Rising Wave of Fentanyl-Linked Deaths in Bulgaria

Over 100 deaths in the country have been linked to opioid use, primarily fentanyl. The alarming trend was reported on Facebook by Yulia Georgieva, director of the “Pink House” day centre for people with opioid dependence on November 5.

Among the people the centre works with, more than 70 individuals have died in just over a year — 44 of them were regular visitors, while the rest were people the team worked with in the field.

An accessible market and high profits on one side, and a deadly outcome on the other — that is the equation behind the use of increasingly widespread fentanyl.

Fentanyl is a medication routinely used in medicine for its pain-relieving effect.

Filip Aleksiev, neurologist: “By acting immediately on specific areas of the brain, it provides instant pain relief and a euphoric effect — even in small doses. The problem is that if the dosage is exceeded, it can directly affect the respiratory centre in the brainstem, causing breathing disorders or even respiratory arrest.”

According to data from the Ministry of Health, in 2024 a total of 127 people lost their lives due to drug use. Fentanyl was detected in 53 of those cases.

One of the reasons for the rising number of deaths is that people who take fentanyl often mix it with other drugs.

Pavel Pavlov, Chair of the “Samo Dnes” Association, Varna: “Fentanyl is very often added into all kinds of combinations because it gives a strong effect — and sometimes it simply cannot be accurately dosed. A dependent person who thinks the amount is safe for them can die if there is an incorrectly dosed amount of fentanyl.”

According to data from the Ministry of Interior, since the beginning of the year more than 6 kg of fentanyl has been seized, mostly in the regions of Plovdiv, Varna and Sofia-city.

Stefan Bakalov, Head of the Anti-Drug Trafficking Department, Customs Agency (archive, 03.11.2025): “Bulgaria is currently experiencing the third wave of synthetic opioid use, specifically fentanyl and gradually mixed forms with other synthetic opioids. Fentanyl use may be reaching its peak. I personally believe that if all institutions continue to act with a focused strategy, we will manage to curb this wave.”

Experts say the fentanyl surge is largely driven by its low price.

Stefan Bakalov (archive, 03.11.2025): “Synthetic opioids like fentanyl and nitazenes have replaced heroin on the market for several reasons. The first is economic — with a very small amount of synthetic opioids, you can meet the demand of the previous heroin market.”

According to Yulia Georgieva from the “Pink House” centre, part of the problem is that Bulgaria still does not ensure access to life-saving treatment medications for people with opioid dependence — medications that can prevent death in almost 100% of cases.

She notes that such medications are not registered in Bulgaria at all. Only emergency medical centres currently have a form of these life-saving treatments.

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In previous years, the number of deaths had been barely around ten annually, making the recent surge particularly alarming. Within just over a year, 70 people connected to the “Pink House” centre alone have died – 44 were regular visitors and the rest were individuals the team worked with on outreach programmes.

Georgieva notes that Bulgaria is lagging in its response to the crisis. According to her, there is still no registered naloxone nasal spray in the country – a life-saving treatment for overdoses widely used across Europe. In Bulgaria, ambulances only carry an injectable version of the drug.

Another major issue, she says, is the lack of mandatory autopsies for people who die without an obvious cause. This means the real number of deaths related to fentanyl and other opioids could be significantly higher than official figures suggest.

Data from a study by “The Pink House” among 480 drug users in Sofia show that:

• 17.5% are homeless
• 12.7% test positive for HIV antibodies
• 63.5% have hepatitis C antibodies
• one quarter began using drugs before the age of 15

Yulia Georgieva warns that the country is facing a hidden epidemic of overdoses and blood-borne infections, for which there is still no comprehensive state strategy.