Synthetic opioid preparation
HSE Update on the emergence of synthetic opioids on the Irish heroin market
Outbreak timelines November - December 2023
On the 9th of November 2023, the HSE National Social Inclusion Office was notified of overdoses of concern occurring in homeless settings in Inner City Dublin, which triggered an urgent review across a number of information sources to identify possible signals of change on the Dublin drug market.
Data was monitored by the HSE from the 9th– 12th November which was the main period where overdose clusters were reported. A total of 57 non-fatal overdoses were recorded during this period.
Analysis by Forensic Science Ireland of a sample obtained by Gardai on the evening of the 10th of confirmed the emergence of nitazenes in a light brown/sandy coloured powder on the Dublin heroin market which resulted in the HSE issuing a Red Alert for the City. This was later confirmed as N-Pyrrolidino protonitazene which was a first identification for Ireland and a substance which is under intensive monitoring by the EU Drugs Agency as of the 11th December 2023.
In addition to the initial Dublin outbreak, nitazenes have since been detected on the Cork market following a steady increase of overdoses in the City. As of the 12th of December, there was 13 non-fatal overdoses reported to the HSE over a 6 day period. This outbreak has been attributed to the same nitazene (N-Pyrrolidino protonitazene) which was identified in Dublin.
Red alerts remain in place for the Dublin and Cork Regions
As of February 2024, red alerts remain in place.
A new alert was issued on the 2nd of February following the identification of a new batch of nitazenes.
The most recent information from the HSE is that nitazenes could now appear in a variety of coloured powders.
National Red Alert Group (NRAG)
A Irish National Red Alert Group (NRAG) has been formed to monitor cases of concern and to rapidly respond to future outbreaks should they occur. This cross-sector group is coordinated by the HSE National Clinical Lead for Addiction Services and includes representatives from the National Social Inclusion Office, The National Ambulance Service Director, The HSE National Drugs Treatment Centre Laboratory, The Garda National Drugs and Organised Crime Bureau, Forensic Science Ireland, The State Laboratory, hospital network ED representative, Trinity College Dublin and HSE Communications Division.
Resources for people who use drugs and service providers
At present, it is only the heroin market which is impacted by the emergence of nitazenes in Ireland. Of concern is the emergence of these substances being sold as falsified tablets in the UK (mainly as benzodiazepines and oxycodone).
This is an area that needs to be intensively monitored for future developments. There are always risks and all drug user groups are advised to follow harm reduction measures and get medical help immediately if a person becomes unwell.
- Harm reduction advice for people at risk of nitazene exposure in Ireland: See our harm reduction page here.
- Reporting forms: Drug monitoring and overdose of concern in services
- HSE alert nitazene A5 leaflets
- HSE alert nitazene A4 poster
- Harm reduction information for a range of drugs can be found on our site here
Medical care providers
Emergency service providers and hospitals are being advised on the requirement for additional doses of naloxone to treat synthetic opioid overdose presentations, with preparations now required to ensure medical service providers have adequate supplies of naloxone should outbreaks begin to occur nationally. With N-pyrrolidino protonitazene now under intensive monitoring by the EMCDDA, all drug market shifts and overdose clusters should be reported to the NRAG for urgent review and action if deemed appropriate..
All organisations that provide emergency care for opioid overdose should ensure staff are supported to:
- Recognise and treat suspected cases as for any opioid overdose, using naloxone and appropriate supportive care.
- Recognise the duration of action of naloxone is shorter than that of many opioids and appropriate monitoring and further doses of naloxone may be required.
Resources for medical care providers
- NRAG update for medical care providers (in development)
- The Centre for Forensic Science Research and Education Alert on N-pyrrolidino Protonitazene (August 2023)