Is the UK sleepwalking into a lethal US-style opioid drugs crisis?

Warning that drugs so potent a ‘grain of sand’ dosage can be fatal could spark a US-style drug deaths crisis

The UK is facing a US-style drugs-death crisis over lethal super-strength drugs contaminating British illegal markets, with investigations launched into 94 deaths in the past six months.

Potent synthetic opioids known as nitazenes – some of which are 500 times stronger than morphine – have been detected in at least 20 postcodes around the UK since September, in a worrying surge in availability, The Independent can reveal.

The drugs – so dangerous that a dose the size of a grain of sand can kill – have contaminated heroin supplies since 2019 but are increasingly found in counterfeit prescription anxiety medication sold on the dark web and at online pharmacies.

Health officials have issued an urgent warning: that the contaminated tablets, commonly marketed as Xanax or Valium, could cause unintended overdoses, while campaigners fear the increase of the potent street drugs could usher in the biggest crisis since the HIV and AIDs epidemic hit drug users in the 1980s. 

The Independent has found that:

• The lethal new drugs have been detected in 20 samples across the UK since September, by users who thought they were illegally purchasing prescription drugs known as benzodiazepines
• They are being sold in blister packs and boxes which look like legitimate pharmaceutical products, with users reporting overdose and hallucinations
• The National Crime Agency (NCA) is investigating 54 deaths linked to nitazenes between June and December, with 40 more deaths awaiting forensic toxicology results
• A leading drug researcher predicts a US-style acceleration in drug-related deaths, with some nitazene compounds found to be so dangerous even a “grain of sand” could kill
• Nitazenes were first developed in the 1950s as a pain-killing medication, but are so potent and addictive they were never approved for use. However they are now becoming increasingly common in illicit drugs markets

Many recent nitazene-related overdoses have been linked to contaminated batches of heroin, but the dangerous compounds are now being detected in a range of prescription products being traded illegally – including fake oxycodone (OxyContin), diazepam (Valium) and alprazolam (Xanax).

The UK’s first nitazene-related death was recorded in 2019. There was a spate of deaths and overdoses in the South East linked to heroin in summer 2021. Those followed constraints on traditional supply routes after the Taliban banned opium poppy production in Afghanistan.

However a “big influx” this summer has seen nitazenes detected all over the country and increasingly sold in counterfeit tablets, Dr Caroline Copeland, director of the National Programme on Substance Abuse Deaths at Kings College London told The Independent.

“This is a big problem. The UK was already facing a drug-related death crisis and we are now faced with synthetic opioids becoming more prevalent. All we have to do is look at what’s happening in the US,” she said.

150,000 nitazene tablets were seized in the country’s largest-ever synthetic opioid haul in October (Metropolitan Police)

The latest figures show drug-related deaths are at a ten-year high, with 4,907 recorded in England and Wales in 2022 – almost half of which involved an opiate. In the same year the US recorded more than 70,000 deaths linked to synthetic opioids, largely fentanyl.

In October the Metropolitan Police seized 150,000 nitazene tablets in the country’s largest-ever synthetic opioid haul. They were being manufactured in east London and allegedly sold on the dark web.

While synthetic opioids are still responsive to naxolone (a life-saving treatment to reverse opioid overdose), it may be less effective with some of the most potent nitazenes.

Dr Copeland said: “Naloxone is only so strong. It can only counteract an opioid of a certain strength but if you are dealing with super-strength opioids it might not be effective – you might need four or five doses in quick succession. We can certainly expect there to be a large acceleration in the number of deaths.”

This month, Public Health Wales issued a warning urging people to only take prescription drugs supplied by a doctor after the deadly new compounds – often compared to fentanyl – were first detected in pills sold as diazepam in February. Since September, this has surged, with nitazenes detected in 20 samples of drugs sold as prescription benzodiazepenes from every corner of the UK, according to the Wedinos drug-testing service.

Drug samples sourced in Northern Ireland, Scotland, Wales, London, the Midlands, Manchester, Leeds, Brighton and Carlisle were among those testing positive for the potentially lethal contaminant.

One sample was sold in “convincing” pharmaceutical packaging and users reported overdose, hallucinations, memory loss and suicidal ideation among the terrifying effects.

This poses a particular threat to thousands who purchase illegal prescription drugs online and receive them through the post – often young recreational drug users or those looking to self-medicate for issues such as anxiety and insomnia.

Professor Rick Lines, Head of Substance Misuse at Public Health Wales and Wedinos, told The Independent contamination with high-potency nitazenes could have “potentially fatal consequences” for unwitting users without ready access to naloxone.

“Since September we have seen a real change over into finding tablets that are packaged as benzodiazepines,” he said.

“People who purchase benzodiazepines wouldn’t necessarily expect them to be adulterated with nitazenes. This creates obvious potential concerns for ill-effects or overdose as a result.”

A drug sold as diazepam tested positive for a dangerous nitazene, the Wedinos drug testing service found (Wedinos)

These users may have previously been prescribed benzodiazepines, but turned to online pharmacies or other online sources when their prescription ran out.

“They see themselves as taking a medicine that maybe previously they had been prescribed and can’t see a problem with it at all,” he added.

Chris Rintoul, head of harm reduction at charity Cranstoun, said the risk of overdose in unwitting users is incredibly high.

He told The Independent: “It’s one of the features of the nitazene story... that it has contaminated a range of drugs. Daily users of opioids have a tolerance. But those who don’t use heroin and don’t have any tolerance are really at high risk. They assume that contaminated drugs isn’t something that really affects them.”

The NCA and the Department of Health and Social Care wrote to the chief coroner in July over deaths linked to the drugs, although the contents of the letter have not been made public.

The NCA’s deputy director, Charles Yates, confirmed 54 deaths were linked to nitazenes between 1 June and 7 December, with the most recent death recorded in Brighton on 5 November, while another 40 deaths are awaiting forensic toxicology results.

However, due to limited screening for the new substances, it is feared the number of fatalities could be far higher – with drug support groups reporting clusters of overdoses.

Some 19 of the recent deaths took place in the West Midlands after nitazenes contaminated the heroin supply. In Dublin last month, 40 overdoses were recorded in 24 hours as nitazenes were discovered in the city’s drugs. 

“I would be surprised if that’s even a tenth of it. I think the real number is probably many times that figure,” Mr Rintoul added.

“Thirty years ago we had a really awful time with people who were using heroin in those days and were contracting HIV and so many died and we really haven’t seen anything of that scale of risk since then. I think we are likely to experience something of the same severity.

“The elements of the perfect storm are there. I do think this is going to the most challenging thing that drug treatment services have encountered since that HIV crisis in the 80s and 90s.”

Abdirahim Hassan, founder of community organisation Coffee Afrik CIC, said the synthetic opioid crisis on the streets of the UK has been ongoing and worsening for months – and people were only now “waking up”. He fears the country is now facing a synthetic opioid “epidemic” like nothing seen before.

At the start of the year, his organisation, which supports drug users as part of its work, noticed a shift in the drug market and supply. Outreach workers were seeing “people literally slumped over in daylight for hours in the streets”.

He said: “We need to call it what it is, which is a public health emergency – and literally, people are dying.”

Whichever synthetic opioid is most prevalent at any one time, “it’s the same thing as it’s creating the same crisis”, said Mr Hassan. At present it is nitazenes, but “the question is, what’s next?”

A drug sold as diazepam tested positive for a nitazene called metonitazene, Wedinos found (Wedinos)

The Home Office announced in November it was cracking down on synthetic opioids, with 15 new drugs. including 14 nitazene compounds, set to become class As in the New Year, but there are concerns it will do little to stop it flooding the illegal drugs market.

While recent figures from the Office for National Statistics (ONS) show rates of drug misuse have remained broadly stable year on year, it is feared this is “masking worrying new trends” in drug abuse.

Cllr David Fothergill, chair of the Local Government Association’s Community Wellbeing Board said: “We are particularly concerned to see a rise in the use of new synthetic opioids and benzodiazepines, which substantially raise the risk of incredibly serious harm to the user and are believed to be linked to a number of drug-related deaths.

“Councils want to see greater regulation of the sale of substances online that often enter the UK in the post; and increased surveillance to alert authorities to the types of drugs people are taking.”

NCA deputy director Charles Yates told The Independent: “Nitazenes pose a considerable risk to people as they can be much stronger than other opiate substances like heroin and indeed fentanyl. However, the opioid antidote, naloxone, still works to prevent overdose death.

“The NCA, working closely with policing, Border Force and other international partners, is ensuring that all lines of enquiry are prioritised and vigorously pursued to stem any supply of nitazenes to and within the UK.”

The Association of Police and Crime Commissioners leads on substance misuse, Dorset PCC (Police and Crime Commissioner) David Sidwick and Durham PCC Joy Allen, said they were taking the dangers posed by the new drugs very seriously.

“We are deeply saddened by the reported deaths caused by synthetic opioids in the UK in the last six months. We take the dangers and risks posed by these drugs, which can be up to 1,000 times stronger than heroin, very seriously,” they said, adding they were working to encourage police forces to expand the use of naloxone to save lives.

A Home Office spokesperson said: “We are highly alert to the threat from synthetic drugs and have already established a cross-government taskforce to co-ordinate our response to the risk from synthetic opioids to the UK.

“Our drugs strategy is focused on tackling the supply of illicit drugs through relentless policing action as well as building a world-class system of treatment and recovery to turn people’s lives around and prevent crime.”