Floreasca Emergency Clinical Hospital. Photo: Inquam Photos Octav Ganea
Although in Romania fentanyl has been on the list of high-risk narcotics since 2003 and is used in a controlled manner in hospitals for general anesthesia or in palliative care wards, in recent years it has started to appear more and more frequently on the black market.
After the shocking accident in the 2 Mai resort, the prosecutors discovered that the family of Vlad Pascu, the driver under the influence of drugs, had fentanyl at home, an opioid consumed by the young man’s entourage. From 2022 until now, more than 13,000 tablets would have been sold in our country, most of them illegally removed from hospitals.
Now, after the case of the resident doctor found dead in a toilet of the Floreasca hospitalthe dangers of fentanyl have re-entered the public spotlight.
In an interview given to the publication Adevărul, criminologist Vlad Zaha answered some essential questions related to how this substance ends up on the black market. He explained the risks to which consumers are exposed and gave the authorities advice on the really effective measures in the fight against this scourge.
Vlad Zaha: “Most medicines can also be drugs”
According to him, the explanation of the drug and drug status is essential to understand the phenomenon.
“We need to know that most drugs can be ‘drugs’ and most drugs can be drugs, the only differences being given by the context – especially the presence or absence of the medical/sanitary environment. Fentanyl is no exception – it is mainly a substance used in the hospital environment, following serious accidents or complicated operations, for example for pain management, anesthesia or sedation”explained Vlad Zaha.
Being a “synthetic opioid up to 100 times more potent than morphine, the amount equivalent to a sesame seed is enough to become lethal,” reports the criminologist.
It is this extreme potency that makes out-of-hospital use particularly dangerous, as the optimal dose is very close to the lethal dose.
At the same time, being so potent in minute amounts makes fentanyl highly profitable for organized crime rings, which use it to potentiate other substances and maximize revenue, according to the criminologist.
“The risks depend on the amount consumed illicitly and include the whole range of accidents, from sickness to life-threatening. Such problems can mainly be avoided if people have the opportunity to test their illicit substances that they consume – either through individually purchased tests or, ideally, through state-provided opportunities such as mobile or static substance testing centers. Similarly, there are overdose prevention centers in a number of European states whose purpose is precisely the safe and supervised administration by medical personnel, in order to protect the lives of users. Also, it is very important that people call 112 if they think something is wrong with illicit substances“, declared Vlad Zaha.
Asked how small a dose is that can become lethal, the criminologist offered a terrifying comparative perspective.
“Although a sesame seed is an extraordinarily small amount, fentanyl is by no means the most potent opioid – we also have, for example, «sufentanil», where the lethal dose can be the equivalent of a grain of sand, or «carfentanil», for which the lethal dose can be the equivalent of half a grain of salt, both of which are much more potent than fentanyll”, he said.
As for the profits generated by traffickers, the global market for all illegal substances is growing rapidly, “to exceed over half a trillion dollars annually, i.e. over 500 billion dollars, an amount far above Romania’s GDPi”, explained Vlad Zaha.
However, the opioid market is not so developed in the European Union, in Romania mainly cannabis, cocaine and methamphetamines predominate.
“An estimate for Romania would be that the income of the big traffickers amounts to a quarter of a billion euros annually for all substances“, explained the criminologist.
“The fight against substances is illusory”
Regarding the difficulties in combating fentanyl trafficking, Vlad Zaha drew attention to an uncomfortable reality.
“Regarding the fight against substances, this is rather illusory – we cannot “fight” a substance used predominantly medically in all hospitals of the modern world, especially a substance where a single large shipment could supply a country like Romania for long periods of time. But we can invest in saving the lives of people who illicitly consume all kinds of substances through risk reduction measures (substance testing, overdose prevention, responsible information), treatment for those who reach to need, prevention made to international standards for providing skills to young people, etc“, the criminologist also specified.
Romania’s vulnerability to the emergence of a fentanyl market is generated, in his opinion, by the fact that all measures that could delay, ameliorate or manage the consumption of substances have been ignored, underfunded, blocked or even demonized.
“We are talking here about decriminalization of users (detention) – if we want to save lives, this decriminalization is the first step to be taken in order to help people. Then about overdose prevention centers for users of injecting substances – sterile utensils, medical-psycho-social support. Then about the possibility of testing substances to detect contamination. Then about emergency medical devices to manage an overdose in progress, such as naloxone. And we’re generally talking about replacing the idea that we can solve something by ‘force’ with the correct idea that we can only solve problems through a public health approach.”declared Vlad Zaha.
The criminologist gave the example of the United States, where overdose deaths have halved in recent years, citing the findings of the American Health and Science Council.
“None of the most plausible explanations for the decline in overdose deaths involves an intensification of the war on drugs. Rather, the evidence points to lower-risk consumption patterns, harm-reduction measures, access to naloxone, and behavioral adaptations in response to an increasingly dangerous illicit market. After more than 50 years of failures, the war on drugs remains far more effective at generating black markets than at saving lives”said Vlad Zaha, citing the mentioned source.
