In 2021, 21-year-old musician Dylan Rocha collapsed in his bathroom. Unaware that the heroin he received in the post was tainted with a potent synthetic opioid, he became unresponsive and was soon pronounced dead. Rocha’s tragic death is believed to be one of the first in Britain linked to a nitazene – substances that can be up to 500 times stronger than heroin.
Rocha’s case is not an isolated incident. Three years later, it stands as part of an alarming pattern of overdose deaths involving nitazenes across the country. They have been detected in every region of England, as well as in Wales, Scotland, and Northern Ireland. On the streets, users play a dangerous game of Russian roulette, often unaware that their drugs might contain the deadly substances. Disturbingly, nitazenes have even been found in vaping products.
Last year, I warned that the UK was sleepwalking into a public health emergency, arguing it was only a matter of time before it faces a synthetic opioid crisis akin to that currently ravaging America. I urged the government to recognise the rapidly changing drug landscape and prepare for the threat posed by substances like fentanyl and nitazenes. A year on, the statistics make for a grim reading. In 2023, England and Wales recorded its highest-ever number of overdose deaths – 5,448 deaths in total, an 11 per cent rise from the previous year. Even more troubling is the climb in deaths involving powerful opioids. While fentanyl deaths have declined, registered fatalities involving nitazenes have soared from just one case in 2021 to 38 in 2022 and further to 52 in 2023.
The Office for Health Improvement and Disparities uses more direct, laboratory-based testing methods to create a more timely – and bleak – view of the unfolding drugs situation, revealing 179 nitazene-related deaths in England between June 2023 and May 2024. Scotland, which continues to have the worst drug death rate in Europe, saw a jump in nitazene deaths from just one case in 2022 to 23 in 2023.
Policymakers must act urgently to counter this growing threat and prevent it from escalating into a full-blown public health disaster. From a political standpoint, failure to address this issue could also have severe consequences for the new Labour government. As I argued last year, Parliament must prioritise a public health approach, which means investing in harm reduction strategies such as the wider distribution of naloxone, the establishment of overdose prevention centres and the expansion of drug-checking services. These evidence-based measures are proven to save lives, and they can help to turn the tide against this potential crisis.
The government should also devolve drugs responsibilities for local health initiatives. The Labour administration has already pledged to hand more powers to local authorities, but if it is to genuinely address regional inequalities leaders must be empowered to tailor drugs responses to their communities’ specific needs – crucial, given that overdose deaths tend to be concentrated in the most deprived areas. Scotland’s repeated calls for drug policy devolution highlight the potential of these steps, while also marking a significant departure from the previous government’s approach.
Meanwhile, the new government should commit to developing a new comprehensive drugs strategy. The previous government’s 10-year plan leaned significantly on supply control and enforcement, relying on punitive measures that are at odds with progressive, evidence-based approaches. A more holistic approach would address the full complexity of drug harm, integrating prevention, education and harm reduction, while also tackling underlying causes of drug use such as poverty and unemployment.
There should be some role for enforcement. While crackdowns that criminalise users cause more harm than good, efforts to limit the availability of substances like nitazenes can help. The National Crime Agency has identified illicit production in China and smuggling through courier services as key contributors to the influx of these drugs. Relevant interventions, such as diplomatic efforts to ban international production or improved border checks, could curb this inflow. It is crucial these supply-side measures complement, and not overshadow, harm reduction initiatives.
The government has an opportunity to make a fresh start and avert this looming crisis. By prioritising public health, empowering local authorities, and addressing the supply of dangerous substances, the UK can turn the tide on drugs such as nitazenes. The stakes have never been higher.
[See also: Our overdiagnosis crisis]
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