Warning as deadly new drug arrives in Irish cities

Acluster of drug overdoses from a drug 10 times as potent as fentanyl is causing severe alarm among medical responders and frontline workers in Ireland.

Called nitazenes, they were developed by commercial pharmaceutical companies in the 1950s as opioid painkillers but were never released for use because they were so powerful.

More than a dozen professionals from frontline organisations have written an open letter warning of concerns around the drug after a series of overdoses in Dublin and Cork in the past six months.

Users were told it was extra strong heroin or Chinese heroin but authorities believe the synthetic opioid was manufactured in clandestine laboratories in the Far East.

Professor Eamon Keenan, HSE clinical lead for addiction services, is a signatory of the letter along with gardaí, fire brigade, ambulance service, Forensic Science Ireland and State Laboratory experts.

“Since the overdose clusters that we experienced a number of countries such as Switzerland, France and the UK have made contact with us asking us about the response and how we coped with the situation,” he said.

“In terms of scale, it was much larger than anything other countries have experienced. So that was the concern from a European perspective.”

The open letter, published in Addiction Journal, urges national preparation for possible future cases.

The Health Research Board said nitazenes can be “hundreds to thousands-fold more potent than morphine and other opioids and tenfold more potent than fentanyl”.

Fentanyl is behind the epidemic of overdoses sweeping the US. “[Nitazenes] can be as potent or in some cases stronger than fentanyl,” said Prof Keenan.

The HSE was first notified of a high pattern of opioid overdoses in Dublin among people attending homeless services on November 9.

“This represented the very early signs of drug market changes and the emergence of N-pyrrolidino protonitazene in Ireland,” said the letter.

“During the following five days there were 57 overdoses among people who use heroin in Dublin city centre.”

This was followed by a second outbreak over six days in the Cork region in December, with 20 overdoses.

“Rapid responses helped to protect people who use drugs through an urgent analytical review of samples, mobilisation of frontline services to deliver tailored harm reduction measures and ‘red alert’ risk communications issued for these regions,” the letter said.

Another alert was issued this year following the identification of the drug in a Dublin prison leading to a small number of overdoses. The drug in the three clusters had come from the same batch.

“In other countries, whenever these drugs had emerged, they were mixed in with heroin or other opioids, whereas we saw this was just mixed with regular cutting agents. So there was no heroin,” Prof Keenan said. “This was a shift in the market, there was something similar seen in France, but they only had four overdoses, where we had 57 in the first instance and 20 in the second instance.”

Prof Keenan added that the use of Naloxone — an antidote for opioid overdose — had been “instrumental” in saving lives.

The ease of cooking up opioid drugs in a laboratory has been coupled with a dramatic reduction in poppy cultivation in Afghanistan which could lead to a heroin shortage in Europe.

“If we’re facing into this scenario where heroin disappears or reduces significantly these synthetic opioids are going to be a problem,” said the professor, adding: “This could happen again at anytime and we need to be prepared.”