Fentanyl, the powerful opioid which has been attributed to thousands of deaths in the US and Canada in recent years, has begun to emerge in illegal markets in the UK. The government must act now to prevent the potential devastation that this could cause.
In April, six people in Yorkshire died of suspected opioid overdoses in the space of two days, prompting police to issue a warning of "deadly" heroin batches in circulation. The batches, the police feared, were cut with fentanyl.
Fentanyl is a powerful opioid, estimated to be 100 times more potent than morphine (as a point of reference, heroin is 4-5 times more potent than morphine), that first gained international press coverage after the death of musician Prince, who overdosed on it.
While some people choose to consume fentanyl – medically or recreationally – many consume it without knowing so, as it may be clandestinely cut into a heroin batch, unbeknownst to the person who uses it.
Fentanyl’s high potency in a tiny quantity makes it cost-effective as a cutting agent for those who sell it, and less risky to smuggle. Additionally, it is extremely hard – if not impossible – to tell from sight whether heroin has been mixed with fentanyl.
The UK is already in the midst of a drugs crisis; the numbers of drug-related deaths in England, Wales, and Scotland are currently the highest ever recorded. The UK government must immediately implement a national coordinated response so to prevent the seemingly-looming rise of fentanyl from exacerbating the country’s drug deaths crisis.It cannot be left to local areas to counter what will inevitably become a nationwide issue if not contained.
The government must be aware of the factors which could contribute to a fentanyl overdose crisis in the UK. Fortunately, it’s not too late to stop a crisis unfolding, but policymakers must act now.
Many people don’t know when they are consuming fentanyl
Since a heroin batch may be cut with fentanyl without the buyer’s knowledge, it must be made easier for people who use drugs to know the contents of their purchase.
The government must deploy, or support the deployment of, forensic testing facilities and services around the country, particularly in areas where illicit opioid use is prevalent.
A prominent example of such services is Multi Agency Safety Testing (MAST), which was introduced by non-profit drug testing organisation, The Loop, in 2016. MAST allows "individual service users [to] submit [drug] samples for analysis and receive their results as part of a confidential, individually tailored harm reduction package delivered by experienced substance misuse practitioners".
While The Loop’s services have been primarily focused on testing the purity and contents of drugs used recreationally at nightclubs and music festivals, a similar community-based service could allow someone who uses heroin to ascertain if their purchase contained fentanyl – or other highly potent and potentially deadly opioids, such as carfentanil. This would also be an opportunity for an individual to receive harm reduction advice and information from experts.
It is very easy to overdose on fentanyl due to its high potency
The government must immediately implement a national naloxone programme.
Naloxone is a safe and affordable medicine that can reverse deadly opioid overdoses. It is described by the World Health Organisation as one of "the most efficacious, safe and cost-effective" medicines that all healthcare systems need. It has little to no effect on people who don’t use opioids, so there is almost no potential for it to be misused.
The government relaxed rules on who can acquire and administer naloxone in 2015, but that change has not gone far enough. The availability of naloxone is dependent on funding provided by local authorities, making it a postcode lottery as to whether someone can acquire it or not. Naloxone should be available to anybody who seeks it, for free and without a prescription.
Such a programme should also be accompanied with information about naloxone’s relationship with safer drug use. For example, some experts warn that larger doses of naloxone may be needed for fentanyl overdoses than are needed for heroin overdoses.
The US Food and Drug Administration claims that "repeated administration of naloxone may be necessary" to counteract a fentanyl overdose. A clinical coordinator at a safe injection facility in Vancouver recently said that "with fentanyl, we're seeing we'll have to give upwards of three, four, five doses of [naloxone] before somebody starts to wake up. It takes a lot more of the naloxone to reverse the effects."
Despite research on the subject, it is not definitively clear if, or how much, extra naloxone is needed to counteract a fentanyl overdose when compared to a heroin overdose.
The abstinence-focused agenda is ineffective at reducing problematic opioid use
The government should support the opening of drug consumption rooms (DCRs), also referred to as safe injection facilities, such as that planned for Glasgow, so that people who use opioids like fentanyl can do so in the presence of trained medical professionals who can administer naloxone and provide other assistance. Worldwide, there has not been a single fatal drug overdose in a DCR.
Additionally, the government should widen the availability of heroin-assisted treatment (HAT), which is currently very limited. This approach – by which people are provided with pharmaceutical-grade diamorphine (heroin) – can undermine the illicit market, while allowing people to avoid the risk of fentanyl contamination.
Criminalisation dissuades people from seeking help and increases marginalisation
Criminalisation does not reduce drug use. In 2014, the Home Office itself admitted that there is a “lack of any clear correlation between the ‘toughness’ of an approach and levels of drug use”.
Rather, the criminalisation of heroin, fentanyl, and other drugs leads to riskier injecting practices – such as sharing and reusing needles, and can make people too scared to seek help or support. The latter may be due to their fear of prosecution, or due to the stigma that criminalisation attaches to drug use.
In mid-June, Public Health England issued an alert concerning an increased possibility of fentanyl's prevalence in heroin batches in West London. While it is unclear if this has led to an overdose as yet, it is not worth waiting to find out.
The UK is in the midst of the worst drug-related deaths crisis on record. If this were virtually any other potential public health crisis, or any other group of people being affected, the government would have already acted pre-emptively to prevent the crisis worsening.
The government still has an opportunity to prevent a fentanyl deaths crisis from taking place, but it must act now.
If you, or someone you know, uses or may encounter fentanyl, be sure to read our harm reduction advice.