Nitazenes: History hasn’t prepared us for synthetic opioids

Nitazenes are up to one million times stronger than opium, but the way we understand drug use hasn’t changed to keep up.

We know that nitazenes have arrived in Tower Hamlets. Stigmas towards drug users have been hanging around for centuries. Could they be holding us back from addressing the modern drug crisis? 

In Victorian England, the East End was known for ‘opium dens,’ a kind of speakeasy for smoking opium imported from the nearby docks. 

The use of opium (both medicinal and recreational) was socially acceptable, and mostly practiced by the middle classes at the beginning of the 19th century, even though opium could also be bought at a chemist without a prescription. Yet the dens were mythologised as dangerous and mysterious places of moral corruption.

Describing an opium den in Shadwell, Charles Dickens said, ‘Johnny the Chinaman swelters night and day curled up on his gruesome couch, carefully toasting in the dim flame of a smoky lamp the tiny lumps of delight which shall transport the opium-smoker for awhile into his paradise.’ 

In the mid-19th century, chemists also began commercially producing morphine. A few decades later, opium was processed further to create heroin, also primarily for use in pain relief. 

By the end of the 19th century, opium’s association with Chinese immigration, trade tensions and the working classes had created a reputation of moral degeneracy. Morphine and heroin, on the other hand, were seen as medicines, not a vice, despite being highly addictive. 

The first drug legislation was passed in the UK in 1916, over fears that substance abuse (particularly morphine and cocaine) was hurting the war effort. The line between medicine and vice moved from opinion to law.

In 1920, heroin and morphine were made illegal outright, and opium was restricted. With trade routes disrupted, domestic police had the upper hand, and the legislation was initially effective in curbing use. 

Once drug use became illegal, the UK’s first underground drug culture was created. It could be argued that this rift has sustained the world’s biggest drug cartels. Following Victorian ideals, drug users were seen as morally corrupt, whereas previously they had only been self-medicating. This begs the question: does it make more sense to criminalise drugs or to regulate them? 

After the Second World War, globalisation reopened the UK to drugs. These included cocaine, LSD, methamphetamines and illicit heroin. The poppies farmed to create heroin were mostly cultivated in Afghanistan. Similar to the initial use of opium in Victorian times, recreational heroin use started as a rare hobby for the affluent. 

Combined with high levels of unemployment and social unrest, increased demand and supply of heroin led to the ‘trainspotting-era’ heroin epidemic of the 90s and early 2000s. 

National and global campaigns in the early days of the epidemic, like ‘Heroin Screws You Up,’ and ‘Just Say No,’ warned young people never to try it. Now, heroin is the ‘big bad wolf,’ bringing to mind needles and destruction. Today, the population who became addicted during the 90s is at an increasingly higher risk of drug-related death, due to ageing and deteriorating physical health. 

Since the 2010s, UK drug deaths have been steadily rising. According to the medical journal The Lancet, ‘Likely contributory factors include: disinvestment in drug treatment, harm reduction, and public services; changing patterns of socioeconomic deprivation; increasing poly-drug use; and an ageing cohort of people who use heroin.’ 

Nitazenes and other synthetic opioids are making an increased appearance in the UK’s drug supply. In the last six months of 2023, they were linked with 54 drug deaths in the UK. One million times stronger than opium, nitazenes pose tremendous risks. The amount needed to overdose is not even visible to the human eye. 

Drugs are getting stronger and more dangerous, but the way the modern-day press paints users is eerily familiar to the opium den days of the Victorian East End. 

As a result of stigma, drug policy in the UK has frequently contradicted available evidence, resulting in avoidable deaths.

As a case study, the UK Drug Policy Commission analysed the press’ reaction to the story during the heroin epidemic, that methadone was being prescribed to prisoners. Methadone is a synthetic opioid used to reduce heroin dependency. It is considered widely effective as part of sobriety treatment, despite controversy. 

Most tabloids, such took up a one-sided stance against methadone treatment. For example, the Sunday Mirror, ran headlines like ‘Jail junkies have it too easy.’ Broadsheets were more balanced in coverage, but some, including The Times, were also clearly anti-methadone, with headlines like ‘Lunatics are running the asylum’.

The politicisation of methadone confused public policy. Tony Blair’s Labour expanded methadone provision as part of their ‘tough on crime and the causes of crime’ slogan. The following coalition government reduced the availability of methadone, seeing the treatment as proof that Labour had created an overdependence on the state. 

In both cases, policy was shaped by the misunderstanding that drug use was a moral disorder, not a physical one. In the end, medical treatment across administrations was inconsistent and politicised. 

Xenophobic tropes connected to drug use also persisted in the mass media, echoing from Victorian times. A 2011 BBC piece on British-Bangladeshi drug use near Brick Lane reads ‘there is a dark side behind the exotic colours, sounds and smells.’ A 2009 Daily Mail article on a young offender describes her as ‘The daughter of two heroin addicts […] spoke a bizarre form of pidgin Jamaican-English.’ 

Stigma and the ‘othering’ of drug users in the media have reduced pressure on the government to treat the health crisis. In reality, opioid addiction behind closed doors spans across all demographics and walks of life. This is even more so the case today, where nitazenes have slipped into everything from counterfeit prescriptions to party drugs. 

Dr Caroline Copeland, Senior Lecturer in Pharmacology & Toxicology at King’s College London and the Director of the National Programme on Substance Use Mortality (NPSUM), tells the Slice that ‘Penalties for drugs hasn’t worked since 1971.’

‘We need to address why people use drugs, to help them to not use them, rather than think that we can just slap penalties on,’ Copeland said. 

The ‘us and them’ mentality treats drug users as belonging to another world. Similar to the HIV/AIDs crisis, this marginalisation has created a slow and ineffective government response. 

During the HIV/AIDs crisis, the government initially ignored advice from the Advisory Committee on the Misuse of Drugs (ACDM) to make sterile needles widely available. Providing sterile needles for drug users later proved widely effective in stopping the spread of HIV/AIDs, but only after many avoidable deaths. 

Today, a potential intervention being blocked is consumption rooms, safe and clean spaces where users can inject drugs and be treated in case of an overdose. Not surprisingly, public reaction to the idea has been mixed, despite health professionals and academics advocating for it. There are also legal barriers. 

A paper by King’s College London academic Andy Guise and his colleagues  argues that ‘The 2021 government drug strategy claims to have evidence at its heart but promotes measures not supported by available evidence, such as increasing punishments to deter drug use.’ Alex Stevens, formerly a member of the UK government’s Advisory Council on the Misuse of Drugs, describes the government’s position on consumption rooms as a ‘moral sidestep’ of the evidence that they are effective.  

In the modern East End, drug use is still high. Release, the UK’s centre of expertise on drugs and drug laws, runs harm reduction services for drug users in Tower Hamlets. Executive director Niamh Eastwood believes that stigma towards drug users continues to make the problem harder to address. 

She described recent coverage of drug-users in Tower hamlets as ‘angry NIMBYism that just punches down on some of the poorest folks using drugs.’

For example, a January 2025 headline from the Sun, describing drug use at the Nag’s Head Estate, coldly reads: ‘We have to walk over ‘zombie’ neighbours jabbing class As into their feet outside our homes.’ 

In September 2024, plans from Tower Hamlets Council to host a ‘culturally sensitive substance misuse recovery centre’ near a nursery sparked protests from parents. Despite reassurances that the centre would only host those ‘stable in their recovery,’ the massive pushback means it’s now unclear whether the centre will go ahead, or where it will be hosted. 

Eastwood continued, ‘The majority of people here want each other to be safe and be well.’ 

Nitazenes and synthetic opioids are a serious health risk for both long-term drug users and those who use drugs infrequently. However, antiquated stigma towards drug users is entrenched in our media and government. As a result, constructive solutions to a worsening health crisis are being ignored.

Criminalisation and moral panic simply haven’t worked. Users need support, not more punishment, and expert-backed ‘low barrier to entry’ and harm reduction approaches need to lead the way. 

If you liked this, read The arrival of an invisible killer: Is Tower Hamlets ready for Nitazenes?