Government urged to prepare for surge in potentially fatal synthetic opioids
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The Government needs to give political priority and resources to prepare for future supplies of potentially deadly synthetic opioids hitting the country, according to an HSE-led expert group.
The continued operation of a small team, set up on an emergency basis late last year to respond to mass nitazene overdoses in Dublin and Cork, is “not sustainable” into the future, the group said.
The sudden emergence of the man-made opioid, estimated to be between 100 and 500 times more powerful than heroin, resulted in 57 overdoses in Dublin and 20 in Cork.
It is thought there was at least one fatality in Cork, with some uncertainty as to whether or not any deaths, or how many, have occurred in Dublin — with inquests awaited.
UN and EU drug organisations are concerned that the supply of nitazenes and other synthetic opioids will accelerate in the coming years after a 95% collapse in opium production in Afghanistan in 2023 and the emptying of existing heroin stocks.
To deal with the response in Ireland, the National Red Alert Group (NRAG) was set up, coordinated by the HSE, and led by National Clinical Lead for Addiction Services, Professor Eamon Keenan.
The group brought together the HSE, Forensic Science Ireland, the State Laboratory, the National Drug Treatment Centre, Gardaí, National Ambulance Service, and the Dublin Fire Brigade as well as academics.
Writing in the journal, the group said the 57 overdoses in Dublin happened over five days in early November, mainly affecting people who were attending homeless services.
The N-pyrrolidino protonitazene then hit Cork in December, resulting in 20 overdoses over six days.
The HSE has established that it was the same batch of nitazene — and that dealers were “testing” the market.
“Rapid responses helped to protect people who use drugs through an urgent analytical review of samples, mobilization of frontline services to deliver tailored harm reduction measures, and ‘Red Alert’ risk communications issued for these regions,” the group said.
It said that two additional alerts were issued this year, the first following the seizures of another nitazene powder (protonitazene) in Dublin. Gardaí were particularly concerned given the size of the seizure — 2kgs.
The second alert followed the discovery of N-pyrrolidino protonitazene in a Dublin prison (Wheatfield), followed by cases in Cork Prison. The total number of overdoses was less than five.
“The current situation creates great uncertainty for the direction of future opioid markets that could impact the estimated 19,875 opioid users in Ireland,” the group said.
It said: “Significant work was required by a small Irish coordination group who adapted current roles to focus on the outbreaks.
“This approach will not be sustainable on a long-term basis, emphasising the need for political prioritization. Increased budget allocation should be provided to improve early warning mechanisms, to expand harm reduction and treatment responses, and to enhance drug checking through a dedicated drug-monitoring laboratory.”
The group added: “The Irish nitazene outbreaks are examples of how these substances can emerge without warning and sporadically on the market.”