Fentanyl in Italy and the European Opioid Market - Royal United Services Institute (RUSI)

CommentaryGuest CommentaryFederico Varese16 October 2026clock8 Minute ReadOpioid threat: Italian Armed Forces and Carabinieri involved in the fight against organised crime and drug trafficking in San Pasquale. Image: NurPhoto SRL / Alamy StockItaly’s low fentanyl death toll reflects Europe’s distinct opioid market history, not mafia restraint – but synthetic opioids such as nitazenes are a growing threat. Italy has recorded very few deaths involving fentanyl. A September 2026 article in The Economist invokes The Godfather films to suggest that ‘the country’s mafias seem to have collaborated to keep fentanyl out of their territory,’ protecting their established markets from a substance that kills customers and attracts police attention. Such a hypothesis had already been put forward by Roberto Saviano in La Repubblica. While it is an intriguing theory, there is no evidence for it. To understand the absence of an American-style fentanyl crisis in Italy as well as in other parts of Europe, we need to look at the history of opioid markets, rather than assume that godfathers hailing from unnamed ‘mafias’ are out there to protect their fellow countrypeople.

WindsorThe Windsor-Essex Community Opioid and Substance Strategy (WECOSS) says 30 opioid overdoses were reported through emergency department visits between Sept. 27 and Oct. 3. Overdoses were reported between Sept. 27 and Oct. 3Desmond Brown · CBC News · Posted: Oct 05, 2026 6:22 PM EDT | Last Updated: October 6Listen to this articleEstimated 2 minutesThe audio version of this article is generated by AI-based technology. Mispronunciations can occur. We are working with our partners to continually review and improve the results. The Windsor-Essex Community Opioid and Substance Strategy (WECOSS) says 30 opioid overdoses were reported through emergency department visits between Sept. 27 and Oct. 3. (Eric Baradat/AFP/Getty Images)A high number of opioid overdoses reported last week have prompted a health alert from a community‑based partnership working to prevent and reduce substance‑related harms in Windsor‑Essex. The Windsor-Essex Community Opioid and Substance Strategy (WECOSS) says 30 opioid overdoses were reported through emergency department visits between Sept. 27 and Oct. 3. Of those cases, 17 involved fentanyl, according to WECOSS.

Fentanyl and other synthetic opioids are still the single biggest driver of overdose deaths in the US. They were involved in around 38,000 of the roughly 70,000 deaths recorded in 2025, according to the Centers for Disease Control and Prevention. Europe’s figures are of a different order. In 16 countries that reported data, fentanyl and its derivatives were linked to a total of around 210 drug-induced deaths in 2024, up from about 130 in 2023. Most of that rise may involve medicines rather than illicitly made fentanyl.