Is fentanyl coming to London?

 (MediaNews Group via Getty Images)
(MediaNews Group via Getty Images)

The sentencing of New York drug dealer Irvin Cartagena would have been unremarkable were it not for the status of the person he accidentally killed. On September 6, 2021, Michael K Williams was found unresponsive at his Brooklyn apartment. He had taken heroin — or what he thought was heroin. In fact, it had been laced with the synthetic opioid fentanyl.

Williams, in a small irony, was best known for playing Omar Little, one of the most beloved characters in the TV show The Wire, the cult show about the lives of Baltimore’s drug dealers. ‘I am very sorry for my actions,’ Cartagena announced to the court on 18 August. ‘When we sold the drugs, we never intended for anyone to lose their life.’ Actuaries may be able to spot a flaw in Cartagena’s argument. Even heroin use, already something of a risk premium on any mortality table, is becoming increasingly dangerous as synthetic opioids seep into the supply. Up and down the social ladder, the American opioid epidemic has become a part of the national conversation.

The night before he died, Prince’s staff requested that the top drug doctor Andrew Kornfeld fly to the pop legend’s Minnesota compound, Paisley Park, to help the hopelessly addicted star. It was too late: he was found dead in a lift just hours later. Fentanyl was to blame and, in recent years, it was also at least partly responsible for the death of the singer Tom Petty in 2017 and the rappers Coolio in 2022, Mac Miller in 2018 and Lil’ Peep in 2017.

The hit Hulu series Dopesick, based on Beth Macy’s book of the same name, used no less an intoxicating presence than Michael Keaton to tell the long story of opioids in America. Patrick Radden Keefe’s bestseller about the Sackler family, Empire of Pain, explained how the Sacklers’ drugs company, Purdue Pharma, over-marketed a prescription opioid called OxyContin, thereby launching many thousands of unsuspecting suburbanites on a path to addiction.

A lack of heroin is a social good, but also an invitation for dealers to seek out substitutes. This is where the gates to hell open

For 20 years, the United Sates has been fighting a losing battle against synthetic opioids. What began as legitimate prescriptions of morphinerelated painkillers such as fentanyl and OxyContin first leaked into the heroin supply before becoming a product category in their own right. Today, on the streets of cities like Los Angeles and Seattle, in legal grey zone districts such as San Francisco’s notorious Tenderloin, open-air encampments have sprung up, where homeless drug users inject or smoke lab-made synthetic opioids that are far cheaper than far-off Afghan smack. Their mortality rates are astronomical. In 2021 alone, 106,000 Americans died from ‘drug-involved overdose’.

Historically, drug trends tended to move from west to east across the Atlantic. Cocaine emerged from Cuban expats in Miami in the 1970s long before it turned up in the banker bars of Aldgate. So far, though, Britain has been spared its own synthetic opioids epidemic. Over here, after the initial explosion in the 1980s, British heroin users are in fact ageing out as a cohort. Half of them are over 40.

Of course, in the past few years London has been hit by a wave of highpurity cocaine as a result of what is effectively a whole new business model. Albanian gangs have moved in on the old supply routes. They’ve taken over street-level dealing by their enhanced capacity for violence. Albanians are the third-most-jailed foreign nationals in Britain, despite being a tiny sliver of the population.


At the business end, their master-stroke has been to team up with the ‘Ndrangheta, the most violent, most globalised strand of the southern Italian mafia who dominate the smuggling routes from North Africa to Europe. Albanian gangs like the Hellbanianz have cuckooed themselves inside shipping companies. They’ve pioneered what management theorists would call a ‘hub-and-spoke model’: the drugs are brought over to the continent at a relatively low level of purity, then they are refined in a new net work of European labs.

The result is that cocaine in London has transformed into a buyers’ market. Dealers actively competing for business, falling prices, frequent special offers and 24/7 delivery door-to-door. By rights, this ought to be the biggest drugs problem that the Metropolitan Police has to deal with. But by a perverse twist of fate, a problem of under-supply may soon turn out to be much worse. It’s been almost two years since the Taliban took over Afghanistan, after a chaotic US withdrawal. One of its first acts was to ban the prodigious Afghan opium industry.

Of course, technically American forces had already banned poppy-growing, but the Taliban’s methods of enforcement have proved rather more persuasive, and it does now seem that this year’s crop will never be harvested. This is huge news, if true. According to the UN’s annual World Drug Report, Afghanistan’s poppy fields supply 90 per cent of global heroin, and 95 per cent of Europe’s. A lack of heroin is a social good in itself. But it’s also an open invitation for dealers to seek out heroin substitutes. This is where the gates to hell open.

What has spared us so far are a few strokes of genuine luck and an accident of geography. Firstly: our miserly prescribing culture. In England, even topical steroid creams sit behind the pharmacist’s glass. A far cry from America’s often commission-based private doctoring. Much of the initial wave of fentanyl that leaked into the American system did so through legitimate scripts, not secret labs. Second: market diversity. In the western hemisphere, all heroin is controlled from the US southern border, by Mexican cartels. These increasingly muscular drug mega-corporations have been much less shy about adulterating their product because their margins are lower — US heroin comes in at only around 35 per cent purity while the European product ranks at about 45 per cent. The cartels found fentanyl an easy fix for their margins; they could often buy it online from Chinese factories.

Tweaking molecules often produces something novel enough to evade a ban. It’s a game of whack-a-mole

The third factor is simply time — the nick of it. We have been able to watch what was happening in the US as it unfolded, and charting the trajectory of that country’s epidemic has allowed us to take evasive action at certain pinch points. ‘The Government has a range of early warning systems,’ says Michael Linnell, co-ordinator of Drugswatch, a national organisation for drugs professionals that examines new and adulterated drugs. In 2017, for instance, six people died over the Easter weekend in Yorkshire from a batch of contaminated heroin.

Within weeks, NCA officers raided a lab in West Yorkshire that was producing fentanyl derivative carfentanil and broke the syndicate. The EU’s early warning system reported in July 2017 that exposure to carfentanil had been confirmed in 29 deaths in the UK, 28 of which occurred between February and May 2017. But now, those early warning alarms are beginning to ping again. While fentanyl has dominated the scene for two decades, a new generation of synthetic opioids is beginning to take over. They’re called nitazenes and work like fentanyl, but they are not chemically related to it. And when you stack them next to that previous generation of the lab-made drug, which was already notorious for being ‘1,000 times stronger than morphine’, they’re another order of magnitude up: generally held to be ‘40 times stronger than fentanyl’.

‘So in terms of the opportunities for smuggling, it’s vast,’ says Linnell. ‘Put it this way: I was once told that if you took all the fentanyl that had ever been smuggled into America, in its purest form, it would fit into a bathtub. And this is much more concentrated than that. It quickly becomes a nightmare for prison officers. You could smuggle it under a thumbnail.’ In June of this year, two deaths at a flat in Basildon were put down to a sub-category of nitazene — etonitazene. ‘We had a death in Blackpool,’ says Linnell. ‘I saw the toxicology report, which was enough to put out a warning to heroin users. The police retested some heroin samples and found it in one of them. That led to a police raid where they found batches of lowquality heroin adulterated with nitazene.’

At the same time, the police are hamstrung. Their sale is banned under the catch-all Psychoactive Substances Act of 2016, and two are already listed as Class A substances. But there still are dozens of similar products that the Government hasn’t got round to passing laws against. Tweaking a few molecules often produces something novel enough to evade a ban. It’s a constant game of whack-a-mole.

Synthetic opioids have taken on a bogeyman status that is both welldeserved and prone to wild exaggeration. Contrary to popular rumour — and one well-documented triple-fatality case in the US — cocaine is almost never adulterated with synthetic opioids. Much of the confusion comes down to the lazy habits of drug dealers, who cut their heroin on the same tables as their coke, without wiping down in between. But other categories of more mass-market drugs do lend themselves to substitution. Xanax, for instance. The Valium-style tranquilliser has been picked up seven times in recent months by the Welsh Emerging Drugs and Identification of Novel Substances Project, or Wedinos, as containing nitazenes. For now, the early warning signals are only trembling, not shaking.

In 2021, there were 4,859 deaths related to drug poisoning registered in England and Wales. That was the ninth consecutive annual rise — and the highest figure since records began in 1993. Yet it’s still a drop in the ocean compared with the US, where there are more than four times as many drug deaths per capita.

The ever-resourceful global heroin smuggling community has sufficient stockpiles to keep serving the European market: there is latency in the system. ‘For years Afghan opium farmers have been producing a surfeit of opium,’ says Max Daly, global drugs editor at Vice. ‘They store this on farms because it will never fall in value, only become more valuable, especially if there is ever a shortage and opium prices go up. Also, outside of farms, for the same reasons, traders based across Afghanistan have also stockpiled large amounts of opium. This means that the reduction in opium production will take at least a year or two to have any impact on the European markets.’

But what happens when that stockpile runs out? For now, the most honest answer is that no one knows. ‘If I had a pound for everyone who claimed they could predict drug market trends, I’d have enough to pay my gas bill for two weeks,’ says Linnell. After all, one of Blair and Bush’s key motivations for invading Afghanistan was meant to be wiping out the Taliban’s opium production. If you’d been shorting heroin in 2002, you’d have lost your shirt. And what if this time, for once, it is for real? ‘If that did happen,’ says Daly, ‘it would be catastrophic in terms of the number of deaths. The US opioid crisis would look small compared to a global opioid crisis.’ It’s a curious paradox, but in 2024 we might be best off wishing heroin on ourselves.