Alert as deadly opiate nitazene is found in fake sedative tablets
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The threat posed by deadly synthetic opiate nitazene has spread across the country and expanded beyond powder sold as heroin to fake sedative tablets.
The HSE has issued a fresh alert overnight regarding the highly potent nitazenes – which were responsible for 77 overdoses in Dublin and Cork late last year – after a new “cluster of overdoses” were recorded in the Mid-West and Galway, as well as Dublin.
Both the HSE and the EU drugs agency have flagged concerns at the emergence of nitazenes beyond the heroin market, in which it is sold in powder form to unsuspecting heroin users, to a broader market of drug users in tablets.
UN and EU agencies have warned that the supply of synthetic opioids, such as nitazenes, could increase significantly later this year as stockpiles of heroin are depleted, resulting from a ban on the growing of the opium plant in Afghanistan, where the bulk of European heroin comes from.
The HSE alert said: “We are advising of an extra risk to people who use drugs following a cluster of overdoses in Dublin, Galway and the Mid- West. Our National Drug Treatment Centre has confirmed nitazene in yellow, round counterfeit benzodiazepine tablets associated with these overdoses.”
All the previous overdoses – 57 in Dublin and 20 in Cork and a small number subsequently in Irish prisons last March – followed the consumption of powder.
A HSE statement said: “Analysis by the Emerging Trends Laboratory at the HSE National Drug Treatment Centre has confirmed nitazene in yellow, round counterfeit benzodiazepine tablets associated with these overdoses.
“The HSE advises that there is EXTRA RISK at this time and strongly recommends people not to take these tablets.” Professor Eamon Keenan, HSE National Clinical Lead, Addiction Services, said: “We urge extreme caution following a number of overdoses related to counterfeit benzodiazepine tablets.
“Preliminary analysis suggests nitazenes, a potent and dangerous synthetic opioid, may be responsible. These pose a substantial risk of overdose, hospitalization, and death.” The statement advised the following harm reduction steps to help reduce the risks:
*Avoid taking these tablets, new batches of drugs, new types of drugs or obtaining drugs from new sources due to unknown risks;
*Talk to your local service or doctor about accessing naloxone for free. Naloxone temporarily reverses the effects of opiate-type drugs like heroin, keeping the person alive until emergency services arrive;
*Get medical help immediately if you see signs of overdose. Stay with the person until help arrives.
The statement said: “Due to the concerning rise in overdoses and the risks posed by nitazene-type substances, the HSE is collaborating with various partners, including hospital emergency departments, emergency services, NGO service providers, An Garda Síochána, and laboratories at the National Drug Treatment Centre and Forensic Science Ireland to monitor the situation closely. Ongoing analysis aims to identify the exact composition of the substance.”
After the first outbreak, the HSE set up The National Red Alert Group, bringing together Forensic Science Ireland, the State Laboratory, the National Drug Treatment Centre, gardaí, National Ambulance Service and Dublin Fire Brigade, as well as academics.
As reported in the Irish Examiner last month, this group urged the Government to give political priority and resources to prepare for any future supply of synthetic opioids, It said the continued operation of this small team, set up on an emergency basis, was “not sustainable” into the future.
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.”
Last week, the European Monitoring Centre for Drugs and Drug Addiction (Emcdda) said EU countries need to prepare for a future heroin shortage and to have a plan in place if the market is filled by far more potent synthetic opioids.
The European Drug Report 2024 said Ireland and France had recently been hit with “localised poisoning outbreaks” and warned that any large-scale supply of these chemicals could result in “multiple poisonings” occurring over a short period, with the potential to “overwhelm” local services.
The group of synthetics opioids known as nitazenes — estimated to be hundreds of times more potent than heroin — suddenly emerged in Dublin and Cork at the end of last year and caused a total of 77 overdoses, including, it is thought, a number of fatalities.
Authorities believe it was all part of one batch and suspect it was an attempt by traffickers to test the market here.
Last week, Dublin man, Josh McGuinness, was sentenced in Cork Circuit Criminal Court in relation to the sale of nitazene in Cork last December.
Judge Cormac Quinn said he knowingly sold drugs that were “highly dangerous” to unsuspecting buyers.
“He was selling drugs knowing they were highly dangerous to people. The fact that he was aware the drugs he was selling were causing drug addicts to overdose is particularly aggravating,” the judge said.
The Emcdda report said the United Nations Office in Drugs and Crime published research this year estimating the production of opium, from which heroin in manufactured, fell by a colossal 95% in 2023.
It said because there appeared to be “substantial” stocks of opium in Afghanistan there has been little evidence of any disruption of heroin flows to Europe.
“However, there are concerns a future heroin shortage could lead to market gaps being filled by potent synthetic opioids or synthetic stimulants,” the report said.
“This could have potentially significant negative effects on public health and safety.” It said it was too early to say if the ban on opium production issued by the Taliban regime in Afghanistan, introduced in April 2022, would be sustained over time.
But it added: “It would be prudent to prepare for a possible heroin shortage in late 2024 or 2025.” It urged countries to ensure they have sufficient drug treatment places available for people struggling with their opioid use and monitor the emergence of potent synthetic opioids, but also more established drugs, such as stimulants.
The agency called on member states to have a “multiagency rapid response plan”, including an effective communication system to alert at risk people and frontline services.
It said there was a wider risk beyond heroin users as synthetic opioids have been sold as, or in mixtures with, other substances.
“The population at risk is not necessarily restricted to those with a history of consuming opioids,” it said.
The Emcdda said a “critical requirement” was for countries to have adequate supplies on the heroin antidote naloxone are available to frontline workers, such as police, ambulance and low-threshold service providers.
The speedy response of the HSE to the nitazene outbreak is highlighted in the report and has been previously praised by agencies in the North and in Britain. It included the provision of naloxone, the setting-up of a multi-agency group, the rapid testing of samples and the issuing of red alerts to users.