The UK’s opioid crisis: why the stats don’t add up

Between 2011 and 2022 the number of opioid-related deaths in England and Wales was more than 50% higher than figures given by the Office for National Statistics (ONS), according to a new report from King’s College London.

This report has profound implications on both government and social understanding of drug issues, with UK opioid problems reflecting a “serious drug-related deaths crisis”, said the lead author of the report, Dr Caroline Copeland.

It is also “likely” that the ONS data has “underestimated” the number of deaths due to other substances, such as cocaine, which could also have significant long-term consequences.

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Why has the number of opioid deaths been under-reported?

Though the “total number of drug deaths is accurate”, the count for deaths due to “specific substances” is obscured as the ONS does not have access to post-mortem reports or toxicology results, the report said.

The ONS is solely reliant on the information provided by the coroner on the death certificate. If multiple drugs are present – often termed “polydrug use” – the findings cannot be interpreted.

As expected, the information collected on these deaths is a major driver of policy, and “fewer people might have died if drug policies had been based on accurate statistics”, a former civil servant told the BBC. The government is now working alongside coroners to “improve the reporting of deaths”.

How many people are killed by opioids in the UK?

The UK has “the largest heroin market in Europe” with “around 300,000 users in England alone”, said The Independent.

King’s College London research estimates a total of 39,232 deaths in England and Wales in the 11-year range of its report, compared to just over 25,000 in the official report by the ONS, which shows that the number of opioid-related deaths doubled between 2012 and 2023 from 22.9 to 43.8.

In Scotland, there is a different system surrounding inquests. Instead of the ONS, the National Records of Scotland (NRS) collates official information. There are no coroners, with the Procurator Fiscal conducting Fatal Accident Inquiries.

The NRS does “receive more detailed pathology reports, but differences in how deaths are reported across the UK make it difficult to compare”, said the BBC.

Why is it getting worse?

There was never a “more dangerous time to take drugs”, said the National Crime Agency last year, though if current trends continue, the situation is set to become worse still.

Nitazenes – types of New Synthetic Opioids (NSOs) – seem to be the leading cause, as one of the “fastest-growing groups of new psychoactive substances” in the world, said The Independent.

Many opioid users are not aware they might also be consuming nitazenes, which are judged to be “50 times more potent than heroin”.

NSOs’ potency means they are used in smaller doses, so they can be transported in smaller quantities while still serving the same number of customers, making them much more attractive to sellers.

They still pose a potentially lethal threat to users who know they’re taking NSOs: the drugs’ “therapeutic window” – the dosage range where individuals experience the desired effects without “unacceptable” side-effects – is “very narrow”, said The Economist.

What can be done?

Governments around the world have been left scratching their heads deciding how to tackle this rapidly evolving, and potentially fatal, problem.

Because nitazenes are concocted in labs, they can be altered easily. Producers can make an “entirely new product of similar potency”, which is “not subject to the ban”, said The Economist.

In the UK, in May 2024, 15 synthetic opioids, “including 14 nitazenes”, were controlled as Class A drugs under the Misuse of Drugs Act 1971, said the Home Office.

In July 2025, China, one of the largest producers of NSOs, introduced “generic scheduling of all nitazene-related substances”, to back up the internationally recognised Convention on Psychotropic Substances (1971), said Public Health Scotland.

Ultimately, if governing bodies do not take further action, continue to keep up to date with new variations, and collate accurate statistics, tackling the opioid crisis could suffer “underfunding” and surging risks in “accidental overdose” for users, said Dr Copeland.