Last week, law enforcement in the UK made their largest-ever seizure of synthetic opioids in the UK. During a series of raids in Waltham Forest and Enfield, north London, police found about 150,000 nitazene pills which they believed were going to be sold on the dark web.

Nitazene is a synthetic opioid similar to fentanyl, a drug responsible for tens of thousands of drug deaths per year in the USA. Unlike natural opioids like heroin, which is derived from poppy seeds, synthetic opioids like nitazene are made in labs, using a range of different chemicals. They’re also known to be much more potent than natural opioids like morphine and heroin and therefore are much more likely to lead to overdose.

While there are no reliable figures yet, a national patient alert sent out in July claimed that nitazenes, which are around 100 times more potent than morphine, had been linked to a rise in overdoses and deaths in people who use drugs, primarily heroin, in England in the two months prior. In that time, some parts of the country had seen an “unusual increase” in opioid-related deaths, which usually sit at around 40 per week. Last month, a BBC NI report found that nitazines were implicated in six drug deaths in Belfast alone and some 30 deaths in the West Midlands are being examined for the involvement of the heroin substitute nitazene and the sedative xylazine.

It’s believed that synthetic opioids are being cut into or sold as heroin and other benzodiazepines without users knowing. 

WHY IS THIS HAPPENING? 

According to Josh Torrance, a drug researcher at the University of Bristol, the rise of synthetic opioids in the UK drug supply is directly linked to the Taliban’s crackdown on poppy production in Afghanistan in April 2022. Before the crackdown, Afghanistan produced some 95 per cent of Europe’s heroin supply. “We are expecting there to be a shortage of naturally derived heroin in the UK,” says Torrance. This means the UK is likely to see an uptick in synthetic opioids, just as in the US and Canada. 

WHAT’S THE DANGER?

Considering the majority of synthetic opioids aren’t being sold as such, the chance of a drug user accidentally overdosing on what they believe to be heroin, valium or Xanax is much more likely. “The overdose threshold with a lot of synthetic opioids is much slimmer than it is with normal heroin,” says Torrance. “Comparatively, there’s little difference between the dose that gets you high and the dose that has a 50 per cent chance of killing you — the margin of error is much slimmer.” On top of that, it’s also likely that drugs won’t be evenly mixed, meaning that one hit could be much stronger than the other. 

Not only that, but Torrance warns of synthetic opioids becoming a permanent fixture of the UK drug market. “What we’ve seen in North America and Canada is that dealers aren’t even pretending that it’s heroin anymore, they’re selling it as fentanyl, and people started seeking out those batches because they are essentially stronger — they get more bang for their buck,” he says. “That would be a worrying future in the UK, that synthetic opioids market gets established and becomes the new normal, which would increase overdose deaths.”

“There’s no silver-bullet, people will still die of drug overdoses, but we find that the likelihood of overdose is much less when you have the right medical facilities on hand” — Josh Torrance

WHO’S AT RISK?

While it’s important not to generalise about who uses certain drugs, Torrance notes that many of the “Trainspotting Generation,” who began using heroin in the 1980s will be in their 40s, 50s and 60s now. “A lot of those people do have a lot of pre-existing health vulnerabilities that make them more prone to overdose deaths, such as COPD, a respiratory condition that you can get if you smoke a lot of heroin,” he says. “If you were to overdose and your respiratory system isn’t working as well as it otherwise could, that might be the difference between you dying or not.”

He adds that it’s fairly common for those who use heroin to be on the fringes of society. “[They may be] in and out of homeless hostels for example, and for various reasons, such as if someone is more likely to be injecting outside on their own, they’re at much greater risk of overdosing.”

But it’s not just heroin users who are at risk from synthetic opioids — as Torrance notes, nitazene has been found in benzodiazepines such as valium and xanax, and people who use these drugs may not have the same tolerance to opioids as a heroin user, and will therefore be at a greater risk of overdosing.

WHAT’S THE SOLUTION?

While local drug services are attempting to get the message out to drug users, this usually happens face to face, at treatment clinics or needle exchanges, meaning that users not actively engaged in treatment are less likely to know about the rise in synthetic opioids. 

Torrance says that there are three main solutions to the issue — better access to opioid substitution treatment, which sees users offered a prescription opioid such as methadone or buprenorphine in place of street heroin. Due to bureaucracy, he says, it may take someone multiple days to access a prescription, which is too long. 

Ultimately, though, he says, treatment needs to go much further. “Methadone and buprenorphine save many, many lives, they and they are really effective, but we should be rolling out heroin-assisted treatment as quickly as possible.” Heroin-assisted treatment sees users offered medical-grade heroin instead of a less potent replacement, and is known to increase take-up and retention in treatment. “The best way to persuade someone to start accessing their drugs through a prescription rather than their dealer is to give them what they want, which is heroin,” says Torrance. “Unfortunately, it’s not available in most of the country.”

Finally, Torrance advocates for the provision of drug consumption rooms, whereby users would be able to use their own drugs in a safe space, with medics at hand to treat overdoses instantly. “There’s no silver-bullet, people will still die of drug overdoses, but we find that the likelihood of overdose is much less when you have the right medical facilities on hand,” says Torrance.

With the absence of drug consumption rooms, Torrance urges drug users to use the BuddyUp app, which was created by the drug treatment organisation Cranstoun. “Basically, if you’re about to use drugs on your own, you can contact a trained worker through the app who will stay on the line with you while you inject,” says Torrance. “If you don’t come round in the expected timeframe, and you’re not responding to them, they’ll send an ambulance to your location. It’s a model that’s worked very well in America.”