DDN November 2023 DDN_November_2023 | Page 6



Now ’ s the time to get strong messages about potentially deadly nitazenes to the people who need to hear them , say Deb Hussey , Jon Findlay , Peter Furlong , Chris Rintoul and Maddie O ’ Hare

A new family of synthetic opioids , known as nitazenes , have adulterated a number of illicit drugs in the UK . It ’ s not clear exactly when this began , but evidence of them being present in cocaine and heroin was detected in 2021 .

Nitazenes are broadly equipotent to the fentanyls – or in layman ’ s terms , they ’ re many times stronger than heroin and morphine . Unknowingly taking a drug containing nitazenes represents a severe risk of
overdose . By the summer of 2023 there was sufficient evidence of them contaminating other drugs for OHID to provide a patient safety alert for all of the UK , based on an increase in both fatal and non-fatal overdoses ( NFOs ).
Nitazenes have been found in contaminated heroin , fake OxyContin ( oxycodone ) and fake Xanax ( usually bromazolam rather than alprazolam ), meaning the risk was extending to young people who don ’ t use heroin but buy what they think is OxyContin from the dark web or a few bars of Xanax from their mate . This group would have no or a very low baseline opioid tolerance to withstand the effects of a nitazene and would be unlikely to have naloxone , putting them at yet further risk . Deaths have escalated throughout 2023 , most notably in the Birmingham area in July .
Still recovering from a decade of budget cuts to drug treatment and the unintended adverse impacts of the recovery agenda moving the focus away from harm reduction – and with drug-related deaths escalating every year since 2011 – treatment services were not ready for the severe overdose risk posed by nitazenes . Many of the people most at risk are no longer engaged with services , do not have or carry naloxone , use multiple drugs in combination and are also getting older .
FIRST THINGS FIRST After communicating the alert the first challenge was to engage with people at risk and offer a form of treatment they would want – whether reluctant returners or newcomers . We need to be more attractive to those people we really should be better at engaging , treating and retaining . In Dr Steve Brinksman ’ s words : ‘ Treatment ( OST ) protects , you ’ re less likely to overdose , and if you do overdose you ’ re less likely to die .’
Many drug treatment services have national leads for harm reduction , and we know , trust and respect each other . We decided that because of the severe threat of overdose we should work together to provide clear advice on how to reduce the risk . A little discussion on X / Twitter with Stephen Malloy of Ethypharm and Dr Judith Yates came about one evening , sharing our concerns as the deaths and NFOs rose and rose .
The plan was simple enough – provide useful advice to people at risk . This came from a genuine place of care and concern . We would all say exactly the same things , and launch on our websites and social media feeds at the same time . The lovely Dr Yates joined in and supported our efforts , and we felt a common responsibility as those with expertise in harm reduction and overdose that we should be the people to lead our organisations and the wider sector through this storm . The unified message we released in mid-July had the advantage that we all had to agree to it before going public , reducing the likelihood of providing poor information . In hindsight we realised that although the advice itself was sound , there was too much of it , meaning it could be overwhelming – or ignored .