Will UK drug deaths follow trends in the US?

One of the reasons nitazenes are of real concern here in the UK is because of the staggering scale of the synthetic opioid crisis that has gripped North America in recent years. Opioids were responsible for 80,000 overdose deaths in 2021 in the United States, and officials are worried a similar surge could be on the way here too. Adam Holland is a public health consultant and an expert on drugs and policy at the University of Bristol. He recently published a study in The Lancet about the UK’s looming drug crisis…

Adam - We can't just compare the UK and the US. We don't know the same thing is going to happen here. There are different social factors. We're obviously situated geographically differently and we have different types of drugs through different routes coming into our countries, but a lot of people are worried that big surge in deaths since 2013 related to one of the other type of synthetic opioids, fentanyl, we might see similar here with nitazenes.

James - These synthetic opioids present particular advantages to producers and suppliers of illegal drugs?

Adam - Yeah, that's exactly right. I think one way of looking at this that some people have argued is this is kind of inevitable, particularly in the context we have with drug policy. We have prohibition, we try and stop the trade of drugs. It is in the benefit of producers responding to those policies to produce drugs that are synthetic - so they don't require a large amount of crops - that can be produced in clandestine laboratories underground, which are very difficult to find. Because they're more potent, a smaller quantity of the drug is needed for the same size of market, so it's easier to transport and it's easier to smuggle. At the moment, we're seeing some concerning changes in the market internationally. In 2022, the Taliban in Afghanistan prohibited the cultivation of poppies, and poppies in Afghanistan are used to produce most of the heroin that is traded in Europe. It's possible production might move to other areas, but the worst case scenario, and something that everyone is very worried about, is that we are soon going to see a massive decrease in the amount of heroin that is being produced. That gap in the market is going to be filled by these more potent synthetic drugs like nitazenes.

James - Conversation at the moment is centred on nitazenes and fentanyl but, given all the advantages synthetic opioids have for producers, is there the potential for more lab made drugs to make their way onto the market in the future? Classifying nitazenes as Class A as the UK government did recently, it's nitazenes today, but it could be something else tomorrow?

Adam - Again, I think that's exactly right. We don't know what's next and nitazenes probably aren't going to be the end of the story. Since the late 1990s, nearly 900 new novel substances have been detected in circulation in Europe. Nitazenes are the latest that are causing an issue. We don't know what direction this is going to go. In terms of the classification, I don't think that classifying nitazenes as Class A is going to help. Nitazenes were already controlled under a piece of legislation called the Psychoactive Substances Act. Now, under that act, the production and supply of drugs is criminalised, but not the possession of drugs. So what moving those drugs under the Control and the Misuse of Drugs Act does is it criminalises the possession of those drugs, the people who are using them. Most people using nitazenes aren't aware that they are in possession of them. They're not intending to use them, so it's not clear that that's going to act as a deterrent. We also know that criminalisation of possession causes a huge amount of harm to potentially quite vulnerable people. It might exacerbate the factors that have led those people to have harmful relationships with drugs in the first place. But the worst case scenario is this is like cutting off the head of a hydra. So you cut one head off and then two more heads are going to appear as people are branching out into other drugs as we're potentially making it a bit more difficult to produce these specific drugs at the moment.