The study is the first to provide scientific evidence to demonstrate the scale and impact, and continued use of this substance in the UK, and demonstrates action is needed to prevent further harm.
The substance, which can be legally sold in the UK for legitimate purposes, has been maliciously promoted on pro-suicide forums. Reports of deaths by suicide by this substance have been growing across the world, but until now, the scale of its use is unknown in the UK.
This study, published in BMJ Public Health, collated analysis of postmortem cases (in the UK and Ireland) where death by suicide was suspected to determine the scale of the use of this substance.
201 postmortem samples of people where use of this substance was suspected were sent to Queen Mary for analysis from 2019-2024. Of the 201 cases, the analysis confirmed that 164 had evidence of high levels of the substance.
Alarmingly, young people disproportionately make up the majority of cases – 71 per cent were from people in Gen Z (born after 1997) or Millennial (born from 1981-1996) generations with a median age of 28. Four percent of cases were of people under 18, with the youngest victim just 14. Young men were disproportionately impacted, making up two-thirds (109 samples) of the confirmed cases.
This new evidence of use of this substance in deaths by suicide in the UK over several years supports calls for immediate and urgent action to implement strategies that prevent further harm from its illicit use, such as stricter regulation of the sale of the substance and making antidotes easily available to emergency healthcare providers.
The lead author, Professor Amrita Ahluwalia, Dean for Research in Queen Mary's Faculty of Medicine and Dentistry and Lead for the University's Vascular Pharmacology Group, has been supporting UK investigations into the chemical since 2019. Her lab in the UK conducts postmortem tests to determine if this substance was the cause of death.
Professor Amrita Ahluwalia said:
"This is an extremely difficult subject to talk about, and we appreciate the impact that this might have on all those affected by suicide. What our research shows is deeply upsetting. But it makes clear why urgent steps are needed to regulate access to this chemical and to reduce the spread of harmful information about it online."
Professor Ahluwalia has been working with the Molly Rose Foundation and bereaved parents of those who have died by suicide by ingesting this substance. Together, they have worked to bring attention to the scale and danger of it and call for urgent action to prevent further harm from it.
Andy Burrows, Chief Executive of Molly Rose Foundation, said: "Professor Ahluwalia's research highlights the devastating impact of this substance in the UK and it is shocking it is still widely available and being promoted on a pro-suicide forum.
"It is crucial that authorities tackle the root source of this deadly harm and Ofcom must now use all the powers at their disposal to shut down the forum for good. Government must go further to upgrade regulation of the substance in the UK and coordinate a stronger response on the frontline to stop it entering from abroad and to respond effectively when ordered and consumed by vulnerable people."
Professor Ahluwalia's study now provides scientific evidence showing the prevalence of this harmful substance in deaths by suicide. However, as Professor Ahluwalia only receives samples from Coroners and Forensic Pathologists who are aware of her work, the true figure could be higher. Without a nationally coordinated approach to routinely test for this substance in suspected cases, it's impossible to understand the true scale.
For reasons of public safety, we will not name either the substance or forum. This reflects best practice and media reporting guidelines.
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