Fentanyl and the Mafia: The Demand That Was Never There

An essay in The Conversation this week takes aim at a story that has circulated widely: that Italy's mafia groups, wary of a drug that kills its customers and draws police attention, have deliberately kept fentanyl out of Europe. The essay's argument is that the theory does not fit what is known about drug markets or organised crime, and that Europe's comparatively low fentanyl numbers are better explained by something less cinematic, namely that there is very little demand for it.

The figures the essay cites are stark. Fentanyl and other synthetic opioids were involved in around 38,000 of the roughly 70,000 overdose deaths recorded in the United States in 2025, according to the Centers for Disease Control and Prevention. In 16 European countries that reported data, fentanyl and its derivatives were linked to around 210 drug-induced deaths in 2024, up from about 130 in 2023, and the essay notes that most of that rise may involve medicines rather than illicitly made fentanyl. In Italy, the government's latest report on addiction counted only five fentanyl-related deaths in 2025.

The essay attributes the American crisis to a prescription wave Europe never had. From the late 1990s, it argues, aggressively marketed painkillers such as OxyContin were handed out widely in the United States with their addictive potential played down, and millions developed opioid dependence through legal channels. When access was tightened in the 2010s, that dependence did not disappear; people turned to the illicit market, first heroin and then fentanyl. Europe, the essay says, never had an equivalent prescription wave, because opioid painkillers are prescribed far more cautiously there.

The essay is careful about what happened to heroin, which it describes as still Europe's most commonly used illicit opioid, according to the EU Drugs Agency. Most of it has historically come from Afghanistan, entering Europe through the Balkans, and the essay describes that market as resilient and stable. Even as Afghan opium cultivation collapsed after the Taliban's bans, the trade adapted rather than vanished. The point is that Europe's opioid market already has a settled product and a settled route, and no large population of dependent users looking for a substitute.

That is where the mafia theory runs aground. The essay does not argue that organised crime groups are principled; it argues that the theory credits them with a restraint that the market does not require them to exercise. If there is no demand, there is no trade to suppress, and no decision to keep a drug out. The absence of fentanyl in Europe, on this reading, is not a choice made by criminals but a gap in the consumer base.

The essay also notes that other potent synthetic opioids, notably nitazenes, have driven recent peaks in deaths in several countries, which complicates any simple story about Europe being shielded from synthetics. The wire does not carry Italian or European enforcement comment on the essay's argument, and the essay itself is a commentary rather than a report of a new operation, seizure or indictment.

For a region that the world knows chiefly through its organised crime, the essay is a useful corrective to a certain kind of flattery. The story that the 'Ndrangheta and its peers are holding back fentanyl casts them as gatekeepers with a code. The essay's account is less flattering and more plausible: a market that never developed the appetite, and traffickers who follow demand rather than restrain it.

What the essay does not do is describe the state of the southern drug trade, the routes through Mediterranean ports, or any recent seizure. It is an argument about demand and prescription practice, drawn from American and European data, and it should be read as such. The figures it cites are the government's own addiction report for Italy and the CDC's for the United States, and the comparison is the substance of the piece.

The practical consequence, if the essay is right, is that the fentanyl question in Europe is a question for health services and prescribing practice rather than for prosecutors. That is a less dramatic conclusion than the mafia story, and harder to put in a headline. It is also the one the numbers support.