How Britain lost its war on drugs

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Ain general practitioner (gp) in the inner-city of poor Birmingham, Judith Yates had an intimate view of the evolution of Britain’s illegal drug market. In the 1980s some of her poorest patients became addicted to Afghan heroin as it flooded the market. In the 1990s they made crack pipes from Coca-Cola cans and asthma inhalers. Some recovered. Others went in and out of prison, where they often became addicted to other drugs. Several died.

In 2010, frustrated by how little ground the government was making in its war on drugs, Dr Yates began visiting the local coroner’s office to gather information about drug deaths. “I wanted to look for patterns, see if we could stop people from dying,” she said. What she found scared her. Drug deaths were increasing every year. And opioids played a big role.

In 2022 Dr. Yates (who retired at the time but continues her research) saw a drug name on the coroner’s reports that she had not seen before: n-pyrrolidino etonitazene. This is one of a class of new synthetic opioids called nitazenes that are at least as powerful as fentanyl (another synthetic opiod that is itself up to 50 times more powerful than heroin) and often many times more.

The drug was found in three men who died, two students and a businessman – very different drug users from those Dr Yates was used to seeing in coroners’ reports. They had bought pills that looked like the prescription level of oxycodone (pain) online. “They would have thought they were self-medicating to reduce the stress of life,” she says. “They certainly didn’t intend to die.”

Dr Yates’ experience is a microcosm of a wider crisis. Drug deaths in England and Wales have increased every year since 2012 (see chart). In 2022, the latest year for which data is available, the figure was 4,907, according to the Office for National Statistics (oz); 89% higher than in 2012. During that time some characteristics of drug deaths have remained constant. The majority of victims are male (see table). The death rate is highest in the northeast. (Scotland, which is subject to the same laws but where drug deaths are counted separately, has one of the highest rates in Europe). And it is the same generation – people born in the 1970s – who are most likely to die.

The vulnerability of this group is partially explained because in the last two decades of the 20th century more young people started using hard drugs, especially heroin and cocaine. These cause more damage to the body as it ages. Deaths caused by cocaine, which has grown in popularity as it has become cheaper, will rise to 857 in 2022 from 112 in 2011. Deaths caused by drugs may rise also because it has become more common to take more than one substance at a time, which tends to be fatal.

But the most worrying part of the picture involves the consumption of synthetic opioids. Britain, like most of Europe, has so far faced the opioid crisis that killed 70,000 Americans last year alone. Because of its nationalized, non-profit health care system (in which doctors are generally responsible for prescribing opioids) it is unlikely to develop a problem as large as America’s.

But experts worry that an opioid crisis could be imminent due to changes in the global drug trade. Most of Europe’s heroin comes from Afghanistan, where the Taliban announced in 2021 a ban on opium, a gum extracted from poppies from which heroin is made . Two lost poppy harvests later, the market for synthetic opioids such as nitazenes – which are relatively easy and cheap to make (in China, it’s thought) and the then post – succeeding.

No one knows how many people in Britain have been killed by nitazenes. They have been found in several dozen cases but are not always tested. Meg Jones, director of Cranstoun, a charity, says that nitazenes are cut into many types of drugs, often accidentally (because they are cut and packed on the same surface). In November the Home Office said it was ordering 15 new drugs as “Class A”, the most dangerous type. Most of them are nitazene compounds.

Britain is particularly unprepared for the opioid crisis. Funding cuts in the 2010s have devastated drug treatment programs. In the second part of an independent, government-commissioned drug review to be published in 2021, Professor Carol Black, a doctor and academic, said that “funding cuts to treatment and recovery services to leave their knees”. The workforce was “depleted, especially of professionally qualified people, and demoralized”. “The current situation is intolerable,” she said.

The government has acknowledged the need for more investment in services like this. But he has to do much more than make up for what he has lost. Since Britain passed the Misuse of Drugs Act 1971, which criminalizes the possession of illegal drugs, it has taken a moralistic, punitive approach to drug use that has achieved little.

Britain is still one of the few countries in Europe that does not have safe rooms for drug use (although one is expected to open in Scotland soon). That’s because running one could mean being charged with a crime. Research suggests that such places do not increase drug use but help users sign up for alternative treatment. In addition, they are a low-cost intervention, which requires little more than a room, a health care worker and a supply of medicines too. But Rishi Sunak, the prime minister, has said that they “allow the use of drugs”.

There has been some progress. More and more police forces are carrying naloxone, an opioid antidote. Once only available in injectable form, it is now available as a nasal spray. Officers prefer to use this instead of handing out drug addicts cpr. (Several doses may be needed to save someone who has taken nitazenes.) Last month The Loop, a charity, opened the first Home Office-licensed drug testing site, in Bristol . It allows users to submit samples of illegal drugs; if there are concerns about the potency and purity of products, local authorities can issue public health warnings and advice and treatment can be offered to the buyer. More centers like this are essential.

In the rapidly changing drug market there is power in information, says Dr Yates. She would, for example, like the government to find a way to speed up the release of information about drug deaths, which are usually confirmed by coroners. The oz says the record delay in investigations means that 64% of deaths recorded in 2022 occurred in previous years. If Britain has an opioid crisis, it may not find out before it’s too late.

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