Britain is not yet an opioid nation but rising drug deaths demand a new approach

Two of those countries are England and Wales, where yearly deaths due to drug poisoning are at their highest since records began. At last count, in 2023, they stood at 5,448. And almost half of those, according to the Office for National Statistics (ONS), are due to opioids, a growing menace. Deaths from this group of chemical compounds, which includes heroin and morphine as well as synthetic newer versions like nitazene and fentanyl, have doubled in the last decade.

But a study published last week by King’s College London finds that these shocking figures may be an underestimate: in fact, the proportion of drug deaths caused by opioids are some 54.7% higher than the ONS had recorded. When it comes to heroin and morphine deaths, for example, researchers found the figure for 2022 was 1,980, rather than the 1,264 previously logged. Similar undercount rates were found for deaths by methadone, codeine, tramadol and fentanyl.

Why the mistake? Coroners often miss this information off death certificates when someone dies with more than one drug in their system – instead of listing the substances involved they use phrases like “multi-drug overdose”. That filters through to official figures; the ONS only has access to death certificates, a fact it makes clear in reports, noting it might not have the full picture. But now King's researchers have cross-referenced these official figures with information from toxicology reports and post-mortems. The mismatch is apparent. For opiates, it is astonishing.

Alarm bells had already sounded about a UK drugs crisis. A health report this year noted that mortality in Britain is outpacing that of similar countries like Japan, Germany and Australia – and put it down to a “sharp rise in drug-related deaths” – which in the UK is almost three times higher than peers. But this new report should focus the mind of policymakers on opioids. They are a rising danger.

The reasons behind the trend are complex. A major factor is simply that heroin addicts are getting older. The drug boomed in popularity in the late 80s and 90s, which is when many picked up the habit; and the growth of treatment centres has helped keep them alive when they overdosed. But the toll of lifetime drug use is catching up with their hearts and lungs. The average age at death from drug use for men has risen from 32 in 1997 to 44 in 2023.

But another, trickier puzzle piece is a rise in a group of dangerous “synthetic” opioids. Unlike heroin, extracted from poppy seeds, these are entirely made in laboratories. They include fentanyl, and a class of opioids called nitazenes, which emerged in the 1950s as potential painkillers, but were never approved as their strength makes it too easy to overdose. Now these are spreading across the globe. They are cheap and quick to produce, and have an added benefit: they don’t rely on illicit crops. Most of Europe’s heroin comes from Afghanistan, but the Taliban recently banned opium production, leading to a dramatic reduction in heroin and a gap in the market. Synthetics are far easier to smuggle, too, as users need smaller amounts to get high.

They are also extremely risky for those that consume them. Fentanyl is about 50 times stronger than heroin, and the family of nitazenes can be stronger still. Etonitazene, for example, has a potency that is 500 times that of heroin. Adding to the danger is that many people end up taking these drugs by accident, according to Harry Sumnall, professor of substance abuse at Liverpool John Moores University. The low cost and high strength tempts producers to cut them into other drugs, to give it a cheap opioid boost. That can surprise older heroin users, but also people who never intended to take opioids in the first place: traces of these drugs are showing up in benzodiazepines, an anti-anxiety drug, when it is sold on the street.

The UK is unlikely to ever develop an opioid problem the size of America’s. That began because of a badly regulated healthcare system and the false claim by pharmaceutical companies that the pain relief their drugs offered was safe: Purdue Pharma, and the Sackler family that controls it, agreed this year to a $7.4bn settlement as a result. Patients became hooked on the opioids, and once prescriptions ran out, addicted patients turned to street drugs.

Our NHS curbs that risk – for a start, Brits are registered with a single GP, meaning they can’t shop around for multiple prescriptions. But it does not eliminate it. In 2019, the UK had the highest consumption rate of prescription opioids in the world – most given for chronic pain conditions. Rates had quadrupled in the previous two decades. Since then, stricter guidelines on prescriptions have brought that rate down, although the use of opioids is concentrated in deprived areas.

Otherwise, little protects us from an opioid crisis, says Ian Hamilton, a senior lecturer in addiction at the University of York. Access has certainly never been easier. Nitazenes are marketed online – last year an investigation found about 3,000 SoundCloud and 700 posts on X advertising these substances, which arrive discreetly in unmarked packages. Marketing is reaching the masses.

Policymakers are alert to the dangers, if not the most effective solutions. Last year the UK banned 14 nitazenes. This approach has limits – producers can just toggle the formula to evade new bans. To academics in the field, this is known as the “balloon effect” – squish down on one substance and another will pop up. Instead, the Lancet has called for more community drug checking services where the public can test substances to check for contaminants. So far, there is just one of these with a license – it has been operating in Bristol since 2024. More overdose prevention centres would help, too – particularly for the older crowd – as would better availability of the antidote, naxalone. Hamilton says some paramedics do not carry enough to deal with overdoses from these newer, stronger drugs. Governments tend to worry such an approach might be seen as condoning illegal substances; but as opioid deaths climb, it might be sensible to start doing what works.

Photograph by Gary Coronado/Los Angeles Times via Getty Images