LANGUAGE MATTERS
I
n much of the UK, what’ s sold as‘ heroin’ is no longer heroin at all. It’ s nitazenes— a group of synthetic opioids up to hundreds of times more potent than heroin and in some cases stronger than fentanyl. Between June 2023 and May 2024, nitazenes were linked to 179 confirmed deaths in England. The real figure is likely higher. The supply looks the same, the dealer’ s pitch is the same – but the risk has changed completely.
A PRESCRIBER’ S DILEMMA As an independent prescriber who assesses and initiates opioid substitution therapy and reviews treatment plans, I find it harder and harder to use the word heroin. It feels dishonest to talk about dose, tolerance, and safety margins using a label that no longer
With a drug supply increasingly contaminated with powerful synthetic opioids, the way we communicate with clients needs to change, says Ernestine Itayi Nhapi
matches the chemical reality. That mismatch isn’ t academic – it can be fatal.
Language shapes risk perception. Calling nitazenes‘ heroin’ tells people that‘ this is familiar – you know what you’ re taking, and you know the dose you can handle’. Those assumptions collapse when the drug is dozens or hundreds of times stronger than expected. With nitazenes, familiarity can be fatal – and our language feeds that familiarity. Renaming street supply in public alerts –‘ nitazenecontaminated heroin,’‘ synthetic opioid mix’,‘ toxic synthetic powder’ – can break complacency and prompt safer behaviour.
LANGUAGE IS THE FIRST STEP So what’ s being done? The UK government has banned multiple nitazene compounds and introduced a generic ban to catch future chemical tweaks, and the Border Force now deploys dogs trained to detect nitazenes
WHAT ARE NITAZENES? Lab-made opioids never approved for medical use. Now widespread in UK street supply.
WHY ARE THEY SO DANGEROUS?
– Unpredictable strength, no two batches are the same – Hidden presence, often sold as heroin – Faster overdoses, less time to respond and fentanyl. Harm-reduction agencies are urging users to test before using, start with a smaller dose, never use alone, carry naloxone and expect that multiple doses may be needed.
But language is the first step We cannot afford to let the label lull people into a false sense of security. Dealers will keep using the term‘ heroin’ – but public health bodies, services, and the media don’ t have to. We need truth in our messaging, because right now the gap between the name and the reality is measured in lives lost.
Ernestine Itayi Nhapi is an independent prescriber
HOW STRONG ARE THEY? Some nitazenes are hundreds of times stronger than heroin. Even tiny amounts can cause fatal overdose.
HOW CAN WE REDUCE RISK? – Test your drugs – Use less, go slower – Never use alone – Carry naloxone( it works on nitazenes, but multiple doses may be needed) healthier options can be simple ways to reduce sugar and fat intake that could be imbalanced. As people’ s addiction habits improve, helping them improve their dietary habits can be a further benefit to complement other improvements to their overall wellbeing. Fergus Dodd, chef, The Wellbourne Clinic
OPEN TO OVERDOSE
I read recently about a young man who had overdosed in prison and would like to share my own experience around why this happens.
I was prescribed sublingual buprenorphine for heroin / opiate use and yesterday I was accused of not taking my medication when the nurse that dispensed it walked off. She was supposed to stand there and watch it dissolve, but she chose not to and apparently I put it in my pocket – bearing in mind that it dissolves rapidly.
Today I was given three choices – paracetamol, methadone, or long-acting injections of buprenorphine. I was not happy at all. I’ d been on my medication for 18 months inside and out, and now they’ ve taken me off everything. The three options were irrelevant as I chose methadone and then I was told I had to move wing, so I told them to leave my cell. I’ m now open to overdose as I’ m feeling ill and not my usual self. But I will bring it to everyone’ s attention, absolutely all relevant agencies, that the buprenorphine is a blocker – it blocks opioid effects. The risks are open to me using drugs due to whatever policy they have in place.
You never know, I may end up being that young lad that ends up overdosing. It happens a lot, including today when I got medication off someone else instead of it being prescribed.
They should not be allowed to take you off the medication that you’ re prescribed outside of prison. This is a massive problem in prisons where they think it’ s ok to take medication off prisoners for something very small. There must be a law on this matter.
That’ s my experience of medication and being pushed into drug use – yet again. Name and prison supplied
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