The war against drugs and addiction is a losing battle
In the battle between law enforcement and the movement and increasing availability of drugs in the UK, law enforcement is certainly not winning. When reading in the media about a drug bust, it is just the tip of the iceberg of the amount of different drugs that are now coming into the country. Illegal drug taking is becoming much more common and almost acceptable with the youth of today.
Existing drugs are still readily available
Heroin, methamphetamine and cocaine (including crack) are still among the most highly dangerous addictive substances in the world that have serious consequences to the user and for those family and friends around them. Alcohol is also classed as a drug – even if not usually recognised as such – and the cheaper costs and completely relaxed licensing laws have led to an increase in younger people with an alcohol addiction. This has arisen due to an increase in home consumption caused in part by the Covid pandemic and working from home, and from a combination of boredom and mental health issues. At The Haynes Clinic we often see the dual addiction of alcohol and Cocaine and whilst there is not a specific detox medication to help with withdrawal from Cocaine, the Librium or Diazepam prescribed for an alcohol detox will help.
The threat from synthetic opioids such as Fentanyl
Although heroin, cocaine and methamphetamine remain prevalent, there are new drugs ‘on the block’. One which has become noticeably more available since 2016 and which has highly addictive qualities is Fentanyl. This is a synthetic opioid and it is between 50 to 100 times more potent than heroin or morphine. Another comparator is Ketamine, which has long been a misused illegal recreational drug that is also a horse tranquiliser. The drug Carfentanyl is almost 10,000 times stronger and has been used as an elephant tranquiliser.
Opioid receptors are found in areas of the brain that control the rate of breathing. Even a small dose of Fentanyl can cause breathing to stop completely which can ultimately lead to death. Fentanyl, is now the leading cause of death by overdose among adults between 18 and 45 in the United States, as it is considered that 2mg could be a fatal dose and many counterfeit pills that are being produced have been found to contain as much as 5mg. Fentanyl is very cheap to manufacture and therefore a small amount goes a long way. Dealers are now often mixing it in with other drugs such as Cocaine and the user has absolutely no knowledge that they could be taking a potentially lethal dose. This is just one of the serious problems associated with this drug.
The importance of the life saving benefits of Naloxone
It is because of this potential new “Russian roulette” approach to taking drugs laced with Fentanyl that users now not infrequently carry Naloxone with them. Naloxone is a medication that can be used to temporarily reverse any opioid overdoses. Naloxone is typically administered through a nasal spray but also comes in an injectable form. This works well with, for example, heroin but with Fentanyl having such a high strength it wears off quickly and will require additional doses of Naloxone to reverse an overdose.
The expected impact of a shortage of heroin
It was announced earlier this year that Europe’s heroin market could be in for a supply shock. Almost all heroin consumed in Europe comes from Afghanistan, where the Taliban have imposed a ban on Poppy cultivation which came into effect in the early part of 2022. The inevitable heroin shortage could make it more profitable for criminals to manufacture synthetic opioids such as Fentanyl, which is cheap and easy to make. This could then be sold to desperate drug addicts looking for a replacement “hit” due to there being this planned lack of heroin. The Taliban banned poppy cultivation in April 2022 after gaining back control of Afghanistan from the US backed government in 2021. The 2022 crop was exempted meaning the results will start to be seen with this year’s April harvest. It takes between a year and 18 months for the harvest to reach the European market as heroin so the true effect of the shortage of heroin will not be felt until next year, 2024. Paradoxically, that means that in the UK there currently not being a shortage of heroin means that the current supply is acting as a protection against the expected increase in supply of synthetic opioids. Once the mass marketing of synthetic opioids begins it is expected that there will be a vast increase in the related overdose and direct death toll amongst addicts.
Fentanyl detox and detox for other synthetic opioids
Fentanyl addiction is treated similarly to a heroin or methadone addiction though due to its higher strength, addicts may require a longer period of detox or a higher strength of prescribed substitute detox medication. Also, if someone has become addicted to Cocaine which has been cut with Fentanyl then they will possibly also need to have an opiate detox but this will only become clear by using a drug test kit at the point of admission to the residential drug addictions clinic.
Nitazenes
Other synthetic opioids which are being produced and that have been arriving in the UK in the last 2 years are called Nitazenes. Examples of these synthetic drugs are Metonitazene, butonitazene and isotonazene. Ironically these types of synthetic opioid were not approved for medical use after their first medical trials back in 1950. They have more recently started being illegally produced during the time of the worldwide Covid pandemic. They are not as strong as Fentanyl but are still at least a hundred times more potent and addictive than heroin. They are also being used to mix and cut with other drugs, including heroin and cocaine, as again their low production cost and high strength from a very small amount makes the potential for further increased profits from drug dealing.
Harm reduction in the face of these threats It is quite probable that this issue of synthetic opioids is about to become a public health matter of grave importance. There needs to be more of a public awareness of a harm reduction approach for addicts and an example of this would be more education about and wider distribution of Naloxone which