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For some years now the UK and most of Europe have managed to avoid the worst of the crisis in fentanyl use that has escalated in the USA since 2010, causing a huge increase in the number of deaths from overdose. There are signs that this North American public health emergency which when combined with Covid, has reduced American life expectancy by more than two years, maybe crossing the Atlantic. European drug agencies are rightly worried.
A Crisis in the Making?
Is the UK set for a fentanyl crisis similar to that currently happening in the US, where 75,000 people died from fentanyl overdoses in 2021? A lot of trends, both good and bad, that begin over there seem to find their way here eventually, but there is no crisis in the UK yet.
In 2021 the number of deaths attributed to fentanyl use alone was just 58, but approximately half of all drug-poisoning deaths in England and Wales involved an opiate of some kind such as fentanyl or heroin(2,219 deaths) (Source: Office for National Statistics). The proportion of opiate-related deaths has steadily increased in the UK since 2005 (although since 2020 this appears to have levelled off). Nevertheless, were a US-style fentanyl epidemic to hit the UK, then an annual death toll of 15,000 or more would be quite possible, given their relative populations.
About Fentanyl
Fentanyl is a potent synthetic opioid with a high potential for misuse and addiction. It was introduced in 1959 to help treat severe pain, for example for cancer or major injuries and operations, and is becoming an increasingly serious problem in the UK. According to Public Health England, between 2015 and 2019, deaths from fentanyl-related drugs quadrupled.
Fentanyl is very powerful and is often mixed with other drugs such as heroin or cocaine, making it extremely dangerous and also harder to detect. It is available on prescription only, although illegal supplies are increasing. It can take the form of patches, tablets, nasal sprays, or injections. Like all opiates, fentanyl slows down many of the body’s basic functions causing:
- Drowsiness, confusion, and coma
- Constipation and slow metabolism
- Nausea and vomiting
- Respiratory depression
- Dangerously low blood pressure and slowed heart rate.
Special Dangers of Using Fentanyl
This type of drug can easily cause breathing problems as it suppresses normal respiratory functioning, especially during sleep, leading sometimes to involuntary coma and death. The huge strength of fentanyl increases the danger – as it is at least fifty times as strong as morphine. People can become addicted to fentanyl very easily and long-term prescription use should be avoided wherever possible. All of this renders it very likely to cause an overdose.
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A Weapon of Mass Destruction
In the USA there are calls for fentanyl to be designated a Weapon of Mass Destruction which would give the Government more power and money to apply to the problem. They also spotlight its real potential as a military weapon, citing the Russian army’s use of the drug in aerosol form to end the hostage crisis in Moscow’s Dubrovka Theatre in 2002 – 125 people died from inhaling the drug. Last year, the US Drug Enforcement Administration (DEA) seized 379mn deadly doses of fentanyl — potentially sufficient to kill every man, woman, and child in the US.
How Fentanyl Is Made Readily Available
Three years ago we published an article on the Castle Craig blog: Fentanyl: UK’s Next Drug Epidemic? There are signs that this epidemic may now be heading our way. For a start, fentanyl has become relatively cheap due to ample supplies from India and China of the chemicals needed to make this synthetic drug.
With the raw materials easily available, Mexican and other Central American cartels then manufacture fentanyl itself, which is quite easy to smuggle because its huge potency means that smaller amounts are needed, compared to bulkier items such as cocaine. ‘This makes them both a very attractive commodity for organised crime and a severe challenge for drug control agencies’ (European Monitoring Centre for Drugs and Drugs Addiction, Oct 2021). Just 2lbs (0.9kg) of fentanyl can kill 500,000 people, according to US authorities.
This deadly combination of cheapness and potency means it is popular as a cutting agent which dealers use to bulk up their supplies of other more expensive drugs (and thus increase profits). There are already established smuggling channels from Central America to Europe for all types of drugs and although fentanyl is currently less popular with customers than heroin, cocaine, and speed, that could change if their prices go up due to global events such as a bad opium harvest.
Young People Are Especially Vulnerable
The drug is particularly dangerous for young people who may be experimenting with drugs and trying them for the first time, perhaps buying them via the internet from dubious sources. They may have little tolerance for such a powerful drug and indeed may think they are buying a different product such as painkillers and have no idea that fentanyl has been added.
Accidental Overdoses
People with drug addiction problems in the UK have tended to avoid fentanyl because of the alarming stories of devastation coming from the US. However, the drug is extremely hard to detect when mixed with other substances and its strength cannot be accurately assessed outside a laboratory either.
This means that a large number of people take the drug unknowingly with often disastrous effects. One pill can kill. If the user isn’t aware of this, then the risk of overdose is significant as they may take their usual amount not realising how much more powerful it has become. Accidental overdose has now replaced suicide as the leading cause of death for Americans under the age of 45.
Contributing Factors to the Fentanyl Problem
The COVID-19 pandemic has worsened the opioid epidemic globally. Disruptions to supply chains resulting from this have forced people to turn to drugs they are less familiar with, especially cheaper ones such as fentanyl, and social-distancing measures have meant more people taking drugs alone, analysts say.
What Can the UK Authorities Do to Prepare for and Counter the Fentanyl Threat?
Overall, a comprehensive approach that combines public awareness, treatment, harm reduction, law enforcement, and monitoring efforts can help to prepare for a potential fentanyl crisis in the UK. The following measures need to be implemented as a matter of urgency:
- Increase public awareness: the government must raise public awareness about the dangers of fentanyl use and how to recognize its symptoms. This can include public service announcements, social media campaigns, and educational programs in schools.
- Improve drug treatment services: the UK authorities should work to increase the availability of drug treatment services, including medication-assisted treatment, detoxification, and counselling. This can help those who are addicted to fentanyl to get the help they need to recover.
- Expand harm reduction services: harm reduction initiatives, such as needle exchange programs and overdose prevention education should be expanded, to reduce the risks associated with fentanyl use.
- Increase access to naloxone: Naloxone is a medication that can reverse the effects of an opioid overdose. Authorities should work to increase access to naloxone for both emergency responders and members of the public.
- Increase law enforcement efforts: efforts should be increased to disrupt the supply of fentanyl and other illicit opioids. This would include targeting drug traffickers and working with international partners to prevent the importation of fentanyl.
- Enhance monitoring systems: authorities can improve the monitoring of drug trends and overdose data to identify emerging problems and respond quickly to any potential fentanyl crisis.
- Work to reduce the stigma, judgment, and discrimination associated with substance use disorder generally by promoting compassion, understanding, and acceptance.
UK Government Responses to a Potential Fentanyl Crisis
In January 2020 the UK’s Advisory Council on the Misuse of Drugs (ACMD) under Chairman Dr Owen Bowden-Jones, wrote to the Home Secretary highlighting the need to take action on their report in response to the looming fentanyl crisis. The letter broadly recommends the measures listed above. In December 2022 the Minister for Crime, Policing, and Fire sent a follow up letter to the ACMD committing to further steps including:
- Research to study diversion and non-medical use of strong opioids
- A review of international drug strategy approaches to fentanyl markets, in particular, the North American experience
- Training of health professionals in the appropriate therapeutic use of strong opioids
- Toxicology analysis of samples of all deaths related to drug poisoning for fentanyl
- Research to monitor the prevalence of fentanyl in drug seizures and non-fatal heroin toxicity episodes and analysis of unadopted Police and Border Force samples for fentanyl and fentanyl analogues under the Forensic Early Warning System.
Dr. Bowden-Jones said the emergence of fentanyl in the UK drug market was of great concern. “We must remain vigilant in protecting the public from this risk,” he said. The UK Government appears to be taking note of the potential danger of fentanyl coming to our shores in increasing quantities although there are some concerns that a public health sector already weakened by the recent Covid pandemic may struggle to meet its commitments.
How Prevalent Is Fentanyl in the UK?
Fentanyl is becoming an increasingly serious problem in the UK although it has reached nothing like the levels experienced in North America. According to Public Health England, between 2015 and 2019, deaths from fentanyl-related drugs quadrupled. For reasons explained elsewhere in this article, the problem may soon become more serious.
What Country Does the Most Fentanyl?
There is no precise estimate for the percentages of world fentanyl consumed by country as illicit drug markets are difficult to measure accurately. However, it is widely acknowledged that the United States is the largest consumer of fentanyl in the world, and it is estimated that the majority of illicitly manufactured fentanyl is trafficked into the United States (around two-thirds).
This has prompted Anne Milgram, Administrator at the US DEA to say: “Fentanyl is the single deadliest drug threat our nation has ever encountered.” According to the DEA, the vast majority of fentanyl seized in the United States is of Asian origin, although there has been increased production and trafficking of the drug by Mexican criminal organizations in recent years.
How Many People Died from Fentanyl in the UK?
The largest number of deaths from fentanyl drug poisoning alone was recorded in 2017, with 75 deaths recorded. There were 58 deaths recorded in 2021 showing a decrease from previous years. However, this is a small part of the picture because fentanyl is very often mixed with other illicit drugs. In 2021, 4859 people died from drug poisoning in England and Wales of which approximately half involved an opiate with the largest increase linked to deaths from fentanyl.
What Is the Current News about Fentanyl Poisoning in the UK?
In the UK, Fentanyl poisoning is becoming an increasing element among causes of fatal drug poisoning. The UK Government has been aware for some years of the devastating effects of fentanyl addiction in North America and has responded with a number of measures aimed to facilitate a robust response if the drug should appear in the UK in epidemic proportions.
EU Drug enforcement agencies have warned of increased supplies coming to the continent, prompting some press comments such as in February this year such as the Mail: Is UK on the brink of its OWN fentanyl crisis?|Daily Mail Online and the Financial Times: Fentanyl: America’s struggle to contain a deadly drug.
Detox for Fentanyl and Other Opioids at Castle Craig Hospital
At Castle Health we recognise that detox is an important first step for many embarking on addiction recovery. Withdrawal from all addictive substances including fentanyl must be undertaken carefully and with full medical supervision as provided on our residential programme. We have been helping to make the experience as easy as possible for a great many people since opening our doors in 1988 and have successfully treated thousands of people with opiate or polysubstance use disorders of all types.
Fentanyl Rehabilitation Therapies
Our main recovery programme is a Twelve Step model which we combine with other therapies in a treatment plan that is unique to every individual. Group therapy and individual counselling are combined with family therapy and aftercare as required. Therapy techniques may include Cognitive Behavioural Therapy (CBT) and person-centred counselling along with complementary therapies such as relaxation, massage, and life skills.
If you would like to know more about our addiction treatment programmes please don’t hesitate to contact us at 01721 546 263. If you are worried about opioid addiction or any other kind of addiction for yourself or a loved one, then we are always ready to chat in complete confidence, to discuss your best options.
