The United Nations has warned of a world-wide problem with accidental overdoses of synthetic opiates, and the UK is the second nation to have this following the USA. The UK is leading Europe in testing for these substances.

Super-strength street drugs more powerful than heroin have been linked to at least 54 deaths in the UK in the last six months of 2023. These were nitazenes, a type of synthetic opiate. There is a plan to class 15 of these synthetic opiates as Class A drugs. Nitazenes first made news in the UK in 2021, when an 18-year-old patient was treated for a non-fatal overdose.  

Fentanyl, another synthetic opiate, contributed to 75,000 deaths in 2022 in the USA. 

Following a sudden spike in UK deaths in the summer of 2023, the government put out a warning across the NHS and drug services. This was the second National Patient Safety Alert in three years.  

Nitazenes were first developed in the 1950s as analgesia, pain-killing medication. They have not been approved for medical or therapeutic use because they are so potent and addictive. They can be injected, inhaled or swallowed. Mixing them with other drugs and alcohol is extremely dangerous and significantly increases the risk of overdose and death. 

The new drugs are covered by the Psychoactive Substances Act 2016. 

The first death in the UK in May 2022, with a synthetic opiate was associated with Xylazine. It is believed that this person was likely to have bought heroin and not known it was laced with xylazine and fentanyl.  

Xylazine is not included in standard drug screens in the UK, so we do not know how widespread the xylazine problem is. The Birmingham toxicology lab who performed the drug screen noticed a strange peak in the test results. They were able to identify this as xylazine. It is because of the vigilance of the toxicologist to notice and report on this strange peak that this was discovered at all. 

Xylazine is a non-opioid sedative, painkiller and muscle relaxant. It is used in veterinary medicine as a tranquiliser for large animals. It can be cut with heroin and fentanyl. It is causing widespread problems in North America. 

Synthetic opiate painkillers are powerful drugs in alleviating suffering for those with acute or chronic pain. Their efficacy is not disputed but their potential for addiction and therefore societal implications requires further monitoring and investigating to keep users safe.  

Synthetic opiate painkillers are also known as opioids. They are medications formulated to mimic the effects of natural opiates (from the poppy) like morphine and codeine. They bind to specific receptors in the brain and spinal cord. This alters the perception of pain. They can produce feelings of euphoria and relaxation. 

Few synthetic opiates are available for medical use. When prescribed they are controlled substances, and many safeguards are in place. However, many are produced illegally and then added to other substances. 

The most significant danger with these substances is accidental fatal overdose. 

The signs that someone may have taken an opiate or opioid are – small, narrowed pupils, reduced level of consciousness, dizziness, drowsiness, difficulty breathing, nausea, vomiting, clammy skin, blue or grey lips and fingernails, low blood pressure or a decreased heart rate. 

Anyone who has consumed synthetic opioids and experiences the symptoms described should seek urgent medical treatment.