Nitazenes
CriticalMaintain synthetic-opioid response plans, widen naloxone access and accelerate toxicology reporting.
Rapid surveillance and signal assurance
Early warning
12 active or monitored drug signals, plus a separate horizon scan. Orphines have progressed to the Critical active watchlist and are not duplicated in horizon monitoring.
Active watchlist12Critical, high and monitored signals
Nitazene deaths195England & Wales · 2024
Ketamine treatment5,365England · 2024–25
Rapid networks4Core public surveillance routes
WEDINOSSample identificationContinuous↗PHS RADARMulti-source surveillanceQuarterly↗UKHSA / OHIDDrug alerts and harmsAs published↗PSNISeizures and arrestsQuarterly↗
01
Horizon scan
Additional substances and market presentations requiring structured monitoring
Protonitazene and metonitazene
HighThe 195 nitazene-involved deaths registered in England and Wales in 2024 included 88 mentioning protonitazene and 46 mentioning metonitazene.
Open evidence ↗Ketamine market expansion
HighEnglish treatment presentations reached 5,365. Border Force seized 1,298 kg in January–March 2026, the highest quarterly total recorded in 15 years and 42% above October–December 2025.
Open evidence ↗Pregabalin combinations
ModerateHigh mortality involvement across England and Wales, Scotland and Northern Ireland points to opioid, benzodiazepine and gabapentinoid combinations.
Open evidence ↗Methamphetamine
ModerateWAND estimated 2,300kg annual consumption in England and a 61% increase across comparable sites, with a wide uncertainty interval.
Open evidence ↗Synthetic cathinone variants
ModerateMonitor 3-MMC, 4-MMC and other cathinones through sample testing; submitted samples do not estimate population prevalence.
Open evidence ↗GBL / GHB
ModerateGBL is prominent in UK chemsex settings, while GHB is also reported and routine datasets often group them. Thirty deaths registered in England and Wales in 2024 mentioned GHB; local non-fatal events are not captured in a comparable UK feed.
Open evidence ↗02
Active watchlist
Priority signals for analyst review
Orphines
CriticalAdd orphines to synthetic-opioid alerts, analytical testing and overdose plans, with rapid notification across drug and alcohol services and partner agencies.
Xylazine
HighStrengthen wound-care pathways and test high-risk opioid samples.
Medetomidine
HighInclude medetomidine in relevant testing and share detections rapidly.
Bromazolam
HighTarget polydrug messaging and strengthen non-fatal overdose surveillance.
Ketamine
HighCommission earlier identification, specialist urology pathways and age-specific treatment capacity.
Pregabalin / gabapentinoids
HighIntegrate prescribing, toxicology, treatment and overdose intelligence rather than monitoring prescriptions alone.
Synthetic cannabinoids
HighImprove prison and housing incident reporting and routes into analytical testing.
Methamphetamine
ModerateTrack wastewater, treatment, sexual-health, seizure and emergency-care signals together.
Synthetic cathinones
ModerateUse analytical testing and contents-first alerts; avoid assuming a sold name identifies the compound.
GBL / GHB
ModerateMaintain overdose, consent and safeguarding pathways alongside sexual-health provision.
Pink cocaine / Tusi
ModerateUse contents-first messaging and promote testing where available.
03
Confidence framework
Applied consistently across the platform
Multiple independent, recent and analytically robust sources with good geographic coverage.
Credible evidence with one or more limitations in coverage, recency or sample size.
Limited, inconsistent or dated evidence that should not drive action alone.
Preliminary detection or operational report requiring corroboration.
Assessment dimensionsIndependent sourcesSample sizeGeographic coverageRecencyConsistencyAnalytical quality
Coverage boundary
The watchlist is deliberately broader than an emergency-alert list. Inclusion means a substance needs monitoring; it does not mean every item is new, nationally prevalent or increasing in every area.
Publication watch
CheckingOfficial releases for editorial review
Checking the official publication index…