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Italy’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.

Low Numbers Across Europe

Fentanyl was identified in two fatal acute intoxications in 2024 and five in 2025, according to the annual reports to the Italian Parliament. The two 2024 cases also involved other substances. Surely, this is a low number. The Economist contrasts these figures with the cases recorded in Germany, suggesting a possible ‘Italian mafia effect’. ‘Germany had 95 [fentanyl fatal intoxications in 2024],’ informs us the author of the article. Actually, the German Federal Criminal Police Office (BKA) table records 98 deaths: 22 in the single-substance category and 76 in the multiple-substance category. Crucially, the BKA methodological note says that neither category requires the intoxication, or the detected substance, to have caused the death. So even the 22 cases must not be presented as a corrected total of deaths caused by fentanyl alone. Italy’s two cases in 2024 were fatal acute intoxications in which fentanyl was implicated in the cause of death. The Italian figure measures a narrower outcome. Presenting these numbers as equivalent exaggerates the apparent contrast between the two countries. In any case, one must look at data from other European countries too.

Pharmaceutical marketing and widespread prescribing helped create a large population dependent on opioids before illicit fentanyl became common

In the Île-de-France region (which comprises Paris), fentanyl or an analogue was detected in 12 of 1,199 deaths examined between 2017 and 2021, approximately 1% of that forensic series, or 2.4 cases a year on average. Nine involved fentanyl, two ocfentanil and one sufentanil. Eight deaths occurred in a context of drug use and four were suicides. There is at least one other study that reports French data: a report published in 2026 describes 13 deaths with post-mortem fentanyl detection between 2020 and 2025 in the jurisdiction of the Strasbourg court, approximately 2.2 fatalities a year. Other psychoactive substances were present in around 70% of cases. These studies cannot establish a national French mortality figure, and their annual averages may conceal changes over time. Nevertheless, they provide examples of low recorded numbers outside Italy. Incidentally, country-level data should be adjusted for population size, something The Economist should have done when citing the German figure. The population of that country is about 42% bigger than Italy’s.

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