°ÄÃÅÀúÊ·¿ª½±¼Ç¼

As part of our Policy Thinking series, we hear from Toby Seddon, Professor of Social Science at University College London and head of the UCL Social Research Institute, on the rising tide of drug-related deaths in the UK, and why a new joined-up approach that focuses on mobilising community public health could help tackle the crisis for individuals and communities.

A public health crisis

Whilst media attention has tended to focus on the , latest figures show the UK is experiencing its . Indeed, Scotland is the very worst affected country in the whole of Europe. The UK problem, as with the rest of Europe, has so far remained , however, there are growing and worrying signs that synthetic opioids are now entering UK drug markets. As well as fentanyl, another class of synthetic opioids, nitazenes, have . The increasing potency of these substances is stark: whilst fentanyl is up to 50 times stronger than heroin, some nitazenes can be a staggering 500 times more potent. We need urgent, targeted and evidence-based action, if we are to avoid potentially being overwhelmed by a serious public health crisis.

What are the causes?

Opioids are potentially deadly because they can lead to ‘fatal respiratory depression’ - that is, they can cause people to stop breathing. More potent opioids increase this risk. Why, though, has there been an increasingly severe opioid deaths crisis in the last two decades? The are complex and difficult to disentangle, and there are different stories for different parts of the world, but the situation is partly rooted in disinvestment in drug treatment and harm reduction. Changing patterns of socio-economic disadvantage and increasing polysubstance use (taking two or more drugs together) have also been cited as factors. An additional concern currently is the instituted by Taliban authorities in Afghanistan in 2022. There is that synthetic opioids can very rapidly supplant heroin within a market and that this may not be easily reversible. If the UK’s heroin problem becomes a fentanyl and nitazenes problem, we will be in a highly challenging situation

What does the research tell us we should do?

There is no single silver-bullet solution to this complex problem. Research suggests that a multi-faceted approach focused on impacting in the short-term (saving lives), medium-term (helping people get better) and long-term (tackling root causes) offers the best way of addressing the crisis.

Short term

There are three evidence-based interventions for immediate impact on mortality. First, establishing Overdose Prevention Centres (OPCs) in areas with street injecting problems. OPCs are safe spaces for supervised consumption where people can also be given advice, brief interventions and referrals to other services. they can reduce overdose risk, needle-sharing and negative neighbourhood impacts (related to street injecting, litter etc), and also facilitate access to treatment. Second, expanding the distribution of naloxone (an opioid antagonist which is as an emergency treatment to reverse overdoses). Ensuring naloxone is available to opiate users, their peers and family members, and to relevant professionals (first responders, hostel workers, pharmacists, outreach workers etc) . Third, drug checking services (e.g. and ) can help opiate users to be better informed about what they are consuming and they can be a useful component within overdose prevention strategies.

Medium term

Bridging from short-term emergency interventions, there is that providing rapid low-barrier access to Opioid Substitution Treatment (OST) can be effective as an immediate form of life-saving ‘’ and can then become a pathway to longer-term recovery. To be fully effective, it is important that OST provision follows the in terms of optimal dosage, provision of wraparound support and flexible access. There is also good evidence that for individuals for whom OST has not worked, who may be at higher risk of overdose, . There is in addition a case for exploring the . Broader investment in high-quality evidence-based drug treatment and recovery services is also critical as part of a prevention strategy aimed at supporting opiate users to get out of addiction and into sustained recovery.

Long term

In the longer-term, it is essential to deal with the that we know drive initiation into opiate use, prolong addiction ‘careers’ and exacerbate harms. Social policy which addresses housing needs, tackles homelessness, supports people into paid employment and provides a safety net for those who need it, will lay the foundations for the . There is also good evidence that the would , by reducing the barriers to accessing treatment and recovery services that are created by stigmatisation.

Keeping ahead of the curve

An integrated multi-dimensional strategy offers our best chance for averting a public health crisis, built on a combination of emergency measures and longer-term prevention which we know is so key to many of our health challenges. One thing we know is that drug markets do not stand still and market futures are very hard to predict. For this reason, it is essential to invest in ongoing monitoring and evaluation of all the components of the strategy, to ensure we continue to build learning about what works and can adjust course as new evidence emerges. We also need to build capacity in and our use of so that in the future we are better able to see what is coming over the hill before it is right in front of us.

is Professor of Social Science at University College London, Head of the UCL Social Research Institute and Chair of .

Ìý