Nitazenes expose dangerous gaps in GP, pharmacy, and medical training in Tower Hamlets

Despite escalating warnings about a new highly potent synthetic opioid, pharmacists, general practitioners, and club-goers in Tower Hamlets remain critically unaware, leaving front-line defences perilously weak.

Pharmacists, GP doctors, and clubbers all have one thing in common – they haven’t heard about nitazenes. 

The synthetic opioid group called nitazenes, which can be significantly more potent than fentanyl, has quietly entered the UK drug supply, including Tower Hamlets. Yet, awareness remains dangerously low among those who should be best equipped to respond.

In June of 2024, Dr. Somen Banerjee, Director of Public Health at London Borough of Tower Hamlets, issued a stark warning that ‘The real concern at the moment particularly with young people is new synthetic substances which are becoming increasingly available, so synthetic opioids like fentanyl and nitazenes.’ 

Since then, despite the warning, only select first responders, drug support services, and charities have heard of the issue. 

Nitazenes have also been detected in ‘party drugs,’ so we sent our reporter Sophie Howarth down to popular east London nightclub FOLD for the evening. She asked clubbers if they knew what nitazenes were, if they ever take unknown substances, and if they ever test their drugs. 

It is possible to test drugs for nitazenes; strips are available at harm reduction support services, but aren’t as accurate as laboratory testing. 

In the UK, you can also send drug samples to the Welsh Emerging Drugs & Identification of Novel Substances Project (WEDINOS) for free and accurate laboratory testing, however, the process is time-consuming. 

Out of seventeen clubbers she spoke to, all had heard of fentanyl, but none had heard of nitazenes. 

When asked if they take unknown substances, the majority said it was common to take drugs on a night out without knowing what they were. Most also said they wouldn’t test their drugs before consumption, and had only come across drug testing services in a festival setting. 

An anonymous clubber said that ‘on a night out and recreational use I’ve never heard of anyone testing their drugs.’ A clubber named Benjamin said, ‘That’s a waste of drugs.’ 

Party-goers may not know that their drugs are at risk of being contaminated. Even if they do know, testing drugs for nitazenes appears to be an uncommon practice, and the risk of unintentional overdose looms. 

In Tower Hamlets, local pharmacies participate in a harm reduction supply programme. Drug users can pick up clean needles, which reduce the risk of injection-borne disease, as well as naloxone, which can reverse an opiate overdose, and other harm reduction supplies. 

Naloxone reverses both synthetic opioid (including nitazenes) and heroin overdoses. However, with some nitazenes, a much higher dose than normal is needed to reverse an overdose. 

Pharmacists end up being the first port of call for many drug users, however, our data shows that most have not been briefed on the risk of nitazenes by health authorities. 

We reached out to all of the participating pharmacies, a total of ten locations. None of the pharmacists we spoke to had heard of nitazenes. All of them said the needle exchange was popular with users. However, naloxone was not very popular with users. 

Shahed Uddin from Bell Pharmacy, which runs one of the harm reduction services, said ‘The uptake of naloxone is not brilliant. That’s my honest opinion,[…] it could be so much better.’ 

The uptake of naloxone is not brilliant. That’s my honest opinion,[…] it could be so much better.

Shahed uddin, bell pharmacy

Uddin felt that people coming in to use the service didn’t have enough information about naloxone, and were scared to use it. ‘They feel like they might get in trouble for taking it, or that they don’t need it, they don’t understand how it works,’ he said. 

He estimated he knows 40-50 residents who regularly use the needle exchange programme, with additional one-off service users. 

Two other pharmacies with similar programmes said their needle exchange service was ‘very popular.’ Three of the pharmacies we spoke to had stopped their harm reduction services because of operational difficulties. 

Although the high uptake of clean needles is positive, it doesn’t protect users at risk of overdose from nitazenes or other strong synthetic opioids. Better naloxone uptake is needed, as well as more consistent outreach from drug users and support for pharmacists running harm reduction programmes. 

Another key area of concern is nitazenes and other synthetic opioids hidden in fake prescriptions. We reached out to nine GP Surgeries across the borough to ask about nitazenes and received no response.

Despite the health risk associated with fake medication laced with nitazenes (or other synthetic opioids), synthetic opioids are not part of doctor training. We spoke to a trainee doctor, who preferred to stay anonymous. He told us, ‘It’s not even in our NICE (National Institute for Health and Care Excellence)  guidelines from what I can see. And that’s our bible.’

‘Doesn’t seem to be part of any of our UKMLA (United Kingdom Medical Licensing Assessment) objectives either, which is a standardised exam for all med students at the end of med school.’ 

Similarly, a doctor at Barts Health NHS Trust said that ‘Our toxicology teaching is pretty limited, […] I feel like GPs would also be pretty limited in what they know about an acutely acting drug.’ 

Opioid dependence and naloxone are both covered in the NICE guidelines. However, synthetic opioids, which have different impacts from heroin and may require different treatment, are not mentioned. 

On the Council level, the Tower Hamlets Substance Misuse Strategy does mention nitazenes (and synthetic opioids) very briefly. The Slice understands that this will be changing soon. The strategy has a two-pronged focus on policing and rehabilitation, with less focus on harm reduction. This means that front-line services managed by the Council may not have all the necessary information. 

Across the UK, some Councils are beginning to roll out strategies to respond to nitazenes. Somerset has launched a ‘Carry Naloxone’ campaign, as well as a first-of-its-kind app for locating naloxone. 

In Bristol, a council-funded service called The Loop tests the local drug supply using highly accurate laboratory techniques. This allows them to then send out city-wide alerts when contaminated drugs are on the rise. 

In London, Greenwich has launched a Synthetic Opioids Response Plan. It includes naloxone promotion and a Local Drug Alert System, which allows local first responders to quickly react to contamination of the local drug supply. 

Although promising first steps, targeted Council responses to synthetic opioids have yet to be rolled out in east London. Tower Hamlets and the wider UK must do more to tackle the growing threat of nitazenes. 

Pharmacists who provide harm reduction supplies need better support from drug experts. Nightclubs where people may take drugs recreationally should have drug testing services on hand in the same way festivals do. And GPs, health educators and public health officials must work together to ensure clear, accessible information about nitazenes is widely available. 

Finally, councils must shift their focus from punitive measures to comprehensive public health education, ensuring that everyone, from clubgoers to clinicians, is equipped with the knowledge they need to stay safe.

Read our synthetic opioids series from the beginning: The arrival of an invisible killer: Is Tower Hamlets ready for Nitazenes?