UK Seeks To Tighten Control on Dangerous Synthetic Opioid Drug

Dr Rob Hicks

January 21, 2022

Today the Home Secretary, Priti Patel, wrote to the Advisory Council on the Misuse of Drugs (ACMD) to commission advice on tightening the control of isotonitazene, a synthetic opioid that has been linked to multiple fatalities as result of heroin overdose.

In October 2020, the World Health Organisation (WHO) produced a Critical Review Report on isotonitazene where it said that the drug belonged to a group of compounds synthesised more than 60 years ago as potential analgesics that were "never clinically approved for marketing". The report added that the drug had "recently appeared on the illicit drug market".

In August last year (2021), Public Health England (PHE) issued a National Patient Safety Alert in response to what it said was "an unprecedented number of overdoses (with some deaths) in people who use drugs, primarily heroin, in some parts of the country". It highlighted that as a result of testing, the potent synthetic steroid isotonitazene had been found. This drug can be used instead of, or in addition to, heroin, and although its potency and toxicity is uncertain, it is "perhaps similar to, or more than fentanyl, which is about 100 times morphine", PHE said, pointing out that the overdoses may have been caused by heroin being mixed with isotonitazene.

Fatal Overdoses 'Deeply Disturbing'

In early 2021, the National Crime Agency said that more than 46 overdoses and 16 deaths linked to isotonitazene had been reported in a 10-day period. According to the Home Office, "current data indicates there have been 25 deaths and seven overdoses linked to Isotonitazene up to September 2021".

Mr Patel said that "reports of fatal overdoses linked to this dangerous substance have been deeply disturbing, and I want to act now to ensure no further lives are lost or families torn apart".

The Home Secretary added: "I’m determined to end the misery and destruction caused by the misuse of drugs and will consider the ACMD’s expert advice on tightening restrictions on this dangerous substance."

The Home Secretary has also requested expert advice on tightening control on the synthetic cannabinoid CUMYL-PeGACLONE, and Diphenidine, which can have ketamine-like effects.

Opioid Overdose Needs Rapid Treatment

Currently the three substances are covered by the Psychoactive Substances Act 2016, meaning that, while supply of the substances is unlawful, possession is not.

Due to the concerning reports around the effects of these three substances, the UK voted in favour of international control along with other countries at the Commission on Narcotic Drugs meeting which took place in April 2021.

The move comes after the government recently published its 10-year Drug Strategy to tackle the harms caused by drug misuse. Illegal drugs are a major driver of homicide – 48% of all homicides in the year to March 2020 were drug-related.

The Strategy involves measures to reduce both demand and supply of illegal drugs including:

dismantling over 2000 county lines, which are used to supply drugs and often involve recruiting children
investing a record £780m in the drug treatment system to get people off the drugs that fuel crime in the first place
delivering a generational shift in demand for illegal drugs, including by ensuring people face tougher consequences for so-called recreational misuse
PHE said that the treatment required for an overdose that may be related to isotonitazene is the same as for other opioid overdoses, but delivering it "rapidly and completely is even more critical", as progression to respiratory arrest, and recurrence of respiratory arrest, are more likely.

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