The Mafia Is Not Holding Fentanyl Back, and the Reason Is Demand

The theory that Italy's mafia groups have chosen to keep fentanyl out of Europe is a compelling story, but it does not fit what is known about drug markets or organised crime, according to an analysis published by The Conversation. Europe's comparatively low fentanyl numbers are better explained by something less cinematic: there is very little demand for it.

The figures the analysis cites are stark in their asymmetry. Fentanyl and its derivatives were linked to around 210 drug-induced deaths across 16 reporting European countries in 2024, up from about 130 in 2023, and much of that rise may involve medicines rather than illicitly manufactured product. In the United States, fentanyl and other synthetic opioids were involved in roughly 38,000 of about 70,000 overdose deaths recorded in 2025, according to the Centers for Disease Control and Prevention.

In Italy, the government's latest report on addiction counted only five fentanyl-related deaths in 2025, the analysis states. That is the number around which the mafia-as-gatekeeper story has been built, and the analysis argues the number reflects the absence of a market rather than the exercise of a criminal veto.

The analysis traces America's crisis to a legal origin. From the late 1990s, aggressively marketed prescription painkillers such as OxyContin were handed out widely, with their addictive potential played down, and millions of people developed opioid dependence through entirely legal channels. When access was tightened in the 2010s, that dependence did not disappear; people turned to the illicit market, first to heroin and then to fentanyl, which is cheap to make, easy to smuggle and potent enough that tiny amounts go a long way.

Europe never had an equivalent prescription wave, according to the analysis. Opioid painkillers are prescribed far more cautiously there, so there was no large population suddenly cut off from a legal supply and looking for a substitute. Heroin, meanwhile, never went away: it remains Europe's most commonly used illicit opioid, according to the EU Drugs Agency, historically sourced from Afghanistan and entering through the Balkans, and the market has proved resilient and stable.

For Sicily the argument cuts against a familiar self-image. The island's organised crime groups are still framed abroad through narcotics — the transatlantic trafficking networks, the alliances with suppliers, the long history of drug money moving through Palermo and its hinterland. The analysis does not dispute that history. It disputes a new and flattering version of it, in which the same groups are credited with a public-health restraint they never claimed.

The reasoning offered is economic rather than moral. Traffickers add products when there is a customer base to serve, as Mexican groups supplying heroin to the United States did when they added fentanyl to their range. Where there is no established demand, there is no commercial reason to build a supply chain, and the risks of a deadly product drawing police attention weigh against a market that does not yet exist. The absence of fentanyl, on this reading, is a market fact, not a policy.

The analysis also notes that other potent synthetic opioids, notably nitazenes, have driven recent peaks in deaths in several countries. That detail complicates any comfortable conclusion that Europe is structurally protected. The relevant question for Italian and Sicilian authorities is not whether the mafia is holding a line, but whether the health system and the drug-treatment network would recognise a shift in supply if one began.

The piece is an analysis of published drug-market and mortality data, not a report of a new operation or investigation, and it names no Sicilian defendant or case. Its consequence lies in the framing it removes. A story that casts criminal organisations as Europe's inadvertent guardians of public health makes the actual vulnerability — low demand today, and no guarantee of low demand tomorrow — harder to see.