Data from June 2023 to May 2024 on the numbers of deaths associated with potent synthetic opioids in England.

Tracking potent synthetic opioid deaths
The Office for Health Improvement and Disparities (OHID) in the Department of Health and Social Care has been working with the National Crime Agency (NCA) to monitor deaths associated with illicit use of potent synthetic opioids. These deaths have been reported through local health and law enforcement networks since 1 June 2023 and also from coroner laboratories directly to OHID since 1 April 2024.

We collect this information for surveillance purposes, to assist national and local responses to the threat posed by synthetic opioids. Counts in this report are based on collating individual cases reported to OHID or NCA through different routes, rather than analysis of a comprehensive database of all drug deaths. So, these are unlikely to have captured all deaths involving synthetic opioids in the period covered (see limitations section). Many of these deaths involved other substances, and we do not yet know their impact on overall drug deaths.

The involvement of potent synthetic opioids in deaths is determined through laboratory testing. The data in this report provides information on deaths that have been recorded by OHID and NCA as of 19 September 2024 and which occurred between 1 June 2023 and 31 May 2024 (after toxicology tests were completed).

About potent synthetic opioids
Potent synthetic opioids are sometimes added to or substituted for heroin. But they are also potentially added to or substituted for other drugs, or openly sold to users as synthetic opioids.

The potent synthetic opioids that OHID and NCA track fall into 2 distinct groups of compounds:

• nitazenes
• fentanyls (illicitly manufactured)

Drugs in these groups are typically many times stronger than heroin and carry a higher risk of overdose.

Nitazenes have caused deaths in England in previous years but there has been increased concern among government, law enforcement, public health professionals, and the media about their presence in UK drug markets since 2023. Illicit use of fentanyls (which includes the specific compound fentanyl) has also caused deaths in England in previous years. Deaths involving pharmaceutical fentanyl are not included in the scope.

Enhanced drugs surveillance and early warning system
Most deaths in the June 2023 to May 2024 period were reported to NCA or OHID through local networks. However, there is a range of ongoing activity to mitigate the health impacts of a potential further increase in consumption of these drugs and other drug threats.

As part of this activity, OHID is working with other government partners, including the government’s Synthetic Opioids Taskforce, to establish an enhanced drugs surveillance and early warning system. From April 2024, this has included collecting toxicology results for fatal overdose cases from laboratories where coroners have given permission for the data to be shared. This information is being added to the joint NCA and OHID log of tracked cases.

Information from other sources
In addition to information on deaths, we are collecting and analysing information from a range of other sources as part of the early warning system including:     

• weekly data from ambulance trusts on callouts where naloxone (the opioid overdose antidote) has been administered
• lab-tested police seizures
• detections from drug-checking services and from biological samples from people in drug treatment
• hospital admissions

We will publish more data on deaths and other sources from the early warning system in a regular report in due course.

Data on deaths involving potent synthetic opioids
Nitazenes involved in deaths
As of 19 September 2024, OHID and the NCA confirmed through laboratory testing that there were 179 deaths involving one or more nitazenes occurring between 1 June 2023 and 31 May 2024.

Table 1 shows the individual nitazenes detected in laboratory testing and the number of deaths in which each compound was detected. Of the 179 deaths confirmed to have involved at least one nitazene, there were 17 deaths in which NCA and OHID had not received confirmation of specific compounds involved.

Table 1: nitazenes detected in laboratory testing of death cases in England, June 2023 to May 2024

Note: more than one nitazene was detected in some deaths, so the sum of detections is greater than the total nitazene deaths.

Deaths involving nitazenes by region
There have been deaths confirmed as involving nitazenes in every region of England.

Table 2: numbers of deaths confirmed as involving nitazenes by English region, June 2023 to May 2024

Deaths involving fentanyls without nitazenes
As of 19 September 2024, there were no deaths between June 2023 and May 2024 in which OHID and the NCA confirmed the involvement of illicit fentanyl, or analogues of fentanyl (which have a similar molecular structure), without nitazenes also present. From available information, it is not always possible to determine whether fentanyl involved in a death was illicit or pharmaceutical.

Limitations
The data collected for this publication does not provide a comprehensive count of all deaths that may have involved potent synthetic opioids in this period. Some deaths involving potent synthetic opioids may not be counted for a number of reasons, including:

• forensic toxicology not being commissioned in cases where there is no suspicion of potent synthetic opioids having been involved
• cases not being reported to local public health networks or onwards to OHID (this depends on local information-sharing processes)
• the date of death not being recorded (these cases are not generally included in the national counts)
• Also, the coverage of coroner lab reporting to OHID is partial and only began in April 2024, although it covers results from deaths occurring before then.

We are collecting this data before deaths are registered and the cause of death is formally established. It’s possible that not all cases in which potent synthetic opioids were detected were deaths caused by drug poisoning. Data on drug-related deaths registered in England and Wales is collected and reported on annually by the Office for National Statistics in its Deaths related to drug poisoning in England and Wales statistical bulletins. These statistics will include numbers of drug poisoning deaths involving nitazenes. However, due to registration delays, most deaths occurring in late 2023 are unlikely to have been registered before 2024 and so will not be included in the upcoming bulletin on 2023 registrations.   

In most cases reported in this publication, other drugs such as heroin were also detected and the levels of these other drugs may have been sufficient to cause death without synthetic opioids in some cases. The impact of the deaths included in this publication on overall drug deaths is not yet known.

It is possible that toxicology testing may not identify the presence of potent synthetic opioids in every death in which they have been involved.