How inadequate nitazene testing is undermining the UK’s response to the deadly synthetic opioid crisis
Delays in better drug checking and toxicology are preventing life-saving interventions, especially in areas with the highest need.
Since June 2023, nitazenes, a powerful new class of synthetic opioids, have been linked to at least 400 drug-related deaths in the UK. Stronger than fentanyl, some nitazenes are so potent that a fatal dose isn’t even visible to the naked eye.
Despite this, there is still no accurate, rapid, or widely available system for testing them. Nitazenes have a different chemical makeup from traditional opioids, demanding entirely new testing methods. But accurate, fast, and widely accessible testing is still not in place.
Without it, users have no way of knowing whether their drugs are contaminated. DIY Covid-style test strips and advanced lab analysis could offer life-saving warnings. But right now, these tools are limited, inconsistent, and hard to access. Testing is also critical to tracking how deeply nitazenes have infiltrated the UK drug supply, helping governments to develop a strategy.
Experts agree: rolling out free, fast, high-quality, anonymous drug-checking nationwide, along with a coroner system that reports drug deaths quickly and accurately, would save lives. The sector is ready to act, and the solutions are relatively simple. But political inertia and red tape are stalling progress.
This sluggish response is no match for the speed at which new synthetic opioids are being developed at overseas labs. The UK is being outpaced by a drugs crisis that is evolving faster than our systems can adapt. with
But some scientists are now scrambling to catch up……
Better than nothing? Home testing strips for drug users
Starting in late 2024, home testing strips, similar to those used for COVID tests, have become available for nitazenes, allowing concerned users to check their drugs before taking them. A positive result alerts the user to the presence of nitazenes, helping them avoid potentially fatal consequences.
Although not as accurate as lab analysis, these lateral flow testing strip tests are cheap and don’t need supervision to use – you mix your drugs with a little water and pour some onto the test strip. A positive result indicates that the drugs could likely have nitazenes in them.
The first lateral flow nitazene tests were crude and often produced false positives from common cutting agents such as acetaminophen and caffeine. They also reacted to other opioids, including heroin, making them unreliable for heroin users who want to avoid nitazenes.
Improved test strips no longer react to opioids such as heroin, but it’s unclear if they still return false positives from cutting agents. They also only detect certain nitazene variants, meaning others may go unnoticed.
Despite their flaws, the strips can alert users to the possible presence of nitazenes and prompt caution. However, frequent false positives risk undermining trust in the results.
In Tower Hamlets, nitazene testing strips are available at most rehabilitation services. They are also distributed at Release’s harm reduction hub in Aldgate and through grassroots harm reduction groups such as Safe Only CIC. However, other outreach services, for example, pharmacies that provide needle exchange, do not stock nitazene testing strips.
Stocking the strips in more locations could be a simple and low-cost solution for Tower Hamlets Council to raise awareness of nitazene contamination among drug users.
Accurate drug testing machines at treatment centres
To make DIY nitazene testing more accurate, innovative techniques are being trialled. Sophia Vietti, a PhD student at the University of Strathclyde, has developed a portable testing system for nitazenes which uses electrochemistry to check if someone’s bloodstream contains nitazenes, similar to a blood sugar monitor.
Although the ‘Covid-test’ style home testing strips have the advantage of being disposable, and thus easy to distribute, Vietti’s innovation could be a low-cost solution for rehabilitation centres and support services that don’t have access to laboratory facilities. The invention could also be helpful for users without samples of what they’ve taken.
Slow but accurate postal testing of drug batches
Small samples from a larger drug batch can be sent to a lab for testing, which benefits cautious users who have time and a fixed address. While not suitable for those needing an immediate hit, it can help users with controlled habits, such as those seeking pain relief they can’t access through a prescription.
To test illegal drugs super-accurately and anonymously, there is currently just one option in the UK, the Welsh Emerging Drugs & Identification of Novel Substances Project (WEDINOS).
This high-tech laboratory, funded by the Welsh government, tests around 8,000 substances a year that have been sent in anonymously by members of the public. Each month, they operate at full capacity.
Senders provide the first line of their postcode, a sample of the drug they want to test, and explain what they think the drug is. WEDINOS then check the drugs and posts the results publicly along with a photo of the sample.
Professor Rick Lines is the Head of Substance Misuse and Vulnerable Populations for Public Health Wales, of which WEDINOS is a part. ‘Our perspective is that […] obviously the best way to eliminate your risk is not to use substances, but if you are going to use, the best way to reduce your risk is to know what it is you’re consuming,’ Lines said.
WEDINOS provides a potentially life-saving service across the UK, which feeds into the international public health strategy. However, within Wales, the team is able to work more closely with local stakeholders, such as rehabilitation services and nightclubs with drug amnesty bins.
To give an example of an intervention that was only possible locally, Lines described a case where a woman in Newport had overdosed, where nitazenes were suspected to be involved.
‘One of the peer workers sent in the cooker that she had cooked up with to us, we tested it, we found nitazenes and some other materials in it,’ Lines said, ‘And so our program lead was able to go out pretty much immediately to the service and […] put out very localized messages through the service.’
‘I think what I’d like to see is not necessarily a bigger WEDINOS, but more WEDINOS type programs, whether they’re national programs like we have or locally based ones,’ Lines continued ‘The much better response is to try to get more drug testing and drug checking programs to meet different types of consumers.’
Although extremely accurate, the downside to WEDINOS results is that they take a few days to process.
‘If you’re talking about people who are particularly vulnerable or maybe scoring every day and using every day, that’s where you really need those kind of localized service-based drug checking services, because they will serve a very different and much more vulnerable population than most of the ones that we would probably see’ Lines said.
‘Someone who needs to score heroin every day to not get sick isn’t going to send heroin into us and get the results back in three or four days.’
Mobile drug checking of confiscated drugs at places of consumption
Mobile drug checking services have been used to test drugs that are confiscated from nightclubs, allowing them to establish if nitazene-contaminated drugs are present in a city or district. Their physical presence at sites of drug consumption provides the opportunity for outreach and drug education.
One such service is The Loop, a mobile national service that provides free and anonymous lab analysis of drug samples in person, with a small lab that can be set up on the street or in a nightclub. This also allows The Loop to do direct outreach and safety awareness.
Although not quite as accurate as WEDINOS, The Loop’s results are much more accurate than the DIY nitazene test strips. However, The Loop is currently only licensed to run ‘back of house’ drug testing in London, meaning they can only test samples of drugs that have been confiscated.
With both The Loop and labs like WEDINOS, the main obstacle to local expansion is Home Office licensing. Testing illegal drugs means they must be held, disposed of and stored in particular ways, and getting permission granted for this testing can take years, and can be slowed down depending on political interests.
‘There are a lot of conditions that go with that license around, you know, the kind of expectations you have to agree to around the premises you’re in and the processes that you’re using to safely receive, store, analyze, destroy, document it all,’ Lines explained, ‘So it’s quite administratively heavy as well.’
A license also depends on how a government approaches drug policy. ‘Some governments sort of have a harm reduction approach, some have sort of more of a recovery-based, abstinence-based approach,’ Lines said, ‘So drug checking services would probably fit within the drug strategies of some types of governments more than others.’
Currently, The Loop is set to expand testing in London. There are no current plans for more anonymous drug testing labs like WEDINOS in the UK.
Toxicology improvements
Toxicologists screen for particular drugs in dead bodies, at the request of a coroner conducting a post-mortem. Their results allow coroners to accurately state the cause of death, which in turn can improve public health data.
Nitazenes in the bloodstream of a dead body are much more difficult to detect than in a drug sample or biological samples from a living person.
Up until last year, toxicologists didn’t know that nitazenes are unstable in the bloodstream, meaning they degrade and are sometimes no longer detectable by the time a post-mortem has been conducted. As a result, it’s likely that nitazene deaths in the UK have been significantly undercounted.
Rebecca Wood, a toxicologist and co-host of The Tox Lab podcast told the Slice that testing for nitazenes in toxicology is beginning to improve. Her lab was one of the first to notice that nitazenes were ‘disappearing’ from post-mortem tests, suggesting the drug could be unstable.
Wood and her colleague, Rob Moore have since published research investigating nitazene metabolites, the byproducts left over when the drug has broken down and ‘disappeared’ from the bloodstream.
Research of this kind is making it easier for toxicologists to say when nitazenes have been involved in a death. This is crucial for understanding the scale of the mortality caused by nitazenes.
Wood explained that within toxicology, each lab screens for substances slightly differently. ‘It will depend on the lab and how up to date their library is, and what they’re sort of screening for,’ she said.
Libraries that provide guidance when testing for compounds vary depending on the laboratory. Although there are standardised libraries that come pre-downloaded in machinery, laboratories will add to their personal libraries in order to improve their own testing. This is especially relevant for nitazene testing, which is continuously being improved.
‘‘Especially when you’ve put a load of work in, some people get quite protective [of their libraries],’ Wood said. ‘It’s why we published [our paper] because I wanted to try and share with people in a peer-reviewed way, look, these are things that we could all be checking for.’
Better information sharing among toxicologists, like the kind Wood and Moore are trying to establish, is a promising way for data on nitazene deaths to get better faster.
Coroners and post-mortem testing
Testing for nitazenes as a cause of death is essential for understanding how many people have died due to nitazenes. Data from coroners is crucial information when developing a drug safety policy at the level of local authorities. If councils don’t know how many people are dying from nitazene overdoses, they aren’t able to respond.
The local coroner does not share any data at all on drug deaths with public health bodies. The Slice has been asking for comment on whether or not bodies are being tested for the presence of nitazenes for the past three months, with no response to date.
The race to detect nitazenes
Since WEDINOS raised the alarm on nitazenes in 2021, there’s been a scramble for better testing. To better tackle this health crisis, we need to first accurately understand which nitazenes are present in the drug supply.
DIY testing strips have improved, but it’s still unclear how much they react with other substances likely to be present in drugs. However, these strips are quick, easy and cost-effective. Even if they aren’t foolproof, they can at least help warn a user that their drugs may be contaminated. Locally, strips could be distributed in other places that provide harm reduction materials, such as needle exchanges.
Lab testing samples for nitazenes is much more accurate, and has been since the beginning of this crisis. However, the labs that provide this service anonymously for illegal drugs are far and few between, despite the willingness within the sector for expansion.
Locally, the Council may be able to facilitate services such as The Loop operating pop-up drug checking. However, slow Home Office licensing is the biggest obstacle to improving the availability of nitazene lab testing.
Post-mortem toxicology is also improving for nitazenes, but it is here locally that we face our biggest obstacle: the coroner. It is up to the coroner’s discretion how much of their drug death data they share.
In the case of Tower Hamlets, the information being shared is absolutely none at all. This leaves local health services as well as national databases out of the loop, despite Tower Hamlets having the highest number of opiate users in London.
On the positive side, it is safe to say testing for nitazenes has been improving in the UK. Whether we are able to reap the rewards of those benefits locally remains to be seen.
Read our synthetic opioids series from the beginning: The arrival of an invisible killer: Is Tower Hamlets ready for Nitazenes?