Published on: 1 October 2026
Drug users are risking their lives by choosing to use alone, with older men particularly vulnerable, because of a complex range of social and emotional factors and a growing sense of isolation, new research has revealed.
Drug-related deaths in the UK continue to rise, with many happening when people use drugs alone, because of the heightened risk of fatal overdose in the absence of someone who can call for help or administer naloxone – a medication used to reverse or reduce the effects of opioids like heroin.
New research by Derbyshire Healthcare NHS Foundation Trust and the University of Derby, part of a 13-week UKRI Accelerated Knowledge Transfer Partnership (AKTP), has exposed the attitudes that lead drug users to make these dangerous decisions, exacerbated by COVID-19 leading to a breakdown in social networks and a sense of trust.
Some people interviewed during the research said using alone was a personal preference, or a protective boundary. “I am more comfortable in my own company,” one participant explained, while another said they preferred to avoid “idiots and people who use a lot,” indicating a lack of confidence in other users.
Other research participants had more practical reasons, such as not wanting to share drugs or needing to use drugs in spaces where there is simply no room for anyone else. The research results also captured the paradox faced by those attempting to reduce or stop using. One participant noted that distancing themselves from other drug users, an important step in recovery, left them more vulnerable: “When you are trying to stop using… that can be very unsafe if you were to overdose.”
Stigma, or shame, was also an underlying factor. Participants described feeling judged by family, friends, health professionals, police, the general public, “everybody,” as one person put it. Another simply attributed judgement to “society.” Shame was common and, for some, directly influenced their choice to withdraw and use alone.
And men over 40 are at even higher risk, with one respondent saying: “Their partners are dying, their friends are dying. Their social network is deteriorating.”
Overall, the data reveals that people are often using alone not because they are unaware of the risks, but because of the environments they inhabit, marked by stigma, scarcity, fractured relationships and inconsistent service practices. In a predominantly rural area like Derbyshire, where the research was conducted, issues were found to be exacerbated due to limited public transport and social isolation.
Where health services deliver clear, respectful, and sustained harm reduction messages, participants engage positively with them.
However, the experiences of participants suggest that preventing drug-related deaths will require more than simply advising people not to use alone; it will require building trust, reducing stigma, strengthening social safety, and ensuring harm reduction practices are embedded reliably across every point of contact.
Both drug users and health professionals participating in the research highlighted the need for wider circulation of naloxone hydrochloride, or ‘naloxone’ for short, which is typically delivered by injection and blocks opioid receptors in the brain.
Naloxone saturation – placing multiple kits within households, peer networks, pharmacies, emergency services, and public-facing workplaces – was seen as the single most impactful solution. Several research participants also suggested increasing the availability of sterile equipment, wipes, foil and naloxone, located discreetly in locations that do not carry stigma.
Similarly, there was strong support for the integration of naloxone training into routine community life, including through families, neighbours, security workers, housing staff and other non-clinical professionals, so that more bystanders are equipped with the means to respond.
Postal naloxone and simplified self-training (short videos, text prompts, QR codes) were viewed as essential routes to reaching the large number of individuals who never appear in services. There were also calls for greater public education about the risks of solitary drug use, starting with honest conversations in schools, and one participant pointed to an innovative model in the United States, a phone line for people using alone that triggers an emergency response if they stop answering, as an example of what proactive harm reduction infrastructure might look like.
Mark Powell, Chief Executive of Derbyshire Healthcare NHS Foundation Trust, said: “These responses show that people who use drugs are not resistant to safety planning; rather, they want interventions that respect them, recognise their circumstances, and offer realistic tools to stay alive. We hope this important research, developed through our strategic partnership with the University of Derby, will shape the conversation around the subject of solitary drug use and, ultimately, result in fewer fatal incidents that could have been prevented.”
Five focus groups took part in the research, including substance misuse nurses and prescribers; recovery co-ordinators and keyworkers; health improvement nurses; criminal justice and prison-link keyworkers; safeguarding specialists and lived-experience recovery staff.
People currently using drugs or alcohol, or who were in treatment, also took part in focus groups, offering insight into personal experiences, motivations, barriers and perceived risks associated with solitary use.
Staff and students from the University of Derby led the research facilitation and analysed the data.
Dr David Patton, Associate Professor in Criminology at the University of Derby, said: “This research highlights the importance of support for users, particularly those living in rural areas.
“Solitary drug use cannot simply be ‘stopped,' as it reflects the social and emotional realities of some people’s lives, but deaths can be prevented.
“The solutions lie in rebuilding the connections that keep people alive, coupled with effective harm reduction mechanisms.”
The collective insight of the research participants is that loneliness, isolation and stigma are a key problem to be solved, and that harm reduction and social connection are not separate agendas but two halves of the same practical, humane response. As one recovery worker said: “You can’t stop people using alone, you can just stop them being alone when they’re not using… if it’s not a using problem, it’s a living problem.”
