Scotland-wide alert after deadly contaminated heroin causes immediate overdose

A Scotland-wide health alert has been issued after a surge in deaths and near-fatal overdoses linked to contaminated heroin.

Some of the overdoses have been characterised by sudden and rapid collapse, with many requiring multiple doses of naloxone to reverse the overdose.

Rapid testing of the substances has identified a nitazene-type opioid in some samples.

Nitazenes are highly potent drugs that can be many times stronger than more common opioids.

In the UK, they have been detected in substances sold as other opioids, benzodiazepines, and cannabis products.

Many consumers are using nitazenes inadvertently, unaware of the risks they face, according the general medical journal The Lancet.

Like other opioids, nitazenes can cause fatal respiratory depression, and some are hundreds of times more potent than heroin.

Further testing is under way to determine the specific type of nitazenes in the heroin samples.

Public Health Scotland issued an urgent warning following a surge in fatal overdoses linked to heroin in multiple areas across the country.

It comes weeks after NHS Dumfries and Galloway noted an increase in overdoses in the region in which the patient “suddenly collapses”.

It is believed drug users throughout Scotland could be at increased risk of harm.

Dr Tara Shivaji, consultant in public health medicine at Public Health Scotland, said: “We are very concerned about the presence of synthetic drugs like nitazenes within the unregulated drugs market across Scotland.

“Nitazenes are potent opioid drugs, which can be many times stronger than heroin and other common opioids such as morphine.

“This means even a small amount poses an increased risk of overdose or death. There are ways to reduce the risk of overdose when taking drugs, but there is no safe way to take nitazenes.”

Public Health Scotland leads Scotland’s drugs early warning system, RADAR (Rapid Action Drug Alerts and Response).

The current RADAR alert on nitazenes, first issued in December 2023, has been updated to include links to new resources produced by the Scottish Drugs Forum to raise awareness of the signs of overdose and how risk can be reduced.

The most recent RADAR quarterly report in January 2025 stated that the drug supply in all parts of Scotland remained highly toxic and unpredictable, which influenced levels and patterns of harms.

Public Health Scotland has urged people to take extra precautions:

• Do not use drugs alone – Have someone with you who can help in an emergency.
• Avoid mixing substances – Combining drugs (including alcohol and prescription medication) increases the risk of overdose.
• Know the signs of overdose – Symptoms include:
– Sudden collapse
– No response to stimulation
– Blue or pale skin
– Snoring, gurgling, or raspy breathing
– Seizures or fits
• Carry naloxone – If you or someone you know uses drugs, having naloxone could save a life.
• Call 999 immediately if someone overdoses – Stay with them and provide first aid until help arrives.