Synthetic opioids and a tranquilliser that have killed thousands of drug users in the US may be behind a rise of dozens of fatal overdoses in the West Midlands.
About 30 deaths over two months this summer are being examined for the involvement of the heroin substitute nitazenes and the sedative xylazine, Birmingham city council’s director of public health, Justin Varney, told the Guardian. Nitazenes are up to 100 times more powerful than heroin.
It is believed the drugs are being cut into, or sold as, heroin without users’ knowledge. They have emerged in the UK after heroin supplies were hit by the Afghan Taliban’s ban on poppy farming last year.
Varney said his area normally sees six to eight drug fatalities a month, making the spike in June and July around double the normal rate. Police have launched a crackdown on dealers that has led to seizures and arrests.
“We have seen [these drugs] globally for a while, particularly in the US,” said Varney. “Over this year we have started to see them appear in the UK. There was a cluster in Birmingham, Bristol, London and Coventry.”
On Thursday, the coroner for Birmingham and Solihull, James Bennett, concluded nitazenes were the primary cause of death of two drug addicts in one night in July at a hostel in the Lozells area of the city. Clive Cooper, 38, was a long-term heroin user with schizophrenia. After he was found on his bedroom floor a neighbour said he had taken heroin. In fact, he had injected nitazene. A wrap of an unused brown crystallised substance was later identified as nitazene, which the case pathologist said was about 20 times stronger than fentanyl.
Maria Green, 42, who lived with bipolar disorder, anorexia and depression, died on the same night from the same drug, Bennett found. She was discovered by a friend collapsed on her bed. She had taken heroin, cocaine and other drugs for years. The day earlier she referred herself for help to a local charity after saying that “her life was going nowhere”, the inquest heard. The cause of death was nitazene toxicity.
Romaan Hussain, the director of the hostel operator in charge where Green and Cooper lived, said at least three other people died in nearby houses of multiple occupation around the same time, probably from the same batch.
“We’re on the frontline of a global issue,” he said. “We require more help.”
“It’s killing people and someone has to stand up,” one local addict said. “My friends are heroin users and I don’t want them dying.”
Two days before the Lozells deaths, Stephen Harrop, 36, died from heroin and nitazene toxicity in a house of multiple occupation in Balsall Heath, while on the same day six miles across the city in Handsworth, the decorator Michael Iddles, 53, was found dead at home caused by heroin and nitazene.
They were not the first fatalities in the city. On 7 June, James Simmons, 38, a labourer, was found collapsed in a house in Aston. His cause of death was opioids, cocaine and nitazene toxicity. A month later, Wayne Purcell, a roofer, died in the same property after injecting nitazene. On 1 July, Armstrong Tabrey 27, was found in cardiac arrest in the corridor of shared housing in Erdington.
Varney said some addicts had become so afraid it had pushed them to seek rehab treatment.
Dr Caroline Copeland, the director of the national programme on substance abuse deaths at King’s College London said the Taliban’s ban “may have done more harm than help”.
“We are now faced with the emergence of synthetic opioids with extreme potencies as heroin replacements,” she said. “With some of these nitazenes even a small amount is sufficient to prove fatal.”
West Mercia police has also issued a warning about as many as 20 nitazene overdoses, including in the Evesham area.
“In one instance, drug users bought what they thought was heroin but instead the substance contained paracetamol, caffeine and nitazene with no heroin present,” it said last month.
Another drug, the sedative xylazine, is used to tranquillise horses but when mixed with fentanyl forms a drug known as “tranq”. The combination increases the risk of overdose and can cause skin ulcers that can result in limb amputation – leading to some describing it as a “flesh-eating zombie drug”.
Xylazine has been detected in tablets sold on the hidden market as the painkillers codeine and tramadol, the anti-anxiety pills Valium and Xanax and cannabis vaping liquid, according to reports published by the Welsh Emerging Drugs and Identification of Novel Substances (Wedinos), which tests users drugs from across the UK.
A user from Birmingham who was left breathless with an irregular heartbeat and suffering a panic attack after taking what they thought was a prescription opioid last month, sent a sample to Wedinos, which found it was xylazine.
The spike in fatalities in the West Midlands appears to have subsided after a multi-agency response involving public health officials, police and drug support charities. Users were warned about the risks by text message, which resulted in more cautious use, potentially reducing fatalities. But agencies expect further peaks as international drug supplies fluctuate.
“Whether it becomes like fentanyl [which has ravaged American cities] we don’t know,” said Varney. “The US experience is concerning but the UK drugs market is different … This is going to happen again whether it is nitazenes or a new synthetic. Like any big industry, the global drug industry is looking at the next big thing.”
• The headline, subheading and main text of this article were amended on 6 October 2023. Xylazine is not a synthetic opioid as an earlier version said; it is a non-opioid sedative.
