PHS urges caution after increase in sudden overdoses in Scotland

Public Health Scotland (PHS) is urging caution, following reports of an increase in fatal and near fatal overdoses in people using heroin in recent weeks.

Some overdoses have been characterised by sudden and rapid collapse, with many requiring multiple doses of naloxone to reverse the overdose. Rapid testing has identified a nitazene-type opioid in some heroin samples linked to these overdoses, with further testing underway to determine the specific type.

Care and support for people at risk and those affected is being managed locally by multi-agency partners, including alcohol and drug partnerships, public health teams, urgent care providers and drug services. The overdoses have occurred across Scotland in multiple areas, however the nature of Scotland’s drug supply means that people in all areas may be at increased risk of harm. Services across the country have been alerted to ensure appropriate action and support.

PHS 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.

Dr Tara Shivaji, Consultant in Public Health Medicine at PHS 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.”

People are being urged 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.

Read the Scottish Drugs Forum alert and resources on overdoses
Read the RADAR alert on nitazenes
Read the latest RADAR quarterly report
For support for people affected by drugs visit NHS inform
Order a free naloxone kit through Scottish Families Affected by Alcohol and Drugs