Nitazenes: The use of life-saving overdoses increases during the synthetic opioid crisis

Nitazene overdose victims will likely need more doses of naloxone to get them back on their feet. Because nitaszenes require extensive testing to detect them, frontline workers are often left guessing as to the true cause of an overdose – as experienced by Gareth John, who runs a hostel in Cardiff.

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

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

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

Nitazenes are here to stay, said Steve Brinksman, Cranstoun’s medical director, adding the government’s decision to make Class A drugs for them does not make a “blind spot of difference”.

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

Recent samples submitted to Wedinos, a drug testing service, show that nitasenes are found not only in street heroin, but also in medications commonly purchased online, such as Valium, oxycodone and Xanax. In one sample, nitazenes were found in a 2CB pill – a psychedelic drug typically used recreationally.

“Once it starts with non-opioid medications, you’re dealing with people who aren’t on opioids, who don’t have the tolerance, and the chance of overdose and death is higher,” Brinksman said. “It’s high enough in people who have a tolerance, but in opioid-naïve people it’s a recipe for disaster.”

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

In May 2024, paramedics in England administered more than 3,500 doses of naloxone – up from 2,385 in January 2023. Instead of a consistent supply, experts told the Big Issue, nitasenes often appear locally in bursts.

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

“There is a delay in terms of information and therefore in terms of our understanding and response. If we react after a large number of deaths have occurred, we will be too late. Drug testing should allow us to lead the way in this area,” Porter said.

As shadow home secretary, Yvette Cooper accused Conservative ministers of “complacency” over the risks posed by nitazenes. Now Home Secretary, a government spokesperson told The Big Issue: “We are not complacent about the threat posed by new emerging medicines. It is crucial that we tackle this problem and prevent it from spreading into communities and prevent tragic deaths from drug use.

“We will continue our work with partners in health, police and wider public services to reduce drug abuse, and move forward with our mission to make streets safer.”

Do you have a story to tell or an opinion about it? Contact us and tell us more. Big Issue exists to give homeless and marginalized people the opportunity to earn an income. To support our work, please purchase a copy of the magazine or download the app from App Store or Google Play.

Big Issue demands an end to extreme poverty. Would you like to ask your Member of Parliament to join us?