Rats grown fat on refuse prowl the streets of Birmingham. Mounds of rubbish pile up outside houses. Desperate to avoid blame, the city’s politicians bleat about being held to ransom by a pesky union. ‘Welcome to Brum,’ one resident said as he caught me taking a photo of a bin mountain. Even CNN has a reporter on the ground. On Saturday, she carefully tiptoed around lots of black bags, as if each were a landmine. This is where Peaky Blinders was filmed, she told her American viewers.
Out of shot, a far greater scandal passes unnoticed. While the national press rummages through Birmingham’s bins, the backstreets of England’s second city are afflicted by a hidden opioid crisis. In 2023, the same year as Birmingham’s last bin strike, and the same year its council effectively declared itself bankrupt, the city’s poorer districts saw an influx of nitazenes – new synthetic opioids up to 40 times stronger than fentanyl and up to 500 times stronger than the heroin it is often mixed with. Since then, overdoses have continued to rise.
These synthetic opioids come mainly from China, where factories found themselves unable to export to America thanks to Donald Trump’s anti-fentanyl policies. Instead, China’s underground chemists switched to nitazenes, while their couriers turned their attention to Britain. Unlike the US, we lack an overdose-tracking dashboard, and official statistics are widely considered a significant underestimate. In January, the Home Office quietly revealed that since June 2023 there have been at least 400 nitazenes-related UK deaths. Curiously, it didn’t say where the deaths occurred.
To get around this, Dispatch, a new magazine I edit, sent Freedom of Information requests to every ambulance service in the UK to find out where naloxone – a nasal spray used to reverse an opioid overdose – was administered last year. Our findings provide the most detailed picture yet of Britain’s opioid crisis: a scourge that extends from Cornwall to the Shetland Islands. Broken down by local authority, Birmingham came top. In 2024, paramedics treated 720 opioid overdoses in the city – the equivalent of two a day, and a 13 per cent increase on the previous year.
Unsurprisingly, the council denies the problem is linked to its bankruptcy. Instead, a spokesperson told me that the city’s local authority is by far the largest in the UK, and so bound to record more overdoses. (If Greater London’s boroughs were merged into one local authority, it would register almost four times as many incidents as Birmingham, although it also has nine times the people.)
But is it simply a matter of size – or is something else at play? After all, 60 per cent of Birmingham’s residents live at the lowest levels of deprivation, where opioid usage is significantly higher. You can see this in the city’s afflicted northern districts, such as Lozells, where users stand outside their hostels or rented rooms, waiting to score. A few weeks ago, I saw a man who succeeded lying on the pavement using one of the many bin bags as a pillow. ‘You can’t move for rats and needles,’ said another man, who was standing outside one of the crumbling Victorian ‘Houses of Multiple Occupancy’ where people overdosed at the start of the nitazenes wave. Another told me: ‘I don’t do drugs but you can see why people do.’
Birmingham’s opioid crisis was first spotted in the summer of 2023. Officially, 21 people died after taking nitazenes, while at least 19 others were hospitalised with overdoses. Just as it was becoming clear that this was an emergency, the authorities made two strange decisions. First, West Midlands police ruled that officers should stop carrying naloxone, later claiming their stock had expired. Second, Birmingham city council implemented a media blackout, and refused to launch a public awareness campaign. This meant drug users and dealers were unaware that their heroin supply had been contaminated. ‘I don’t understand how the nitazenes weren’t picked up at the start,’ the mother of one victim told me. ‘There were no warnings. He didn’t stand a chance.’
Birmingham tends to be viewed by the rest of the country with little more than grim fascination. We look at photos of bin bags and rats, and comfort ourselves that it’s not our problem. But as this new data shows, the same can’t be said for the city’s opioid crisis. When it comes to nitazenes, where Birmingham goes, the rest of the country follows.
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