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' You only detect the drugs you ’ re looking for – there are probably others out there ...'
DR ADAM HOLLAND
only was there adulteration to consider , but also a whole market shift . ‘ Synthetic ’ was a very broad term that included substances such as MDMA , and there were at least 14 different drugs classified as nitazenes . As he pointed out , ‘ You only detect the drugs you ’ re looking for – there are probably others out there we have not been looking for .’
Inappropriate doses occurred as people used the drugs in unexpected combinations – someone who had ordered benzos might have no opioid tolerance at all . The difficulties of unknown contents extended to medical emergencies as staff were unsure how to treat the patient appropriately . ‘ There could be many more deaths related to these drugs than we ’ re aware of ,’ he said .
Holland agreed with the call for more surveillance and testing . He also pointed to ‘ a decade of underinvestment ’ in drug services . ‘ We need funding to be sustained and ideally increased ,’ he said , and identified same-day and lower threshold prescribing , crack pipe provision , widespread naloxone , postal drug testing and supervised injecting as areas for immediate investment . ‘ We need a central strategy – at the moment it is local initiatives happening where the Swiss cheese holes line up ,’
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he said . ‘ We also need more support in wider health and social care to prevent trauma happening in the first place .’ Above all , he warned , ‘ we can ’ t assume that we can carry on doing the same thing .’
Changing drug classification – nitazenes to class A , xylazine to class C – when they were already illegal was ‘ clearly not a deterrent when there are such big profit margins ’. The delay in coroner reports – up to two years – made it ‘ impossible to respond in a timely fashion ’. And we were missing many surveillance opportunities by not having enough testing . The ‘ decade of disinvestment ’ meant that urgent attention was needed .
HARM REDUCTION In the immediate term , drug services needed to rethink their offer for people who use drugs – whether benzos , crack , opioids – and offer more flexible prescribing options and harm reduction advice and equipment . More harm reduction services were a very necessary response , he said – more naloxone , more drug testing services ( in-person checking and a UK-wide postal testing service ) and the creation of spaces for supervised drug use , in OD prevention centres , high tolerance housing , and drug-use spaces in hospitals .
‘ Our policy environment is not conducive to sensible responses ,’ he said . But drug adulteration was going to get worse and emerging drugs were likely to exacerbate the drug-related death crisis . ‘ How big does the pile of bodies have to get ?’ he asked . ‘ We need to go up a notch .’
CONTAMINATION Abigail Wilson , lead clinical pharmacist at WithYou , gave a picture of the many challenges being faced by services who were encountering contamination with novel drugs . When people presented for treatment , nitazenes and xylazine were not showing
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up in urine or saliva screening tests , ‘ as manufacturers haven ’ t caught up ’.
She explained that test strips for substances could not be used in services without a Home Office licence , but they could be used by clients to test drugs themselves . This can lead to challenges with tests being completed accurately and can slow down the identification of trends , and she highlighted that tests are ' not a tick in the box to say the drugs are safe '. Through a case study she explained that a client had tested negative but was in acute withdrawal . A further test by WEDINOS ( the drug-testing and harm reduction service in Wales ) confirmed nitazenes . ‘ It ’ s so hard for our services to know what ’ s in a drug ,’ she said . In another case study , the client thought they had taken ketamine , had overdosed , and was brought round by naloxone – so it turned out to be an opioid-related OD .
The obvious flaw in the system is not having more local access to testing . Other action points were to ' get naloxone in every situation ', similar to how defibrillator boxes are placed and accessed ; to talk to young people about avoiding risks ; and to talk to the media to help them understand these issues .
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Other action points were to ' get naloxone in every situation ', similar to how defibrillator boxes are placed and accessed .
ABIGAIL WILSON
‘ When media outlets call xylazine a " zombie drug " people don ’ t access services .' Also , talking about drugs as ' potent ' and ' high strength ' ( instead of ' dangerous ' and ' harmful ') might make them seek it out . Using language mindfully was another tool in a toolbox that needed to be in use right now . DDN
@ WeAreTheLoopUK
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