The theft of 80 vials of fentanyl from Rome’s Ospedale Israelitico, a major specialized hospital and healthcare network in the Italian capital, is a serious incident that highlights ongoing vulnerabilities in the day-to-day handling of controlled substances in healthcare settings despite strict regulations. Although some institutions use digital systems that clearly identify the individual responsible for each drug withdrawal, many Italian facilities still rely on safes or cabinets secured with basic keys passed from one staff member to another — keys that can be easily duplicated — or on passwords written on notes kept nearby.

This is certainly not the first time that morphine or other opioids have been stolen from a hospital. Specifically regarding fentanyl, according to the Corriere della Sera (Italian daily newspaper), since 2018 there have already been about 20 cases of theft in hospitals, clinics, and nursing homes across various Italian cities, leading to the arrest of 60 people, including about 10 doctors.

Fentanyl abuse has been occurring in our country for at least 8 years, but fortunately, its use outside of medical contexts — where it is invaluable and irreplaceable — has so far remained marginal compared to the widespread harm caused by other drugs. On the one hand, there are the new synthetic substances that are introduced to the market every day — substances that are therefore little known, making it difficult to assess and prevent the harm they cause to health; on the other hand, above all, cocaine, which, according to the latest European Drug Report, is the second most common drug after cannabis and the leading cause of hospital admissions for acute toxicity; it was responsible in 2024 for 27% of drug-related deaths in Europe and for about one third of drug-related deaths and hospitalizations in Italy, according to the latest Report to Parliament on the Phenomenon of Addiction in Italy.

For the time being, here in Italy, there is therefore no indication of an illegal spread of fentanyl as is the case in the US, where tens of thousands of people die each year from overdoses of the substance, not to mention the incalculable consequences for public health, the social fabric, and even the economy of many areas affected by what has, with good reason, been considered an epidemic.

A Different Story

Why, then, has the phenomenon not taken hold in Europe? Roberto Saviano argues that it was the mafias themselves that prevented its spread. In my opinion, we must also consider other factors that distinguish the Italian reality from that across the Atlantic; therefore, it is not a given that what happened in the US — under very specific circumstances, which, fortunately, cannot be replicated here today — will necessarily be repeated in Europe. The illegal supply of fentanyl, in fact, emerged in response to a surge in demand that occurred under very specific circumstances, as depicted in films and television series such as Pain Hustlers, Dopesick Nation, and Painkiller.

In the late 1990s, US clinicians were the focus of a broad campaign urging more aggressive treatment of chronic pain, extending beyond cancer and end-of-life care. Although the message initially appeared well intentioned, it was advanced in part by companies marketing newer synthetic opioids such as OxyContin, which were promoted as nonaddictive and therefore safe for widespread use. As a result, millions of patients with headaches, back pain, and other musculoskeletal conditions became dependent on opioids — often without realizing it, and in some cases without their prescribing physicians fully recognizing the risk.

In the late 2000s, when the full extent of the problem became clear, a crackdown by health authorities curbed prescriptions, but this pushed those who had already developed an addiction to seek substances on the black market — first heroin, which around 2010 caused a rapid increase in overdoses, and then illicitly produced fentanyl, which was cheaper and easier to obtain and which, starting in 2013, triggered the current crisis.

Heroin and Fentanyl: Similar yet Different

To understand just how unique — and different from the situation in Europe — the situation in the US was, it is worth noting that 80% of the people who used heroin during those years had initially received a prescription for opioids from a doctor. Even today, more than half of those addicted to opioids in the US also suffer from chronic pain; therefore, as recommended in a recently published article in The New England Journal of Medicine by experts from the National Institute on Drug Abuse in Bethesda, Maryland, when proposing a detoxification program, we must not forget to provide patients with support for the underlying problem, to prevent them from relapsing in their search for relief from uncontrollable physical pain.

In Italy and Europe as well, we experienced what we might call an “opioid epidemic” in the 1980s. Back then, it was heroin, and the victims were mostly young people seeking an escape from social or existential distress. In the US, however, people of all ages have fallen into the fentanyl trap — not while seeking out a drug but by following the instructions of their trusted doctor.

I therefore do not believe that the mere presence of larger quantities of fentanyl on the market is enough to trigger a phenomenon similar to that in the US. It is right for the authorities to take action, especially given the risk for overdose from such a potent substance, and for emergency services to be ready to use naloxone to save the lives of those who might encounter it; it is also important that those who abuse opioids be informed and aware that they may find far more dangerous products on the black market.

However, the conditions for a crisis comparable to that seen in the US do not appear to be in place, given that the epidemic was driven not by supply alone but by strong demand. That demand was fueled less by the Mexican drug cartels, which later exploited the crisis, than by unethical corporate practices and the involvement of physicians who helped expand opioid prescribing, bearing substantial responsibility for the resulting harm.

This story was translated from Univadis Italy, part of the Medscape Professional Network.