As heroin in Afghanistan dries up, Europe could face an overdose crisis like the U.S.

For anyone living in America, the nightmarish shift in a contaminated drug supply is all too familiar. For roughly two decades, the United States has been gripped by an increasingly deadly overdose crisis, largely driven by the opioid fentanyl, that has killed more than 1 million people since 2000. These deadly trends, experts say, are largely driven by an unstable and unpredictable drug supply made possible by prohibition.

Many people know it began with the overprescription of opioids like Oxycontin, which resulted in a DEA crackdown that shifted many users to street heroin. Demand became so high that illicit drug manufacturers realized they could make more money and traffick drugs easier by shifting to synthetic opioids. Thus came the rise of ultra-potent opioids like fentanyl, which is increasingly mixed with other drugs including stimulants, xylazine, benzodiazepines and nitazenes. If any of these drug names seem unfamiliar to you, just know that what used to be a predictable bag of dope has now become a soup of different substances, some of which provide a buzz or act as fillers, others that can kill.

In Europe, the last few decades have played out differently. Overdose deaths have remained steady, largely thanks to a regular, relatively pure supply of heroin shipped straight from Afghanistan.

"I remember roughly a year or so after the Taliban came into power, good heroin slowly disappeared," a friend living in London recently told me. "I haven't had any users I know die of heroin overdoses for many years before. I quit last September and it was around the time nitazenes and other synthetic stuff started to appear on the streets regularly. I caught up with an acquaintance around Christmas and was told three people I knew died."

For decades, Europe has avoided the fentanyl crisis plaguing North America through a pure supply of heroin straight from Afghanistan. But following the Taliban's poppy ban in 2022, there have been fears that a heroin drought will clear the way to even deadlier alternatives. 

Unlike synthetic opioids produced using chemicals in a lab, heroin and morphine are refined from the gum extracted from Papaver somniferum, the opium poppy. Until the early ‘70s, much of Europe and America’s heroin originated from the poppy fields of Anatolia in Turkey until, under American pressure, the Turkish government shut down the industry.

Poppy fields then reemerged in Iran, until they were eradicated in the Islamic Revolution, and finally Afghanistan, where CIA-backed rebels were battling the Red Army since 1979. Opium was sold to purchase bullets for the guerillas. Warlords such as Mullah Nasim Akhundzada even issued edicts ordering peasants to harvest more poppy, one of the few plants that flourished in the dry, dusty landscape. Plagued by tribal rivalries, war raged in Afghanistan long after the Soviets retreated. By the late ‘90s it was exporting around three-quarters of the global opioid supply.

The Turks remained important middlemen for transporting heroin from the Middle East to Europe, first partnering with the Bulgarian KGB and then, following the collapse of communism in Eastern Europe by the early '90s, Albanian mobs. This network, known as the Balkan route, has remained robust for the past half-century. The steady stream of smack meant there was no need for traffickers to diversify their product portfolio.

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In 1999, the Taliban, an Islamic fundamentalist movement that emerged triumphant from the Afghan civil war, wanted to legitimize themselves on the world stage as the rightful rulers of this mountainous land. Their treatment of women rightly alienated the Western world, but their war on drugs did not, imposing a brief but effective ban on poppy cultivation that even won praise from then-U.S. Secretary of State Colin Powell. 

Good news? Not quite.

Alarm bells first sounded in the Baltics. A heroin shortage in Estonia following the first poppy ban was quickly filled by fentanyl labs in St. Petersburg, and by 2012 the tiny nation in northeastern Europe was suffering one of the worst overdose crises in the world. A massive sweep in 2017 arrested the major players and Russian mafia responsible around Tallinn and Ida-Viru County, near the Russian border, leading to a scarcity as users switched to speed or fentanyl analogues. Since then, however, fentanyl supplies been restored, almost completely supplanting any remaining heroin demand.

Carrie Hankins, of Jefferson County Public Health, holds a Fentanyl test strip during an event held at Lakewood Library on August 25, 2022 in Lakewood, Colorado. (RJ Sangosti/MediaNews Group/The Denver Post via Getty Images)

The heroin market remained stable throughout the rest of Europe as America and its allies invaded Afghanistan in 2001, the Talibs retreating back to guerrilla mode and turning to the dope business to make ends meet. But Uncle Sam’s military might was no more able to subdue Afghans than the Russian Bear – all the Talibs had to do was wait (and occasionally, fire an RPG in the enemy’s direction.) 

Immediately after the last U.S. soldier left Kabul two decades later, the Taliban seized power and shortly later, reimposed prohibition. The Students, as their name translates to in their native Pashto, achieved what decades of foreign occupation could not, uprooting poppy fields with tractors and rounding up opioid users into jail-like detox. By 2023, the UN estimated opium gathering in Afghanistan had plunged by 95%.

“The heroin market seemed to have been prepared for the first year of the Taliban ban: there was enough heroin in circulation and stocked up to dampen any supply shocks,” explained Andre Gomes, head of comms for the British charity Release, which provides legal advice on drug cases. “Heroin is also highly adulterated in the European market, so a source ban wouldn’t have immediate effects. A second year of [ban on] poppy cultivation will most likely lead to higher prices for dwindling supplies, and more incentives for more potent synthetic alternatives to be explored.”

Poland in particular has been troubled by a recent spate of fentanyl deaths. While clandestine fentanyl factories are still extremely rare in Europe and most of what appears on the black market are rediverted medical supplies (in Poland, it is rather easy to obtain an online prescription for fentanyl patches as painkillers, rather like pill mills in the U.S.), this could change if honest-to-God smack becomes more scarce.

“Compared to North America, synthetic opioids play a relatively small role in Europe’s drug market overall, but feature prominently in the opioids market in the Baltic countries,” a representative of the European Union Drugs Agency wrote in an email. “There is growing concern about their use in some other EU member states. Despite the difference in scale, and in the nature of the opioids causing harms, concerns are growing that highly potent synthetic opioids are increasingly appearing on the European drug market. Vigilance is crucial.”

At the same time, nitazenes and xylazine, have been creeping up in fatal overdose reports in the U.K. since 2023. First developed as painkillers by the Swiss company Ciba Pharmaceuticals in the 50s, nitazenes are synthetic opioids roughly as potent as fentanyl but sometimes demanding more naloxone to revive from an overdose. Xylazine, an animal tranquilizer which has caused chaos on the streets of Philadelphia, is now being found across the pond in bootleg codeine, tramadol, Valium and Xanax. Both nitazenes and xylazine are now banned by the British government but are still being smuggled from China, sometimes hidden in cans of dog food.

“Since nitazenes have come on the scene, we’ve seen spikes in related deaths across the country, particularly in the northeast [of England], that are very concerning,” Gomes said. “We fear these spikes are signs of a worrying underlying trend. We know there’s a backlog of reported cases in coroners offices, meaning that real figures for nitazenes deaths are only going to be revealed later this year and the next.”

Mat Southwell is a harm reduction worker in Bath, a small city in southwest England where one up-and-coming dealer was recently arrested for selling nitazenes-laced heroin.

“He was selling really good quality crack, which made him attractive … and he bought some nitazenes off the internet,” Southwell explained. “Initially, there was this view among local peers [drug consumers] that this is really great, strong heroin, and then people started to go down really hard.”

Luckily, ambulances arrived in time to revive them with naloxone.

“I think it's like a perfect storm,” Southwell said of the opioid crisis. “The government is pumping more money into drug treatment, but actually drug users are not coming forward to use it because it’s such a coercive model. Then we've got Afghanistan taking out 95% of its opium crop. That's not going to be impacting now — it takes at least 18 months to two years for that crop to work its way through … At the moment, the police are able to take out [retail nitazenes dealers] pretty quickly, but once it starts to hit higher in the chain, and then once people are suddenly going ‘we’ve got no heroin’ — that's the moment we're all looking at with super fear.”

When it comes to synthetic opioids, China is the new Afghanistan thanks to its vast, loosely-regulated chemical industry subsidized by Beijing. Although fentanyl itself was banned in 2019, unscrupulous companies still happily ship the raw ingredients (known as precursors) to Mexican cartels and other customers, which are not illegal under Chinese law.

In March, a package of nitazenes was discovered in Holland for the first time, bound for the States. Although the Dutch are major manufacturers of synthetic drugs like MDMA (ecstasy), it’s unclear whether the pills were produced locally or not.

“In Europe, we have the benefit of foresight: we saw what happened in America and can prepare accordingly to avoid the worst outcomes,” Gomes continued. “We know that there are potential synthetic opioids in our supply and can implement drug checking systems, safe use sites and prepare treatment systems to support people if and when they need it. Decriminalization and harm reduction interventions will be key to keep people safer and to avoid fatal overdoses.”

In some ways, Europe is better-prepared already. Certain countries such as Germany, Switzerland and Holland have either supervised consumption sites – essentially BYOD (Bring Your Own Drugs) shooting galleries where naloxone and medical assistance is right at hand – or even heroin-assisted therapy, a treatment where pure diamorphine (i.e. pharmaceutical-grade heroin) is administered to patients at specialized clinics, removing the risk of a fatal poisoning. (In controlled doses, heroin and indeed even fentanyl can and are ingested safely.) It also helps users avoid unpleasant encounters with either side of the law and diminishes the incentive to commit crime: why trap or steal when you can score every day for free?

This was once known as the “British system,” where until the 1970s, free heroin, morphine and cocaine were dispensed to registered users with addiction. Although it had its hiccups, like Lady Isabella Frankau overprescribing from the backseat of her car, overall it had the problem contained. Britain today has largely abandoned this system, although last year the country’s first supervised consumption site was greenlit in Glasgow, Scotland, and is finally due to open this month. Scotland currently suffers the worst overdose crisis in Europe, and the Scottish government has been pushing for reform, including decriminalizing personal quantities, providing safe consumption spaces and widening access to naloxone. 

There’s no guarantee yet that Europe will experience an overdose crisis like North America. But the warning signs are all there, and it’s better to be safe than sorry.