The corner of London with an epidemic of highly addictive 'flesh-eating' drug that could be fatal

The man was barely breathing and an ambulance was called
-Credit: (Image: Facundo Arrizabalaga/MyLondon)


It’s a Thursday afternoon in East London and Whitechapel is as busy as ever. Ambulances zoom past Royal London Hospital with sirens wailing and flashing blue lights, a bunch of school kids who are done for the day walk through the market and are laughing uncontrollably as they play a video from one of their phones, while market traders are welcoming a final rush of afternoon customers.

Despite so many people milling about, a disturbing scene is unfolding right next to one of the market stalls and no one seems to be taking any notice. A man lies on the floor with hospital trousers pulled up to his knees. His two legs are covered in blood, and there is a cluster of puss and sores which have been temporarily wrapped in bandages while a hand is covering his face.

The man is clearly in agony and has passed out from the pain. His chest rises and falls slowly, but it’s not frequent enough and it catches the eye of outreach worker Abdi Hassan, who has seen a number of drug users in the area display similar symptoms in recent weeks.

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This man could have been out cold for hours all while Tower Hamlets Council's headquarters is just a few metres across the road
This man could have been out cold for hours all while Tower Hamlets Council's headquarters is just a few metres across the road -Credit:Facundo Arrizabalaga/MyLondon

Abdi dials 999 and while he waits for the emergency call handler to tell him what to do next, he points out to the Local Democracy Reporting Service (LDRS) that Tower Hamlets Council’s headquarters is just a few metres across the road, yet this man has been out cold on the floor for potentially a few hours.

He and his colleagues at Coffee Afrik, a community organisation that supports people with drug addiction in East London, believe synthetic opioids and other substances are causing irreparable damage to those who normally use heroin or crack in Tower Hamlets. But without the right people and resources behind them and backing their theory, it’s extremely difficult to prove as so little is known about a new wave of opioids that appear to be sweeping through this part of East London.

Another man in Bethnal Green told the LDRS he was in a lot of pain from his leg before revealing a large abscess on his hip
Another man in Bethnal Green told the LDRS he was in a lot of pain from his leg before revealing a large abscess on his hip -Credit:Facundo Arrizabalaga/MyLondon

Rotting limbs and a 'flesh-eating disease'

Abdi, who is the founder of Coffee Afrik, tells the LDRS that in the last few weeks he has seen more and more users suffering from rotting limbs, large holes across the body and leaky abscesses the size of golf balls. Mahamuud Ali, a colleague of Abdi’s, tells the LDRS during a separate outreach visit to Bethnal Green: “I think we need a lot of experts, we need the right people to come together and find out exactly what's going on.

“I don't have the answers because I'm not qualified, I'm not a medic and I’m not from the local authority - what I do know from my own experience is that it's getting worse.”

Abdi and Mahamuud believe drug users are unknowingly using heroin or crack that has been laced with other substances and is causing them to suffer from a “flesh-eating disease” which has been linked to the use of xylazine in America, an animal sedative that causes a zombie-like deterioration of the skin that can be so severe it can lead to amputation. They believe they are seeing the adverse effects of synthetic opioids following the Taliban’s national ban on growing and farming opium poppies in Afghanistan in April 2022 which has stemmed the flow of heroin to the UK and around the world.

Abdi refers to an article which mentions how the impact of the shortage could see more synthetic opioids “fill the market void” for heroin. “It makes sense with the synthetic [opioids] that are being cut”, he says.

When xylazine is mixed with extremely strong synthetic opioids such as fentanyl, it can prove fatal as it starves the brain of oxygen, slows down a person’s breathing and rapidly reduces their heart rate in an instant. America is seeing a growing number of overdose deaths related to the “tranq” drug xylazine being mixed with fentanyl. Only last month this prompted the White House to launch a government crackdown which promises to have better testing, an improved system to track xylazine-related deaths and tougher sanctions on those who are caught supplying it.

Back in East London, an ambulance arrives 10 minutes later and a paramedic jumps out. Calm and collected, she strolls towards the man and wakes him up gently to see if he needs any help.

There is a huge workforce crisis in addiction services, according to one doctor
There is a huge workforce crisis in addiction services, according to one doctor -Credit:Facundo Arrizabalaga/MyLondon

Abdi waits for a short while before carrying on with his outreach work and checking in on other users in the area. When he stops to speak to a couple of drug users sitting on a bench nearby, he asks them about the man and whether people are getting the help they need.

‘Huge backlog’ of cases

They tell him and the LDRS, “you don’t know how big the problem is” and that “you’re only just scratching the surface” before complaining that it takes several weeks to be put on a treatment programme because staff at rehab and addiction support services are dealing with a “huge backlog” of cases.

The LDRS contacted several rehab clinics in the area with these concerns but none of them responded. A local hostel for the homeless which offers services for addictions said they had seen no evidence of the zombie-like symptoms witnessed by outreach workers and the LDRS, but they did say they had seen an increase in referrals to their programme.

Daily life around the Whitechapel Market in East London
Daily life around the Whitechapel Market in East London -Credit:Facundo Arrizabalaga/MyLondon

Dr Emily Finch, chair of addictions faculty at the Royal College of Psychiatrists, told the LDRS that the UK’s addiction services are having a major workforce crisis that is impacting the quality of treatment patients receive. She said: “I think our biggest problem at the moment is the workforce, there's a real difficulty to recruit doctors and nurses - they're not well paid. People don't get as much high quality treatment because they don't build a good relationship with a member of staff who is supporting them.”

On whether the UK could see the same devastating effects of synthetic opioid use that is tearing down communities in the US, Dr Finch said: “We genuinely don't know whether this is the beginning of a really big problem or whether it's a bit of a blip - we've had blips before.

“At the moment the testing for [synthetic opioids] is not systematic enough - baring in mind heroin itself kills you, it properly kills you. The biggest risk is not a mental health risk, the biggest risk is overdose because it suppresses your respiration - [synthetic opioids] probably add to that and are making it worse - and it may be that they are causing more deaths because of that.”

Some users in the area told the LDRS that rehab and addiction support services are dealing with a “huge backlog” of cases
Some users in the area told the LDRS that rehab and addiction support services are dealing with a “huge backlog” of cases -Credit:Facundo Arrizabalaga/MyLondon

Earlier this month it was reported that 30 drug-related deaths that happened in Birmingham in June and July of this year were linked back to a new synthetic opioid drug called N-desethyl Isotonitazene which is 20 times stronger than fentanyl. Dr Finch said although she hasn’t heard of anything similar happening in London recently, “it doesn’t mean there isn’t”.

She said: “The jury is out, the case reports of synthetic opioids in England were in Birmingham [and not London]." She added that she and other practitioners would like to see more comprehensive testing and that "coroners routinely do some but they don't necessarily always test for the right things".

She said: “There’s often quite a big time lag with the coroner - it's not much use if you say there was [evidence of synthetic opioids] in the heroin a year ago; you want to know quickly.”

Dr Finch says the known effects of xylazine are comparable to the symptoms found in heroin users and that the 'zombie-like' wounds seen in London may be purely down to heroin use. She said: “I have seen good old fashioned heroin, I've seen awful legs and it may be that what you're seeing is from synthetic opioids or xylazine and is causing more problems, but I think heroin itself could cause those problems.

“Any injection causes bad problems. Injecting is bad news and then people start injecting in their legs. There has been a community in London of people with awful abscesses for years and it may be increasing but I don’t think at the moment we've got the evidence [to say it's definitely caused by synthetic opioids].”

She added: “When people inject into their veins again and again, their veins eventually get stopped and it means their normal blood flow stops. What happens is you get a situation where the skin just gets less and less healthy because you're getting less good blood, you're getting abscesses that break down and they don't heal. The same thing actually happens with other medical conditions but they're usually in very elderly people.”

Preventing overdoses and an epidemic on London's streets

Naloxone is a medication that is used as an antidote during a drug overdose and can reverse the effects of opioid use within two minutes. Paramedics across the UK are stocked up with the life-saving treatment but the Met Police are currently without it, Dr Finch explains.

“People should know that, that's what they should get if they go into treatment,” Dr Finch says. “We had a patient this week who was brought back from an opioid overdose using Naloxone, it’s what ambulances carry, police in London don't carry it, but police in some parts of the country do and it saves lives.”

While London may or may not be on the verge of a new drug crisis, Dr Finch said there's only one way to know for sure - testing. She said: “The biggest thing is you've got to do two types of testing; you've got to test people who have died, you've got to test people who are using and maybe have it in their systems and you've also got to test seizure samples - things that the police have seized.”

A spokesperson for the Met Police said: "In relation to naloxone there are trials being completed across England and Wales and there is a full roll out in Scotland. These trials, and where appropriate other evidence, will be subject to further review in the Met over the next 12 to 18 months. This is being overseen by the MPS’ senior advisor for first aid and the MPS clinical panel."

A Tower Hamlets Council spokesperson said: "Our substance misuse outreach workers have not seen xylazine as being a commonly used drug at this time. They are out every day working with police, charities and health providers to provide support people need to turn their lives around. Our Tower Hamlets enforcement officers continue to work closely with the police to share intelligence and help them tackle the supply of drugs."

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