HARM REDUCTION
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itazenes have been a topic of conversation for well over a year in the UK , as we have had multiple instances of clusters of lives lost in short periods due to contaminated drug supplies . Treatment providers have responded to fears of a nitazene-adulterated drug supply by increasing naloxone provision , providing nitazene testing strips , warning opiate users that they risk overdose even when smoking , as well as issuing alerts when nitazenes are detected locally . Despite these adaptations , many in the sector are still in denial about the real prevalence of nitazenes in our drugs market . As a result , people with dependencies on these drugs are often met with disbelief and a service offer which is woefully inadequate .
George is a Release caller who first started using nitazenes in 2022 , when he was 17 . After many difficult years struggling to manage co-occurring mental health disorders and an unstable home environment , George found himself experimenting with different drugs in an attempt to relieve the worst of his mental health symptoms . One of the drugs George used were pills advertised as ‘ pressed oxycodone M30s ’. It didn ’ t take long for George to develop a dependency .
Most of the harm reduction conversations around nitazenes in the UK thus far have focused
Nitazenes are now part of the UK ’ s drug supply – and services need to listen to the people using them , says Fraser Parry
on reducing risks among people whose drugs have been contaminated with nitazenes , assuming that the user does not know about – nor desire the presence of – nitazenes . ‘ The thing is ,’ George explained , ‘ everyone buying pressed oxies knows they really contain synthetics . “ Pressed pill ” is basically slang for either fentanyl or nitazenes .’ This highlights the first way in which our treatment services and harm reduction messaging are letting people down . We fail to recognise that some nitazene users are not encountering these drugs by accident – they ’ re seeking them out .
When George first entered treatment at his local drug service , he quickly found that there was no real understanding of nitazenes . For starters , workers were unaware that these drugs are unlikely to be detected by their drug testing equipment , and despite his daily nitazene use , George ' s first urine test was negative for opiates . ‘ Good news , you ' re not using opiates ,’ said the clinician . George was only able to begin methadone treatment at a later appointment , having learned that without smoking heroin in addition to his nitazene use he would not be prescribed .
George continued to be disbelieved as he titrated up . Different nitazenes vary in strength , but range from anywhere between ten and 2,000 times stronger than morphine . As a result , a dose of 90ml of methadone was leaving George in significant discomfort . We know from North America that people using synthetic opioids can require doses in excess of 100mg – doctors in Canada have even produced new guidance on the topic . Despite explaining this to his prescriber , and describing his withdrawal symptoms in detail , he was told that there was no way he could still be under-dosed . His prescriber ’ s failure to listen , and refusal to meet George ' s needs , led to him managing his withdrawals by returning to nitazene use on top of his script .
Eventually George was able to be seen by a different prescriber , who agreed to a higher dose if required . Frustratingly for George , whose trust in his treatment provider was at an all-time low , even at this stage they still refused to accept that his dependence had been formed by nitazenes . His prescriber insisted on referring to the drugs he had been using as oxycodone , despite multiple tests that George conducted on his pills and on his urine using nitazene test strips . George was told that these strips were too unreliable to be considered accurate , and his trust in his treatment service was further damaged by this unwillingness to believe him . A Wedinos result would later confirm that the only active ingredient in his pills was isotonitazepyne .
Treatment providers may sometimes struggle to respond in an agile way to emerging crises . It ’ s understandable that drug workers , even clinicians , may not know the best way to treat a dependency on an emerging drug . However , we do know that good therapeutic relationships and patient trust are important in keeping people engaged ( and alive ), even when the finer details of someone ’ s treatment plan are a bit fuzzy .
‘ The thing is ... everyone buying pressed oxies knows they really contain synthetics . “ Pressed pill ” is basically slang for either fentanyl or nitazenes .’
Nitazenes have now been part of the UK drug landscape for three years , and it needs to be accepted that these drugs are sometimes used with intention , that they are increasingly prevalent , and that we must listen to people using these drugs . We must adapt our approach as a sector if we have any hope of supporting people using nitazenes in the future , as they are very likely here to stay .
Fraser Parry is drugs advocacy and support adviser at Release
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