Police could stop opioid deaths with this drug. So why do some UK forces stop officers carrying it?

The man was unconscious as PC Hollie Flannigan arrived, his eyes open and his body cold to the touch. An ambulance was on the way, but Flannigan, a police officer in the Cathays area of Cardiff, knew there was no time to waste. His life could be in danger. She sprayed one dose of naloxone up his nose, but it did nothing.

“I gave him a second dose and soon after he came around was sat up talking to us,” Flannigan said. “The ambulance arrived shortly after and he was taken to hospital.”

As the threat of synthetic opioids, which contaminate drugs such as heroin and valium, creeps across the UK and claims lives, those first on the scene have a powerful weapon against deadly overdoses: naloxone. 

Known as narcan in the US, naloxone can be sprayed up the nose to reverse the effects of an overdose. It has no effect if somebody is not in the throes of an opioid overdose. As Big Issue revealed in October, its use by paramedics has surged as the synthetic opioid crisis intensifies. 

Read more of Big Issue’s investigation into the deadly toll of nitazenes:

• The inside story of nitazenes and the drug deaths crisis rocking Britain: ‘No one is talking about it’
• My son died after taking deadly nitazenes, aged 33. Why did nobody save his life?
• Nitazenes: Use of life-saving overdose drug surges by 50% amid synthetic opioid crisis

Even a tiny amount of synthetic opioids such as nitazenes can kill, often taken unwittingly by heroin or oxycodone users whose supply has been adulterated. And they do kill. Nitazenes have been linked to at least 400 deaths in the UK since June 2023. The fatalities come in waves, popping up and then receding in cities like Birmingham, where nitazenes claimed 38 lives in the summer of 2023, many of those people who were homeless at the time. As that crisis grows, drug related deaths have reached a record high in England and Wales.

Following a push by the Home Office, as well as the Department for Health and Social Care and the National Police Chiefs’ Council, most police forces have given their officers the choice to carry naloxone. The Police Federation, until recently resistant to the rollout, has now said it supports the voluntary carriage of naloxone where an operational need is identified.

Yet had that man in the lane in Cardiff overdosed elsewhere, he would have faced a lottery over whether a police officer arriving on the scene carried the life-saving spray.

Now 32 forces either carry naloxone or are in a pilot phase, and a further 12 have agreed to pilot or fully roll out its use. Some 20,000 police officers now carry naloxone. Nationwide, police officers have used naloxone 1,232 times from June 2019 to December 2024. South Wales police officers have used it 134 times in situations they deemed life-threatening.

But there are two police forces holding out: Suffolk and Greater Manchester. Big Issue asked them why.

A spokesperson for Suffolk Constabulary told us their decision was based on a “wide range of criteria” including drugs intelligence, and that their position is “under continual review.” The spokesperson said: “Suffolk Constabulary continually works with partners and subject matter experts and to assess best practice in all areas and this includes drug-related incidents. While officers in Suffolk do not currently carry naloxone, we will continue to review national guidance to make decisions that best support our officers and staff and the communities we serve.”

A Greater Manchester Police spokesperson told Big Issue: “We have considered the impact of rolling out naloxone to our officers and believe that we are much more effective in working with partners to tackle the issues of drug use on our streets, which involves enforcement, prevention and safeguarding.

Greater Manchester Police told us that deaths remain low, as do the discovery of nitazenes, “so the impact currently is low.” A spokesperson for the force added they have a dedicated operation on nitazenes as well as an early alert system, and were the first force in the country to make arrests over the drugs. “We are actively playing our part in this space by playing a key role in GM’s first drugs strategy launched last year. This is through pursuing perpetrators and protecting victims that are being exploited to deal the drugs that blight people’s lives and our communities,” the spokesperson added.

Yet Greater Manchester’s drug authorities have been putting out alerts over dangerous nitazenes found in the city – including warnings in December and August 2024 of “extremely dangerous” pills containing nitazenes.

“It’s not about police officers doing more. It’s actually about the fundamental point of what policing in the UK is for, and that is preservation of life,” Meg Jones, director of new business and services at drug charity Cranstoun, told Big Issue. “I’m really disappointed to see there are two forces pushing back against that, when clearly the momentum across all UK police forces is to do the right thing and carry naloxone, and equip their officers with a life-saving intervention.

“In fact, I would say Greater Manchester in particular, having one of the biggest cities in the UK, there’s no rationale there that’s evidence based and driven by anything rational why police officers shouldn’t carry naloxone.”

Jones, who helped West Midlands become the first police force in England to offer its officers naloxone, added that the geographical gaps were unfair: “It’s literally life or death isn’t it? That is a basic unfairness that’s built into the way it’s rolled out.” Norfolk Constabulary, which borders Suffolk, has trained 216 officers to carry naloxone, and they used it 16 times in the run-up to December 2024. In Scotland, it is mandatory for officers to carry it, but they use it at their discretion.

It is hard to predict when nitazenes will surge and claim lives. “If they wait to know nitazenes have arrived it will be too late to train the police and to get naloxone kits,” said Judith Yates, a former GP from Birmingham who collates information on nitazene deaths from coroners.

“One person can import a little envelope full of nitazenes and you can have 30 people die in a very short period of time,” she added.

“It could be that you have never seen any nitazene related deaths in your city, and then one person could add it to the heroin supply and dozens of people, young people could die. So I don’t think the situation will continue for long. I think Manchester and Suffolk are on the wrong side of history and will hopefully be pushed into taking this small step.”

Sergeant Simon Pickering was on patrol in Sheffield city centre one Friday night in January when he noticed a woman who had collapsed. First attempts to revive her had failed, but the month before South Yorkshire Police had begun its pilot of naloxone, and so Pickering was carrying the spray. Within five minutes of using it, she had come around.

“Administering the naloxone stopped her from going into cardiac arrest and potentially saved her life,” Pickering said.

“I was really impressed by the response of naloxone and it was very unintrusive as it works as a nasal spray.”

Neither Suffolk nor Greater Manchester explained specifically why they did not give officers the option to carry naloxone – or why their forces were resisting endorsements from police chiefs and the government.

When an ambulance is called for somebody who has overdosed on opioids and stopped breathing, crews aim to arrive within seven minutes, treating it as a “category one” call. But one stumbling block for police officers has been the fear that, if they are first on the scene and administer naloxone, the call may be de-prioritised – and that in the gap, they may run out of doses of naloxone. Officers interviewed by the polling firm Ipsos gave examples of extended wait times of up to four hours.

In the West Midlands, Jones said police and ambulance crews agreed that there would be no difference in priority after naloxone was used. “Assurance was given to leadership within the police that there wouldn’t be an impact on a response if a police officer had issued naloxone,” she said, adding that similar agreements had since been used elsewhere. In Scotland, ambulance crews have agreed to keep the calls high priority after police had given somebody naloxone.

Officers have also reported concerns that they may end up being investigated if they administer naloxone but a person dies. But a spokesperson for the Independent Office for Police Conduct (IOPC) confirmed to Big Issue: “An unsuccessful attempt to save life by administering naloxone would be extremely unlikely to amount to a death or serious injury (DSI) case requiring referral to the IOPC. The matter would not need to be referred unless there was evidence which indicated that administering naloxone itself may have caused or contributed to the death. Without this evidence, it would not meet the definition of a DSI referral.”

The spokesperson added the IOPC was “supportive of initiatives undertaken by the police service to equip officers with life-saving equipment, where appropriate”.

Yates believes it is only a matter of time before the two lagging police forces take a different approach. “They are going to be changing their minds surely,” she said.

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