On December 8, 2025, the European Drug Alert System (EDAS) issued a risk communication regarding the deepening fentanyl problem in Bulgaria.
The increase in the availability of fentanyl has been accompanied by signals of an increasing fentanyl-related harms in Bulgaria. In 2024, forensic national mortality registries recorded a total of 127 drug-induced deaths, of which 53 (42%) with confirmed exposure to fentanyl. This compares to 47 drug-induced deaths in 2023, including 5 with confirmed fentanyl exposure. It is not known whether fentanyl caused or contributed to these deaths, nor whether fentanyl detected in biological samples was medicinal fentanyl, from diverted medicinal products or illicitly produced. In 2025, approximately 65 drug induced deaths with fentanyl detected have been reported up to November. While some of the increase may reflect improved coverage of toxicological analysis at national level, surveillance and enhanced laboratory capacity, the trend remains concerning.
Furthermore, between June and December 2024, a total of 13 acute drug toxicity presentations with self-reported exposure to fentanyl (including 10 analytically confirmed cases) were recorded by a sentinel hospital of Euro-DEN Plus network in Sofia. No cases were reported in the first half of 2024. Preliminary data indicate that this trend may continue in 2025.
Anecdotal reports from harm reduction services suggest that some users are aware they are consuming fentanyl and are adapting their consumption methods, shifting from injection to inhalation, in an attempt to reduce overdose risk.
In connection with the above, the EU Drugs Agency makes recommendations for response and action required by Bulgaria.
At its first regular meeting, held on January 20, 2026, the National Drugs Council considered the submitted document. Based on it, the following decisions were adopted for action required:
- Strengthen overdose prevention and harm reduction interventions through a comprehensive set of measures implemented in close cooperation with health authorities, which includes sterile needle and syringe programmes for people who use drugs.
- Consider disseminating this risk communication to relevant national authorities, including public health agencies, drug treatment services, emergency medical providers, harm reduction organisations, law enforcement agencies, and forensic, customs and toxicological laboratories.
- Maintain a high level of vigilance, monitor closely the opioid market and report expedited to EUDA any signals suggesting changes on the opioid market as well as any specific response measures implemented.