The UK is facing a drug-related crisis, influenced by factors such as disinvestment in treatment and harm reduction, changing socioeconomic conditions, increasing poly-drug use, and an aging cohort of heroin users. While the scale of the crisis in the UK is less severe than in the US, where fentanyl and synthetic opioids have been the primary drivers of overdose deaths, the emergence of nitazenes, a highly potent synthetic opioid, poses a growing threat. Nitazenes, which were developed in the 1950s but never approved as medicines, have been detected in various substances sold as opioids, benzodiazepines, and cannabis products, leading to unintended use and fatal respiratory depression. The UK National Crime Agency reported 54 deaths in the last six months where nitazenes were detected, with many more cases likely to be discovered. This trend is also observed in other European countries, particularly the Baltic states. The rapid and inexpensive production of nitazenes, driven by the decline in heroin production due to the Taliban's ban on opium cultivation in Afghanistan, could exacerbate the crisis. To address this, drug services must adapt by improving accessibility and acceptability, expanding naloxone programs, and introducing harm reduction services such as drug checking and overdose prevention centers. However, structural and social stigma pose significant barriers to policy innovation, and governments must find the political will to implement necessary measures to prevent further deaths.The UK is facing a drug-related crisis, influenced by factors such as disinvestment in treatment and harm reduction, changing socioeconomic conditions, increasing poly-drug use, and an aging cohort of heroin users. While the scale of the crisis in the UK is less severe than in the US, where fentanyl and synthetic opioids have been the primary drivers of overdose deaths, the emergence of nitazenes, a highly potent synthetic opioid, poses a growing threat. Nitazenes, which were developed in the 1950s but never approved as medicines, have been detected in various substances sold as opioids, benzodiazepines, and cannabis products, leading to unintended use and fatal respiratory depression. The UK National Crime Agency reported 54 deaths in the last six months where nitazenes were detected, with many more cases likely to be discovered. This trend is also observed in other European countries, particularly the Baltic states. The rapid and inexpensive production of nitazenes, driven by the decline in heroin production due to the Taliban's ban on opium cultivation in Afghanistan, could exacerbate the crisis. To address this, drug services must adapt by improving accessibility and acceptability, expanding naloxone programs, and introducing harm reduction services such as drug checking and overdose prevention centers. However, structural and social stigma pose significant barriers to policy innovation, and governments must find the political will to implement necessary measures to prevent further deaths.