In the detailed area of substance misuse, pharmacy professionals are uniquely equipped to implement real-time evidence, promote safer medication practices, and enhance harm-reduction services. Research facilitates a shift from individual experiences to robust, measurable strategies, addressing the complexities of this field.
Substance misuse continues to cause significant harm across the UK. In 2024, 5,565 drug-poisoning deaths were recorded in England and Wales, with 3,736 attributed to drug misuse. Adulterated street drugs, diverted prescriptions, and counterfeit products create unpredictable risks. An emerging concern is the group of novel synthetic opioids, commonly referred to as ‘nitazenes,’ which have been detected in illicit supplies like cocaine and heroin, and in some counterfeit medicines.
Rising Potency and Evolving Risks
Some nitazenes are highly potent. For example, isotonitazene has been reported in animal models to be around 500 times more potent than morphine. This potency increases the risk of overdose and complicates identification, as initial toxicology screening may not detect them. Prescription and over-the-counter medicines also contribute to challenges, including dependence, diversion, and harmful drug combinations, particularly with high-risk opioids or gabapentinoids.
Pharmacy teams see these issues firsthand. They play a key role by conducting structured medication reviews, providing patient-centered counselling, and collaborating with prescribers on stewardship. Another rapidly evolving risk comes from unregulated online sales and counterfeit medicines. The Medicines and Healthcare products Regulatory Agency (MHRA) has taken enforcement action against the illicit supply of unlicensed weight-loss products. In October 2025, this included a major seizure of thousands of injection pens labelled as containing tirzepatide and retatrutide, which lacked safety controls and posed serious risks.
These are real challenges faced by patients in community pharmacies, hospital wards, and drug and alcohol services every week. Pharmacy professionals are at the heart of the response. As independent prescribers, they assess and initiate opioid agonist therapy, conduct reviews for high-risk prescribing, supply naloxone directly, and provide harm-reduction counselling.
Research in Action
The power of pharmacy-led research lies in transforming routine practice data into reliable, actionable evidence. A compelling example is the expansion of take-home naloxone. Since 2 December 2024, amendments to the Human Medicines Regulations 2012 have enabled registered pharmacists and pharmacy technicians to supply take-home naloxone kits without a prescription.
This change was informed by evidence from Advisory Council on the Misuse of Drugs (ACMD) reviews, pilot programmes, and real-world data demonstrating both the barriers to timely access and the life-saving potential of wider naloxone availability. As a result, community-level reach has expanded significantly. Pharmacists can identify at-risk individuals, such as those with opioid prescriptions, and provide practical training on overdose response. They offer ongoing support and tailored kits as part of a holistic approach.
Research is not an academic extra — it is what makes our daily clinical decisions safer, more efficient and more defensible. Even small efforts, like tracking naloxone supplies or reviewing prescribing patterns, can generate actionable insights that support busy staff and reassure patients. This means remaining alert to clinical presentations that deviate from expectations and being proactive in conversations about overdose risk, especially given the potential presence of nitazenes in unsuspected drug supplies. Two recent articles in the International Journal of Pharmacy Practice highlight methods that can be adapted to enhance practice or initiate local research.
Your Next Steps
Consider exploring these articles in the International Journal of Pharmacy Practice, published by the Royal Pharmaceutical Society in partnership. One article is a systematic review and narrative synthesis, identifying barriers and enablers for pharmacists in preventing opioid misuse. The other is a retrospective evaluation of a pharmacist-led review clinic, measuring reductions in strong opioid prescribing in a high-deprivation area.