Opioid crisis: how the UK will be affected by the Taliban’s poppy ban

It’s a turbulent time for the international drug trafficking scene. If there was a WhatsApp group chat, it would be littered with more passive-aggressive jibes than a dinner table on Christmas Day. With Afghanistan sorting us out a consistent and reliable supply of heroin for decades, the Taliban now says it is cutting us off.

In April 2022, Haibatullah Akhundzada – the Taliban supreme leader – announced that farming poppies, the opium from which is a key ingredient in heroin, was strictly prohibited, with violators facing punishment according to Sharia law, as well as having their crops destroyed. But when this was announced, last year’s crop was exempt, meaning that this April’s harvest is the first one affected by the new rules.

A Taliban spokesman told the BBC it initially ​“imposed the ban because of the harmful effects of opium […] and because it goes against their religious beliefs.” According to its findings, the BBC found that annual poppy cultivation – which, according to the BBC, ​“makes up 95 per cent of the market in Europe” – could be a staggering 80 per cent down on last year, with farmers in Afghanistan saying ​“they are suffering financially.”

Meanwhile, the United Nations Office on Drugs and Crime says that it takes between 12 and 18 months for heroin to migrate from poppy fields in Afghanistan through the entire process and pipeline, to the end customer in the UK scrambling to find a vein. That’s our grace period – if the ban does go ahead, the UK could have roughly up to 18 month’s worth of heroin left. Then, experts worry, the market could become much more dangerous.

“If the Taliban ban does result in a dramatic reduction in heroin produced from opium poppy, that could create a possibility of us seeing more synthetic opioids,” Paul Griffiths, scientific director of the European Monitoring Centre for Drugs and Drug Addiction, says. More synthetic opioids like fentanyl (an estimated 50 to 100 times stronger than heroin) or drugs from the nitazene class like n‑pyrrolidino etonitazene (an estimated 20 times more potent than fentanyl) will inevitably mean more accidental overdoses and more deaths, as we have seen in recent years in the US.

Away from the heroin scene, synthetic opioids are already finding their way into the UK’s drug supply. ​“We had the first three deaths related to n‑pyrrolidino etonitazene,” Dr Judith Yates, who collects the data for drug overdoses in Birmingham, told THE FACE. ​“They were 18 and 19-years-olds. And I’ve since spoken to three families in other parts of the country, where 18-year-olds have died buying fake oxycodone pills which contained that horrible n‑pyrrolidino etonitazene.”

Various similar synthetic opioids, also from the nitazene class of opioids, are currently being found by drug testing outfit WEDINOS. ​“It’s not just fake oxycodone but [synthetic opioids] are being found in fake Xanax,” Dr Yates says. And even in some THC vapes, a man from Hampshire found out last year, when he sent his in for testing. ​“So people are ordering Xanax and are being given an opioid that’s 20 times stronger than fentanyl, which is 50 times stronger than heroin.” If you happen to take Valium or Xanax bought from the black market, get everything tested first.

I asked Austin Smith, Policy Officer at Scottish Drugs Forum, if he thinks that the Taliban’s poppy prohibition could lead to a huge rise in synthetic opioids in the UK. ​“It is a possible scenario,” he told THE FACE, but that doesn’t mean that he’s utterly convinced this will play out. ​“It depends, first of all, on if that ban – on a very lucrative part of Afghanistan’s economy – actually happens. If it does, that could well impact the supply in the UK, but the extent of that impact, I don’t know.”

“We could end up in a situation where there is a substitution [from heroin derived from the poppy plant to more dangerous options] because there’s more readily available synthetic opioids like fentanyl and so on, and so it might be that the market goes that way. It’s a possible outcome.”

Synthetic opioids have ravaged the United States in a spectacular way. In 2020 alone, they were linked to 58,000 deaths. For context, the figure for the same period in the whole of Europe was less than one hundred. According to the Centers for Disease Control and Prevention, synthetic opioids contributed to a blistering 75,000 overdose deaths in the US last year. That’s a devastating loss of life.

Could that happen here? Lucky for us, it’s unlikely to be quite so widespread. One of the reasons the situation got so bleak in the US was due to doctors in the ​’90s making a monumental fuck up by underestimating the dangers of opioids. Misjudging the risk profile of highly addictive drugs because Big Pharma misled them, they began flinging out opioid-based painkillers like a pub landlord dispensing pints in a sunny pub garden. Some patients became hooked, while some overdosed. Many moved on to the black market when their prescription ended.

Our healthcare system has never worked like that; when the NHS prescribes opioids, it’s only as part of a ​“carefully supervised trial of opioid therapy”. Studies have found that doctors in the US sometimes prescribe certain drugs more because they personally receive financial incentives to do so. It’s a common marketing strategy that the shameless pharmaceutical industry uses across the pond. Issues with synthetic opioids are likely to affect certain pockets of society (like people who buy downers on the black market) and be less mainstream. But we do need to act now to protect those who are vulnerable.

Both Dr Yates and Smith agree that we should prepare in case we do eventually see the black market dominated by synthetic opioids. I’m guessing that sending the Taliban a polite letter explaining the situation and asking them to drop off some smack isn’t going to work, so what should we do? Firstly, we must make treatment as accessible as possible. This includes opioid substitution treatment, where people using street opioids like heroin or fentanyl are given a pharmaceutical equivalent in a controlled setting, minimising the risk of overdose, transmission of infectious diseases and the use of contaminated drugs.

Sometimes, drugs like methadone are used, but research has found that ​“a small minority of entrenched opioid users repeatedly fail to respond to interventions of this kind”. In these cases, diamorphine (essentially the same thing as heroin) is required. ​“We should be making treatment readily accessible,” Smith says. ​“Especially methadone. If someone walks into a clinic asking for help, we should be able to get them a prescription and on methadone that day.” He adds: ​“If people are motivated to get into treatment, we have to offer them treatment then, because they could become demotivated fast.”

If the UK braces itself for a potential rise in synthetic opioid overdoses, a key part of this would involve the nationwide roll-out of drug consumption rooms, also known as overdose prevention centres. These are places where users can consume illegal drugs in a controlled setting. ​“Such facilities provide much more than a safe space for drug consumption,” the Global Commission on Drug Policy wrote in a report last year. ​“These are professionally supervised facilities designed to reduce the health and societal problems associated with drug abuse. In addition to reducing acute risks of disease transmission and preventing overdose deaths, they help to connect those suffering from substance dependence, a group too often marginalised, with treatment, health and social services.”

Drug consumption rooms have been operating successfully across Europe for the last three decades. Last year, 80 prominent medical, academic, and third sector organisations called for their roll-out in the UK. Despite this, the British government is only interested in kicking the idea around in games of political football rather than helping people.

“We should have drug consumption rooms,” Dr Yates says. ​“If they [users] are not yet ready to engage fully with drug treatment services, they can at least be in a safe space while they use the drugs. People can advise them and test the drugs and talk to them about ways to keep themselves safe.”

As many opioid users as possible should start carrying naloxone, a drug that temporarily reverses the effects of an opioid overdose. Last year, the London Assembly Health Committee (LAHC) published a report titled Reducing Drug Deaths in London. They urged the government to ensure that police officers carry naloxone spray, while highlighting the need to make it easier for people to get their drugs tested ​“including at clubs and music events”.

At the moment, it’s very difficult to get your drugs properly tested in the UK – WEDINOS is the only UK organisation to currently offer a postal testing service. The Loop provides a pop-up testing service in Bristol once a month and are sometimes at festivals providing back and front-of-house testing. That’s it. It’s just not good enough – the Home Office needs to provide more licences for drug checking services.

Drug-related deaths in England and Wales are already the highest since records began in 1993. In spite of this, funding for services aimed at helping people with addiction issues have been cut drastically in the past decade. The SNP have recently cut £19m from the Scottish drug and alcohol services. The last thing we need is synthetic opioids, some of the most dangerous drugs in the world, being misrepresented as ​“heroin” or ​“benzos”. Hopefully, that won’t happen.

With a bit of luck the Taliban will abandon their poppy prohibition and continue to send their smack. ​“I wonder if the Taliban’s ban on cultivation is actually an attempt to more closely control the market and derive more profit from it,” Smith contemplates. Perhaps underground chemists will stop mis-selling benzos, too, and everyone will start testing their drugs.