The first session of Stronger Together explored how people could unite to address the ever-increasing risks from nitazenes and other potent synthetic drugs.
‘In 2021 when I first joined Turning Point there was a series of overdoses from something that we all called ‘iso’, because nobody could pronounce it,’ Turning Point’s national safer lives lead Deb Hussey told the morning session of Stronger Together. ‘Maybe naively, we thought it had gone away.’
Isotonitazene hadn’t gone away, however, and by 2023 nitazenes had fully entered the UK’s drug supply. ‘They’re being found in everything – they’re crossing genres,’ she said. ‘We don’t really know the statistics of how many people have actually died, so getting those effective messages out is key.’ Turning Point had begun distributing more naloxone and warning people, she said. ‘And we kept warning them, until there were so many warnings that it just became white noise and people weren’t hearing them anymore. So how can we really get those messages across?’
Pragmatic advice
It was decided that what was needed was ‘really pragmatic advice’ that was applicable no matter what drug the person was using, she said – and with the same message coming from all treatment providers. The organisation brought several other providers onboard, and made sure that everyone was posting the same messages on social media in the run-up to International Overdose Awareness Day. ‘We knew these messages had been developed with people who use drugs, and we really thought they would land. But actually we were just talking to each other – not the people who really needed to hear this stuff. And the overdoses continued to happen.’
A survey carried out by the organisation’s Somerset service found that three quarters of respondents had witnessed an overdose, with more than half witnessing five or more. ‘These were the people we needed to get sharing those messages, the people who could really have an impact,’ she said. ‘And we already knew what works.’ An ACMD review looking at a peer project in Wales had found that for 70 per cent of people receiving naloxone it was their first kit, and almost half were not in treatment at all. ‘These are the people we need to be getting the harm reduction messages about nitazenes to.’
A fifth had even refused naloxone, she added. ‘I don’t know why that is, but maybe it’s because of who offered it. Maybe if they were offered it by a peer they’d be more likely to take it. Is that going to be the same around advice for reducing the overdose risk from nitazenes? I suspect it is.’
Her colleague Jude Duncan, however, had witnessed first-hand what happens when nitazenes get into the drug supply. ‘We had 18 non-fatal overdoses hospitalised and four fatal overdoses in 24 hours,’ she said. ‘Nitazenes were linked to all of them.’ But the actual number of overdoses was likely to have been far higher, she told delegates – ‘we were being told about people who’d been saved by their peers and weren’t going to hospital.’ On the streets that night with a homelessness outreach team she found people were ‘shocked, stunned, worried, scared,’ she said. ‘What I saw was complete devastation and fear.’ It reinforced the vital need to ‘work alongside, and be led by – not do to – people,’ she said.
Market vacuum
‘I was raised in the synthetic opioid crisis and I’ve administered naloxone 48 times,’ said drug service coordinator at Release, Shayla Schlossenberg, who uses they/them pronouns. ‘We’re two years into a Taliban ban on opium production in Afghanistan and the market reacted really quickly to that before the actual supply had been hit.’ The cost of heroin had risen and the purity had fallen, creating a vacuum for synthetic opioids and other adulterants to fill. ‘So our drug supply is poisoned – not just heroin but benzo supplies and other opiate pill supplies.’ Nor was it just limited to nitazenes – there was also the synthetic non-opioid xylazine (known as ‘tranq’ in the US), along with fentanyl and its analogues.
‘The number of people dying continues to rise, and half of these people are still not in contact with treatment. In England we don’t have a national naloxone campaign and we don’t have a click-and-deliver service.’ Coverage was piecemeal and dependent on your postcode and who was commissioned in your area, they said. ‘And we don’t have a functioning early warning system.’
Drug-related deaths in the UK were already an emergency before synthetic opioids became a significant concern. ‘We’re already awash with problems in the way we deal with drug-related harm in this country. We know things have got to change but what do we start with? The metaphor I like to use is that we both widen and deepen our toolbox.’ This meant returning to the tools we already had and improving them to maximise their effectiveness – along with expanding the range of tools available. ‘I see “harm minimisation” used synonymously with needle and syringe provision, but I don’t see the ethos of harm reduction in many of those programmes – non-judgmental and non-coercive, and honouring the agency of people currently using drugs. That’s not necessarily happening.’
Co-production
The arrival of nitazenes meant that all of this would need to be done ‘super-quickly’, and one example of making the toolbox deeper was services being delivered and led by people who were current drug users – ‘genuine community involvement’. Drug treatment often wasn’t attractive, with the barriers ‘too high, and the wait times in many areas too long. People are not empowered to partake in treatment because it’s not co-produced with them to be about what will work for their individual lives.’
Promoting and supporting drug user unions could also help to deepen harm reduction work, they said. ‘A union is not the same as a service user feedback form. It exists for and of itself, not to improve a service.’ An example of widening the toolbox, meanwhile, would be opening an overdose prevention site (OPS). These were already ‘hugely evidence-based’, with more than a hundred around the world, and many offering housing support, trauma support, health support and more. In terms of the oft-cited legal liabilities around having an OPS, many were already shared by current NSPs – ‘and we already manage them.’
Nothing would work without real community involvement, however. ‘You can’t do the grassroots mobilisation and buy-in and the changing people’s minds and bringing people with you if you don’t have real people who are impacted by these things at the centre. We might win OPSs and we might win drug checking, but we could lose it if we don’t do the people building along with it.’
People power
‘We’ve always been about empowering our members,’ said Radha Allen of the peer-led B3 organisation in Brent – through training, education, volunteering and more. ‘Even all but one of our board of trustees have lived experience.’ B3 was based in both of the treatment hubs in its borough, and keyworkers would get in touch if their clients needed support with ‘literally anything’, she said.
Colin McMahon had initially come into contact with B3 as it was based in the same building as his treatment provider Addaction, he said, and he’d become a B3 ambassador last year. ‘My addiction took me to the gates of insanity and hell. It destroyed me. I came into recovery in 2015 and all I had was a bin liner full of clothes. My life revolved around police, prison and criminality. My life was black and white but when I came into recovery it changed into colour and I started living again. I’ve gone on to do so much.’
B3 emphasised training and volunteering skills and getting people back into the community, said staff member Nadil. ‘When I first started as a volunteer I had nothing, no qualifications. We want people to be able to gain qualifications that take them to wherever they want to go.’
The organisation also ran recovery champion schools, added B3 volunteer Nitsu – ‘a very well-structured programme delivered through a series of workshops and lessons.’ Be Safe was yet another B3 volunteer-run service, said volunteer Sue. ‘We help each other and give each other support and confidence and growth. I’m no longer in survival mode – I’m enjoying life. And living.’
Watch the video footage of session one here: