The inside story of nitazenes and the drug deaths crisis rocking Britain: 'No one is talking about it'

Authorities are reluctant to discuss the growing epidemic that has ravaged Birmingham, but Big Issue’s investigation led us to a retired GP who’s gathered the truth. This is the inside story of nitazenes – the synthetic opioid crisis sweeping the UK

As we sat at a well-worn wooden kitchen table in the leafy Moseley suburb of Birmingham, Judith Yates pointed at a spreadsheet on her MacBook. Each row told a clear story, painstakingly collected by the retired GP, of a person in Birmingham whose death involved drugs. 

Among those deaths, she pointed out, as we ate chocolate digestives and drank coffee, were 38 individuals where something newer and more dangerous was found: nitazenes. 

Nitazenes, a type of synthetic opioid which can be up to 500 times stronger than heroin, have been linked to at least 284 deaths in the UK since June 2023, according to the National Crime Agency. Nationally, authorities have reacted to the threat they pose. The Home Office banned 14 types of nitazenes in March 2024, making them Class A drugs. OHID, one of the UK’s main public health agencies, has told councils to prepare for the synthetic opioids showing up on their streets. 

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First developed in the 1950s as an alternative to morphine, nitazenes are a group of synthetic opioids which range from 50-500 times stronger than heroin. Too dangerous to have a medical use, they were abandoned. But when a Taliban crackdown on opium production hit the global heroin supply, chemists began to manufacture nitazenes which made their way onto the streets of the UK. They are usually taken accidentally, mixed in with other drugs such as heroin, oxycodone pills or street Valium. 

But it was a cluster of deaths in Birmingham last summer which brought me to Yates’s kitchen. Data from Yates’s database, shared with Big Issue, shows that in the three months of summer 2023, 21 people died from nitazenes. Many of those lived in homelessness, or died in homeless accommodation. One weekend in July saw three people lose their lives. 

Had it been a train crash, fire, or flood, it is hard to imagine 21 deaths in one city, with a single cause, passing without widespread media and political attention. But as England’s second city mustered an emergency response and people died in hostels, workplaces and on pavements, what happened went largely under the radar. Authorities remain unwilling to talk about the lives lost. So to find out how deep the human toll really was, I had to come and see Yates in her kitchen. 

Three deaths give a hint of what’s to come 

Nobody paid Yates to go and sit in the coroner’s office, but she did it anyway. Every two months, she took herself down to the ageing, cramped space in the downstairs of Birmingham coroner’s office and over the course of two or three hours pored over thick, ringbound plastic folders containing a record of every inquest which had taken place that year. She wasn’t allowed to use their computer – in fact, for many years they simply did not have a computer. 

From these records, she picked out drug-related deaths and added them to her database. Then, every two months, she would attend a meeting where officials – from the police, ambulance service, drug services – picked through her database and tried to learn the lessons which could be learned. 

“These are all individual people who died, I think every person should be counted. It feels important to me that people don’t get ignored, and every person that’s died is thought about and added so that we can try and keep other people alive,” said Yates, who has lost none of the frankness of a GP. “I think it’s extraordinary how little people take an interest in who has died.” 

After retiring in 2015, she carried on the unpaid work she had begun in 2009. The database, she joked, was funded by her NHS pension: “It’s like a special grant.” 

One day in March 2023, leafing through as she did, Yates noticed something new. A 20-year-old had died, and the report mentioned something called a nitazene. “What on Earth is that?” Yates thought. She googled it, and soon the coroner’s officer walked past and mentioned they had two more cases waiting to come through the system. 

That first case was Dylan Michael Byfield-Levell, a 20-year-old student from Sutton Coldfield who was found collapsed at home after a night out with friends on 2 October 2021. Miles Elliott Davis, a 27-year old entrepreneur, died on 10 October 2021. 

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Jakob Wozniak, a 19-year-old student, was found collapsed on 3 January 2022. They did not know each other. But they both died after taking N-pyrrolidino etonitazene, unbeknown to them mixed into the oxycodone pills they had swallowed. 

A small chemistry lesson: heroin works by stimulating opioid receptors, mostly clustered around the brain stem. But when the receptors are overstimulated, the brain can stop sending the signal to breathe. In this way, even small amounts of the far-stronger nitazenes can trigger a fatal overdose – especially when they are taken unwittingly. 

It was summer 2023 when things changed. “These people who died, this particular group of people who died, were living in hostels and HMOs [houses of multiple occupation] across the north of Birmingham, and they were very vulnerable people,” said Yates.

A wave of deaths rocks England’s second city 

Four men died in the city in June, all having taken heroin with N-desethyl isotonitazene (NDI) mixed in. This was a different variant to the N-pyrrolidino etonitazene taken by the men who died in late 2021 and early 2022. It was a sign of what was about to be unleashed upon the city. 

At this point, Cranstoun, a national drugs charity which runs a drugs and alcohol service in Birmingham, had been keeping an eye on the international situation and growing worried. 

“At the time, no one was really talking about nitazenes. And I think, if I’m honest, there was a bit of a reticence to talk about it, because some people deemed it to be sort of scaremongering,” said Meg Jones, Cranstoun’s director for new business and services. Trying to raise the alarm, the charity produced a report and lobbied the government. “It’s really worrying in the homeless population, but it’s also spreading to other types of drugs,” said Jones. 

But when the deaths started happening, there was no way of knowing for sure. The names and details only made their way onto Yates’s database months afterwards, when inquests had taken place. So those working in frontline services had to be prepared. Heroin being mixed with other substances was nothing new – and in a way the task was the same as before: getting the word out to people on the streets using heroin, and helping them make themselves safe. 

In turn, those on the streets fed information back on whether anyone they knew had experienced weird effects, or if drugs were a different colour or strength, said Deb Northcott, an outreach worker for the homelessness team at Change Grow Live (CGL). “You’d be surprised the conversations we have around who’s got the best drugs and what the effects are,” said Northcott. 

Her team leader, Helen Boland, added: “It became apparent summer last year. That’s when we started working a lot more to get the word out. We spoke to partners, harm reduction, drug alerts. From then we really ramped up trying to get people into treatment.” 

July arrived, and the deaths came fast. On the 1st, a 27-year-old man died in hospital from heroin and NDI toxicity. Cocaine was also found. On the 7th, a 64-year-old man died, again from NDI toxicity. The next day, a 45-year-old man died: heroin and NDI again. The next day, a 64-year-old man, but this time metonitazene was found. Two days later, a 41-year-old man died, with Yates’s database showing “heroin overdose together with cocaine and N-desethyl isotonitazene”. Another two days passed, and a 53-year-old man died. 

While frontline services often did not know for sure whether somebody had taken nitazenes, there were clues – overdose victims were requiring more and more doses of naloxone, a “miracle” drug which can reverse opioid overdoses. “We have seen a growing trend. Where before we would use one kit, maybe one and a half kits, sometimes when people are having an overdose, we’re seeing up to three full kits being used. So we can see that there’s an increase in strength, which tells us there is something a lot stronger present within the drugs,” said Boland. 

On 15 July, two people died: a 38-year-old man and a 42-year-old woman. N-desethyl isotonitazene was found in both cases. They were later named as Clive Cooper and Maria Green, and died in the same hostel in Lozells. Both had a history of drug use and mental illness. An inquest into Green’s death, reported The Guardian, heard she had referred herself to a local charity the day before, saying her “life was going nowhere”. 

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Around this time, Alex Lawson got a phone call. In his lab at University Hospital Birmingham, Lawson has an unusual role. The consultant clinical scientist analyses all kinds of samples – from the living and the dead – to find out what’s in their blood. A couple of years previously, his lab noticed a number of cases in Birmingham of people taking illicit oxycodone bought on the internet which contained N-pyrrolidino etonitazene. Nitazenes, said Lawson, are difficult to detect via normal methods, but earlier cases meant his lab was set up to test for them. 

The call was from the coroner. There had been a number of deaths in HMOs, and they were suspicious something was amiss. Lawson’s lab was sent a powder to analyse and his team processed it the same day. The results showed it was NDI: the strain of nitazenes responsible for the deaths that summer. But this was not yet widely known. With the results, Lawson and his team were able to add the drug to their screening methods, and from then on could easily test for it in those who came to A&E after overdoses. Nitazenes were commonly seen in “people who are established drug users”, said Lawson, and “quite prevalent in the homeless and no fixed abode demographic”. 

“It did seem to be a significant outbreak of these things. I think it could have been a lot worse if we hadn’t acted swiftly to get the information out there about the risks of this drug,” he said. 

You want it to end. You don’t want anyone to die unnecessarily

As the deaths mounted, the city’s authorities sprang into action under the banner of the “West Midlands Local Resilience Forum Strategic Coordinating Group”, with data shared between councils, the coroner, the ambulance service, and OHID, and meetings chaired by Birmingham’s director of public health. Homelessness and drugs services were involved. Cranstoun sent texts to service users, while CGL sent out alerts to the people it helped. But Yates grew frustrated that the message was not spreading quick enough – she hoped making the public well aware would spook dealers. “We did try to, within closed doors. We went out to the hostels and things. But nobody spoke to the public,” she said. “Birmingham didn’t talk about it, didn’t want to talk about it.” 

Praising the response, Victoria Loveridge, CGL’s head of services, said: “It wasn’t a good time, it was tough for everybody. It’s the unknown, isn’t it. But I think how quickly everyone responded was brilliant. 

“You want it to end. You don’t want anyone to die unnecessarily. Ultimately, it’s about that.” 

But amid the response, on 27 July, West Midlands police told its officers to stop carrying naloxone. Northbolt carries it in her gym bag, Boland in her handbag. Yates, saying you never know when you will come across someone in need, implored me to buy my own. In a pioneering move, West Midlands was the first force to train and equip its officers with naloxone. “Police officers are often the first on the scene in overdose situations. Officers being able to carry naloxone means a greater chance that people’s lives can be saved,” said the West Midlands police and crime commissioner in a letter to parliament’s health committee. Four lives were saved during the trial. But, just as deaths reached their worst, this stopped as new chief constable Craig Guildford decided to carry out a review of naloxone. 

“It’s a massive disappointment they withdrew that, particularly at a time which was critical, in my opinion, in terms of the nitazenes issue emerging,” said Cranstoun’s Jones. “It couldn’t have been worse timing, in terms of the impact on people who use drugs. It was just really bad timing and really disappointing”. West Midlands Police told Big Issue much of the existing stock had reached its expiry date. Eventually, in May 2024, the force reversed the move and announced it would train officers across the force to carry naloxone. 

Deaths only tell part of the story. Data obtained from West Midlands Ambulance Service by Big Issue points to the wider wave of nitazenes in the region, and hints at a number of near misses. High numbers of doses per person, say some experts, may point to the presence of nitazenes. 

In July, paramedics gave naloxone to 295 patients – the high water mark from January 2023 to July 2024. On 7 July, 17 patients were given a total of 32 doses of naloxone. On 8 July, 14 patients were given 24 doses. 

On 7 June – the day the death of one 64-year-old man is recorded in Yates’s database – four patients received nine doses, or 2.25 doses each. On 24 August, nine patients received 46 doses of naloxone between them – over five doses per person. 

Five more people died in August. Two of those – a 49-year-old man and a 32-year-old woman – are recorded on Yates’s database as dying “outside”. In total, over the three summer months, 21 people lost their lives. More may have slipped through the net with testing – and as the ambulance data shows, many more likely came close. 

Have nitazenes changed Birmingham? 

Those who were part of the response say the tragic flashpoint has changed the city, and how it responds to synthetic opioids. On a basic level, drug users in the city are now aware something more dangerous is going around the city. Homeless services are giving out more naloxone, and say clients are increasingly wary of possible naloxone. 

Testing has been ramped up. Now, if there is a spike in non-fatal overdoses, the local drug information system will be used to decide whether spot testing can be carried out, offering a quicker and more complete picture than the bluntness of deaths. “Knowing those results as quickly as possible will have a significant impact, because we’ll know what we are dealing with,” said Loveridge. “I think it will be absolutely fantastic. It’s difficult when you’re trying to manage a situation but you don’t know the whole picture”. 

CGL is also part of an early warning system being piloted by OHID. Small amounts of samples are sent each month, to help build a national picture. “That will detect the presence of nitazenes. We’ll see how that goes,” said Loveridge. “That’s exciting for us”. 

Police have been making headway. In May, a police raid in Frankley, a town to the south-west of Birmingham, yielded 10 kilos of nitazenes. It was, police said, aided by the government’s decision in March 2024 to make 14 types of nitazenes Class A drugs. 

Yates is certain there are similar spikes elsewhere we don’t know about, due to a lack of widespread testing and a lag on coroners’ reports. “Every single person who dies is an avoidable death,” she said. “A few people, they’ve done it on purpose, but most people haven’t, and generally there’s something that we could have done to wrap cotton wool around the person.” 

What are nitazenes?

The Swiss scientists who first synthesised nitazenes in the late 1950s believed they might be useful for treating and managing pain. Ranging from hundreds to thousands of times more potent than morphine, this class of synthetic opioids formally known as benzimidazole-opioids was never approved for medical use. 

When the Taliban took control of Afghanistan in 2021 and cracked down on opium production, prices rose from £30 per kilogram to up to £1,000. Sensing an opportunity, underground chemists are believed to have turned to old research papers and re-discovered nitazenes. 

Drug authorities in the UK and US believe they are manufactured in Chinese labs and making their way to the streets through the post. Like the fentanyl crisis in the US, dealers lace their product with nitazenes to keep it potent as prices surge. But nitazenes are far more powerful than fentanyl, and easily induce an overdose. Along with pain relief and euphoria, they can stop a user breathing. Naloxone, carried by paramedics, can reverse this overdose. 

What are the numbers?

14 varieties of nitazenes banned as Class A drugs by government in March 2024

284 deaths in the UK linked to nitazenes by the NCA since June 2023

38 deaths linked to nitazenes in Birmingham from June 2023 to May 2024

150,000 nitazene tablets seized by police in one London raid in 2023

x500 How many times more potent etonitazene, a form of nitazene, is than heroin

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