The first edition of UK Drug Trends Intelligence points to a drug market that is not moving in one simple direction.
Some harms are rising. Some indicators are stable. Some substances are appearing more often in testing, but we still do not know how widespread they are. And in several areas, different datasets tell different stories.
A few findings stand out.
Cocaine remains a major concern.
Cocaine-mentioned deaths in England and Wales rose from 1,118 in 2023 to 1,279 in 2024, while household prevalence did not show a significant annual increase.
That suggests harm can rise even when reported prevalence appears broadly stable.
Ketamine is becoming a much bigger service issue.
Treatment and wastewater indicators are rising, particularly among younger people, while urinary and hepatobiliary harms require much stronger links between drug services and medical care.
Nitazenes remain a serious preparedness priority.
Scotland recorded a sharp rise in nitazene involvement in deaths, while differences in toxicology, reporting and testing mean a single UK trend cannot yet be claimed confidently.
The contents of drugs are becoming harder to assume.
Tusi, counterfeit medicines, novel benzodiazepines, synthetic cannabinoids and emerging sedatives such as medetomidine all reinforce the same point:
What someone thinks they bought may not be what they actually took.
Polysubstance use also needs to be understood as an episode, not just a list of drugs.
‘Heroin and cocaine’ on a record does not tell us whether they were injected together, used separately, used hours apart or used on different days.
Timing, route, alcohol, prescribed medicines and purpose of use all change the risk picture.
Wastewater data are useful, but they do not tell us how many people are using a drug.
At the same England sites, ketamine and methamphetamine estimates rose while cocaine, heroin and amphetamine fell between 2024 and 2025.
These are quantity-based signals, not prevalence estimates.
Young people’s needs are changing too.
Specialist treatment data show growing ketamine involvement and high levels of polydrug use and mental health need among children in treatment, but these figures should not be confused with prevalence in all young people.
The strongest overall message is probably this:
Services need to get better at understanding the whole episode of use — what someone intended to take, what they actually took, how they took it, what else was involved, and what happened afterwards.
The drug name alone is increasingly not enough.