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We were Warned

Kaitlin Dryburgh

Heads drooped down, bent at the waist, stagnant eyes, and an eerie motionless state. A sight that press in North America have branded “the zombie pandemic”. A sad sight that depicts the very worst of widespread synthetic opioid use. Although a picture paints a thousand words, numbers also don’t lie. Synthetic opioids such as fentanyl are 50-100 times more potent than the likes of heroin and they have been the cause of tens of thousands of deaths throughout the US. For several years now the USA has been battling these “zombie outbreaks” in small towns and cities through-out the country, first grabbing headlines back in 2017 when a collective 33 people were seen in this zombie state in New York. This has been a predominantly North American problem, with Canada also having to deal with the rise of synthetic opioids. Although Scotland and the rest of the UK have not been a stranger to these newer drugs, we haven’t had to deal with anything on the scale of the US and Canada. Yet in this modern and connected world, something that is happening 4,000 miles away can have a huge knock-on effect to you and your community.

Earlier this year the Taliban put a ban on all opium production. There were sceptics who didn’t believe in the seriousness of their threat, as the previous attempt hadn’t really stuck. Yet perhaps they were forgetting that the last time this happened, at the start of the 2000s, fentanyl popped up on the market for the first time. Scotland and the UK dodged it that time, but this time it seemed rather definite.

The global drug policy community took it seriously and foresaw the knock-on effects it could have. No opium production, less heroin, and an increase in price. Something would have to fill the demand and synthetic opioids would do just that. The UK Is estimated to get 95% of its heroin supply from Afghanistan. Synthetic opioids aren’t expensive to make either, for some of them the biggest chunk of production costs goes towards packaging. A worrying fact indeed.

We were warned. The European Monitoring Centre for Drugs and Drug Addiction made it clear back in March what we should be expecting. The UN in August asked that Europe and Australia learn lessons from the USA, as their synthetic opioid deaths had increased by 73% since 2014. Not only that, Canada warned us. Making it clear that we should utilise this precious head start that they didn’t enjoy and get our ducks in a row to stop the wave or at least be prepared for it.

I would love to say that’s what we did, and we have testing centres ready to go, public health announcements out in full force and a heightened awareness throughout the public but that’s not what happened. The UK government decided to take this time to ban laughing gas, an issue that affects everyone apparently. They did put out a warning to drug services, but a warning to those working within the services is hardly the harm reduction tactics that we need in this situation. Meanwhile the Scottish Government did give the green light for overdose prevention centres, which we are yet to see and seemed to celebrate a little too hard with this year’s decline in drug deaths. Charities wrote to UK governments, the Scottish Government expressed concern, and the Welsh Government was asked to evoke an emergency public health response, which they didn’t.

Well guess what, Afghanistan has decreased their opium output by 95%, they weren’t joking. And now the trickle of synthetic opioid deaths are starting to take hold in the UK. In the last six months there have been 54 deaths related to synthetic opioid overdoses throughout the UK (that we know of), more specifically a drug called Nitazenes, sometimes used as a replacement to heroin or sometimes found in traces of other drugs such as Cannabis or Oxycodone, at times it can be over a thousand times stronger than heroin. It is likely that there have been more deaths related to synthetic opioids but there still remains a lack of testing to consistently keep up with new variations. However, Public Health Scotland has noted a spike in the new synthetic drugs on the market and this they believe is the cause of harm indicators trending upwards this year. Meaning that drug-related hospital admissions were up 26% and emergency department attendances increased by 13%.

Transform Drugs, a policy foundation, believes we are woefully under prepared for what is coming and recommends three actions we could all take. The first being testing. Testing for the sake of users so they can for sure know what they are taking and its strength. As these substances become more frequent, they will make their way into other drugs, and that’s when we start to see accidental overdoses especially in young people. But we also need be conducting more testing to gain a better understanding of the current drug market so we can make better informed policy decisions and catch any new substances swiftly.

Drug treatment services. Harm reduction techniques are always welcomed but there will be people who are ready to cut their addiction and gain help. Although a rehab service may not be successful the first time around even just using services is proven to cut chances of overdosing and helps to build trust between a medicalised setting and a user. Although advocating for legalisation is a very legitimate option we must also invest in treatment services.

Lastly overdose prevention centres. Scotland have approved the opening of these centres but we are still yet to see one in operation, and even then, one centre for the whole of Glasgow probably won’t cut it.

Although there are still some who believe that the link between Afghanistan and the UK’s drug market is not as conclusive as many are making it out to be, the next 6 months will be the most decisive in finding the truth, as it can take a maximum of 18 months for the Afghanistan harvest to make it to the UK. However, the current increase in synthetic opioids seems to be playing out exactly how many warned and we are in desperate need of more testing to gain a full picture of what’s happening.

Going forward the UK government is planning on classifying 15 synthetic opioids as Class A drugs, having already done the same with 11 back in February. However, Public Health Scotland points out an issue with that plan, the very nature of these synthetic drugs rely on changing chemical structures. Chemicals are altered and a new drug emerges, its use increases and it’s banned, then the cycle begins all over again. New synthetic drugs are appearing at such a fast rate the process of classifying and criminalising them is taking time and resources away from the actions that would save peoples lives.

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