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Nitazenes: Use of life-saving overdose drug surges by 50% amid synthetic opioid crisis

The use of naloxone has increased as fears over nitazenes, a synthetic opioid, grow

Ambulance crews’ use of naloxone – an emergency drug used to reverse opioid overdoses – rose by 50% in 18 months amid widespread concerns over synthetic drugs such as nitazenes on the UK’s streets, the Big Issue has found.

The number of patients given naloxone by ambulance crews increased by 57% from January 2023 to May 2024. Nitazenes, a potent form of synthetic opioids, have been linked to hundreds of deaths nationally, including dozens in Birmingham, with the homeless population particularly at risk.

While the government has made 14 types of nitazenes illegal, the data suggests the crisis is far from over, with data obtained by the Big Issue showing the use of naloxone higher in every month of 2024 than the same month in 2023.

Nitazenes have made their way into street heroin, benzodiazepenes and more after a Taliban crackdown on opium production reduced the UK’s heroin supply. 

Eager to maintain their product’s potency, dealers have been adulterating drugs with nitazenes. But these drugs, up to 500 times more potent than heroin, easily result in overdose when taken unwittingly. 

The National Crime Agency linked nitazenes to 230 deaths in the UK in the year to June 2024.

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Victims of a nitazene overdose are likely to need more doses of naloxone to bring them back around. Since nitazenes require extensive testing to detect, frontline workers are often left guessing about the true cause of an overdose – such as one experienced by Gareth John, who manages a hostel in Cardiff.

“We found the gentleman laying on the floor with a needle. We put him in a position but we also put naloxone into him. We put four, five amounts of naloxone inside the person,” John told the Big Issue, adding it was not uncommon to use 10 or 12 doses of naloxone.

John, who works for homeless charity The Wallich and sits on local boards responding to drug deaths, said the Welsh capital saw a wave of deaths around Christmas 2023.

“It was just like another death, another death, another death, and every week it was information being shared from the area planning board with the hostels, to make sure everyone was up to date,” he said.

Nitazenes are here to stay, said Steve Brinksman, the medical director of Cranstoun, with the government’s decision to make them class A drugs not making a “blind bit of difference”.

“With the Taliban’s destruction of the opium crop in Afghanistan, then this year and next year the supply of heroin is going to become much more restricted,” Brinksman said. “It’s likely people will look to other things… to bulk out the bits of heroin that they get. It’s potentially a very significant change in the UK’s drugs scene.”

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Recent samples submitted to Wedinos, a drug testing service, show nitazenes are present not just in street heroin, but in drugs often purchased online, such as valium, oxycodone and xanax. In one sample, nitazenes were found in a 2CB pill – a psychedelic typically used recreationally.

“Once it starts to get into drugs that are not opioids, then you’re dealing with people who don’t use opioids, who don’t have the tolerance, and potential for overdose and death is greater,” said Brinksman. “It’s high enough in people who’ve got a tolerance, but in opioid-naive people it’s a recipe for disaster.”

With information on the nitazenes crisis patchy and limited, the Big Issue went to ambulance services to try and understand the extent of overdoses not captured in official death data.

In May 2024, paramedics in England administered over 3,500 doses of naloxone – an increase from 2,385 in January 2023. Rather than a consistent supply, experts told the Big Issue, nitazenes often appear locally in bursts.

A lack of information and consistent testing makes it difficult for authorities and drug services to respond, said Katy Porter, CEO of The Loop.

“There is a lag in terms of information and therefore in terms of our understanding and response. If we are responding once there has been a large number of deaths, we are too late. Drug testing should enable us to get ahead of the curve here,” said Porter.

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As shadow home secretary, Yvette Cooper accused Conservative ministers of “complacency” over the risks nitazenes pose. Now she is home secretary, and a government spokesperson told the Big Issue: “We are not complacent to the threat posed by new emerging drugs. It is vital we grip this problem and prevent them spreading more widely into communities and prevent tragic deaths from drug use.

“We will continue our engagement with partners across health, policing and wider public services to drive down drug misuse, and move forward with our mission to make streets safer.”

Do you have a story to tell or opinions to share about this? Get in touch and tell us more. Big Issue exists to give homeless and marginalised people the opportunity to earn an income. To support our work buy a copy of the magazine or get the app from the App Store or Google Play.

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