The NCA has linked nitazenes to 230 deaths within a year. But official death figures on nitazenes are likely to be the tip of the iceberg. Nitazenes are not always tested for, and results from inquests take a long time to come through. Information helps save lives, however. So Copeland’s database – formally named NPSUM, or the National Programme on Substance Use Mortality – represents vital information in the fight against fatalities.
‘If Putin invaded, I’d be there with the two last unscanned boxes’
Coroners send in the reports of those who have died following drug use. Copeland and a cohort of PhD students, roped in to keep the database functioning, pore over the records and build the database.
When Copeland joined KCL in 2019, records had piled up in a filing cupboard. NPSUM’s founder died suddenly in 2012, but coroners kept posting the reports in.
“I spent most of Covid entering literally thousands and thousands of cases,” she said, having to digitise and scan the antiquated filing system.
“I was joking that if Putin did invade, everyone else would be there with their suitcases of their most precious belongings, and I’d be there with the two last unscanned boxes.”
The nitazene crisis is marked by a lack of information. While drug users on streets and in hostels face danger, authorities and support services must respond without knowing the full picture.
Some cases may come with up to 100 pages of evidence, allowing NPSUM to build a picture of the circumstances of deaths, as well as the bare statistical fact of the lost lives. A Forensic Early Warning System, part of the government’s response to nitazene deaths, is being set up – but Copeland said a lack of contextual information could make it “more limited in its powers than what NPSUM can do”.
Information, sources told the Big Issue, is a big – and missing – weapon in the fight against nitazene deaths. Drug users are in danger largely because they do not know what they’re taking. Authorities can be reluctant to make concerns public. “I think sometimes there is a resistance to really shout about this to make sure that people are aware of it nationally,” said Meg Jones. “There is a lag in terms of information and therefore in terms of our understanding and response. If we are responding once there has been a large number of deaths, we are too late,” said Katy Porter, CEO of The Loop.
‘You’re at risk of overdosing even if you take one dose’
The first nitazene death Copeland’s team became aware of was in 2019. That was when the drug was assigned a code in the database. It was a man who had deliberately taken nitazene – unlike most subsequent deaths.
“I believe he was a pharmacist, he was a self-described ‘psychonaut’,” she said.
“At that point it just looked like, you know, another, another NPS [novel psychoactive substance] death. So we weren’t too alarmed at that point, because it was also an isolated incident.”
After that single blip on the radar, there was nothing in 2020. There were some deaths in 2021, in the south east of England, but they became a much bigger problem in summer of 2023, and in particular Birmingham, said Copeland.
“Because they’re so potent, you’re at risk of overdosing even if you take one dose,” Copeland said. And so, gathering the information can save lives, she added: “In terms of the challenge of the nitazenes, it’s getting the message out there soon enough and effectively to mitigate their harms. Death is the ultimate adverse effect but there’s plenty of other harms.”
The insights gleaned from Copeland’s digging have resulted in a number of academic papers, too: one looks at the “characteristics of drug-related deaths where individuals are found submerged in a bath or hot tub”; another at the possibility of using drones to deliver naloxone to people overdosing on opiaites; and one in February 2024 on the dangers of nitazenes fuelling a second wave of the UK’s drug death crisis. “Without concerted action, nitazenes could devastate communities of people who use a range of drugs,” the paper, published in the Lancet journal, warned.
‘Should the UK be relying on Saudi money and a woman on maternity leave to get their synthetic opioid data?’
“It is run purely by my sheer grit and determination, and getting my students to do case entry and analysis,” she said. She is, as she speaks, on maternity leave, but more than one person told Big Issue Copeland is known to pop up on Zoom calls where a response to the crisis is being felt out, with baby in tow.
“That’s why people think I’m completely mad because I’m keeping on working on mat leave, but if I didn’t, I don’t know who else would be doing this. Then we’d be more in the dark.”
The database, said Copeland, is being kept alive by work she’s doing around it – private consulting, providing councils with the data and interpreting it for them – and the bench fees of PhD students, most of whom are sponsored by foreign governments.
Copeland and her team receive no government funding in advance of doing their work. The extent of government money they have received this year is £12,000 – for providing data Copeland said was worth closer to £15,000.
“This work is being sponsored by the governments of Saudi Arabia, Kuwait and China,” Copeland said. “Should the UK really be relying on Saudi money and a woman on maternity leave to get their synthetic opioid data?”
And rely on it the government does. When they come asking, Copeland is in a bind over whether to refuse or not: it costs her to get the data, so she is reluctant to give it out for free. But giving it away can help demonstrate its value. And then there is the fact it can be used to save lives.
“I actually have the Home Office emailing me, asking to inform their Synthetic Opioid Taskforce about trends,” said Copeland. “Should we really be relying on a woman with a two month old baby to be informing government strategy? Who has no meaningful funding from the government to do so?”
The lack of funding puts the project’s future in jeopardy. Just one admin assistant would be helpful. Copeland estimates £100,000 a year would be enough to run the database sustainably. More funding, she said, could mean warnings get out quicker.
In the meantime, each number which enters into Copeland’s database is a death. “I have to have some form of sociopathic tendencies to not be crying myself to sleep at night,” she said. “But at the same time, if we can use these cases to try and prevent future deaths from happening, I think that’s the best legacy we can give these people.”
A government spokesperson said: “We are not complacent to the threat posed by new emerging drugs. It is vital we grip this problem and prevent them spreading more widely into communities and prevent tragic deaths from drug use.
“We will continue our engagement with partners across health, policing and wider public services to drive down drug misuse, and move forward with our mission to make streets safer.”
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