according to a report by the EMCDDA and Europol. They were sold openly online, before the government took action that significantly slowed the death toll.

Estonia was also bruised by fentanyl: among drug addicts, it was "the most used opioid after a heroin shortage in the early 2000s," said Griffiths. Since 2001, the EMCDDA has recorded 1,600 fatal overdoses in this small Baltic country, mostly due to fentanyl and other synthetic opioids.

But health and police efforts are starting to pay off. "Last year, fentanyl almost disappeared" from the Estonian market, according to Griffiths.

In France, the consequences remain limited and the cases of small scale. At the OFDT, Magali Martinez mentions "less than 10 deaths per year" directly linked to fentanyl and "seven fatal cases which concerned fentanyloids" (derivatives and analogues of the substance) between 2015 and 2018.

But vigilance remains essential not to know an American-style scenario: a recent report from the drug authority (ANSM) identifies 10 million French people whose doctor prescribes an opioid, more or less strong. "The issue of pain management creates a permanent risk of falling into a health crisis", fears Matthieu Noël, head of the strategic analysis division of the anti-narcotics office (Ofast).

- Clandestine labs and darknet -

France, Estonia, Germany, Sweden, Poland, Slovakia: several small laboratories capable of ensuring the complete production of fentanyl have been dismantled by the anti-narcotic services in recent years.

However, "most of the goods come from China via the darknet and are sent to Europe by parcel. It is a very anonymous process (...), very difficult to detect," continues Les Fiander at Europol.

The European police agency "does not want to be alarmist", he adds. But she "takes this problem very seriously" and collaborates regularly with the American authorities. Because the market is growing: of the 49 new synthetic opioids detected in the European drug market by the EMCDDA for ten years, 34 are derivatives of fentanyl and six were identified for the first time in 2018.

Hidden on the darknet, the traffickers are "difficult to identify", says the policeman. Some networks "have proven to be very sophisticated operations, organized like a pharmaceutical or commercial company, with managers for logistics, orders, site content ..."

But it is the evolution of organized crime in Mexico that worries him the most.

In North America, "the Mexican cartels have gone from methamphetamines to fentanyl, because it is a very profitable traffic. They are supplied directly in China in large quantities" to sell the goods in the United States, details Les Fiander.

However, "we have recently identified Mexican criminals in Europe, involved in the production of methamphetamines. In the future, they could perhaps use fentanyl. This would be a very serious situation."

For traffickers, fentanyl "is a very profitable commodity", recalls Mr. Griffiths of the EMCDDA. According to the American anti-drug agency (DEA), one kilogram of illegal fentanyl can generate at least $ 1.5 million in revenue in the United States.

"Synthetic drugs will become more and more important as it becomes more difficult to find places in the world to grow coca or opium," predicts the expert. "There is a real comparative advantage in developing very powerful synthetic drugs and fentanyl fits fully into this model."

This drug and its derivatives have already been spotted in fake Xanax pills and in certain e-liquid refills for electronic cigarettes, according to Europol and the EMCDDA.

Faced with this protean danger and the increasing consumption of other opioid drugs, European health authorities want to facilitate access to naloxone, an antidote capable of countering an overdose, which was long only available by prescription.

Eleven European countries, including France, have a program to market ready-to-use kits (by injection or nasal spray), without the need to consult a doctor. However, the availability of the remedy in pharmacies is far from sufficient, according to specialists.

© 2020 AFP