The UK is facing a drug-related crisis, with factors such as reduced investment in treatment and harm reduction, changing socioeconomic conditions, increased poly-drug use, and an aging heroin user population contributing to the problem. While the US has a much higher rate of drug-related deaths, the UK is now witnessing a rise in synthetic opioids, particularly nitazenes, which are not approved for medical use but are increasingly found in illicit drugs. Nitazenes are highly potent and can cause fatal respiratory depression. The UK National Crime Agency reported 54 deaths linked to nitazenes in the last six months, suggesting the issue is underreported. Similar trends are emerging in other European countries, including the Baltic states. The decline in opium production in Afghanistan has created a market gap, potentially increasing the use of nitazenes in Europe. Current enforcement and scheduling measures may not be sufficient to address this issue. To combat this, drug services need to adapt by offering accessible and acceptable treatments, including same-day prescribing and harm reduction services. Drug checking services, overdose prevention centres, and safer supply models are recommended to reduce overdose risks. However, stigma and political resistance hinder progress. Governments must take action to prevent more deaths. The article highlights the need for policy innovation and funding to support these initiatives.The UK is facing a drug-related crisis, with factors such as reduced investment in treatment and harm reduction, changing socioeconomic conditions, increased poly-drug use, and an aging heroin user population contributing to the problem. While the US has a much higher rate of drug-related deaths, the UK is now witnessing a rise in synthetic opioids, particularly nitazenes, which are not approved for medical use but are increasingly found in illicit drugs. Nitazenes are highly potent and can cause fatal respiratory depression. The UK National Crime Agency reported 54 deaths linked to nitazenes in the last six months, suggesting the issue is underreported. Similar trends are emerging in other European countries, including the Baltic states. The decline in opium production in Afghanistan has created a market gap, potentially increasing the use of nitazenes in Europe. Current enforcement and scheduling measures may not be sufficient to address this issue. To combat this, drug services need to adapt by offering accessible and acceptable treatments, including same-day prescribing and harm reduction services. Drug checking services, overdose prevention centres, and safer supply models are recommended to reduce overdose risks. However, stigma and political resistance hinder progress. Governments must take action to prevent more deaths. The article highlights the need for policy innovation and funding to support these initiatives.