Cluster of overdoses linked to opiate nitazene ‘came out of the blue’ – HSE clinician

A type of synthetic opioids called nitazenes are emerging as a “serious worry” for healthcare services in Ireland, following a cluster of overdoses and increasing seizures of the drugs throughout the country this year.
Nitazenes are up to 25 times more potent than fentanyl, which has caused thousands of deaths in the US.
Authorities are on red alert as tablet forms of the drug have begun to arrive in Ireland, after previously being detected in Northern Ireland and the UK. There have been 284 deaths confirmed in the UK from nitazenes since last June, according to the UK’s National Crime Agency.
The drug was first identified in Ireland in 2022, but “it wasn’t in circulation yet, it was seized in a very small consignment of drugs. Then it started to emerge as a problem in Europe in 2019, and year on year it’s increasing,” Prof Eamon Keenan, national clinical lead of the HSE’s Addiction Services, said.
At first it was mostly an issue in eastern European countries, with “a significant share of overdose deaths” in Estonia and Latvia last year, according to the European Drug Report, published in June. But at this stage, most European countries have seen the drug emerging, Prof Keenan said.
Nitazenes were first produced in the 1950s, intended as a replacement for morphine.
“But they were never marketed because they’re too potent. The risks and dangers associated with them were highlighted even then,” he said.
As far as authorities can tell at this point, they are being produced as synthetic opioids in China, in laboratories, before being shipped to Europe. “Because of the potency, a small amount can produce quite a lot of doses,” Prof Keenan said.
The issue “came out of the blue” in Ireland in November last year with the first cluster of overdoses suddenly emerging in Dublin.
“We suddenly started getting phone calls one Thursday into my office saying there was something odd going on. People were collapsing and turning up at the hospitals. It was very clear when I rang the emergency departments that an abnormal situation was arising,” said Prof Keenan.
On a normal day, an emergency department in Dublin might see three-four overdoses, but that first day, there were 34 overdoses in a 24-hour period, Prof Keenan said. “We knew something was happening but we didn’t know what. A sample from the guards was brought to the forensic science lab and we had the result by Friday afternoon, confirming that nitazene was identified.”
From then on, authorities went into “red alert” because of the high risk associated with the drug.
The HSE contacted Dublin City Council to distribute extreme warning signs and flyers, particularly targeted at the population of homeless opioid users who were most affected.
The warning messages were effective in Dublin, with overdoses reducing over the following week.
“Then it got interesting because suddenly there were overdoses in Cork from exactly the same batch of drugs. The dealers couldn’t sell any more in Dublin because of the warnings, so they went there,” he said.
What was unusual in Ireland was that the drug was turning up in labs as pure nitazene, whereas in other European countries so far, they had been mixed with heroin. “You need to look at this in the geopolitical context,” Prof Keenan said, referring to the Taliban seizing power in Afghanistan again in 2022.
Afghanistan’s poppy cultivation and harvest is responsible for more than 90 per cent of illicit heroin globally, but the regime has banned its production and, as a result, the European market was now becoming “ripe for the introduction of synthetic opioids”.
The last time the Taliban were in power, there was a reduction in heroin supply, resulting in “a lot of cocaine usage, but that was fairly short lived”, said Prof Keenan
However, now the drug market is more fluid, with far more substances being sold, and synthetic opioids are emerging as a “real worry” for services.
Senior Garda officers, including Garda Commissioner Drew Harris, have already expressed their concerns that once heroin becomes more difficult to source, a synthetic drug culture will take hold, with potentially devastating consequences.
The situation in Ireland has been evolving quickly, with another alert issued in February, following the identification of a new batch of nitazenes. The red alert was extended by the HSE to prison settings in March.
By June, the HSE issued a risk communication to people who used drugs following a further cluster of overdoses in Dublin, Galway and the midwest. Currently, the drug is being sold on the streets as benzodiazepines, with most who take the drug “unaware what’s actually being sold to them”.
A resident and business owner in Dublin city centre said he was increasingly seeing groups of men showing up in his laneway to buy the yellow, round counterfeit benzodiazepine tablets associated with recent overdoses.
In July the Irish Prison Service issued its own urgent drug alert to all prisons after nitazenes were confirmed to be connected with several overdoses, one of which was fatal.
But nitazenes were not associated with the recent overdoses in Portlaoise Prison earlier this month, the HSE confirmed. The substance involved was identified to be clobromazolam, another new synthetic drug “never seen in Ireland before”.
“The situation at Portlaoise Prison recently is an example of how volatile the drug market is. New substances are appearing on the market and causing harm quickly,” Keenan said.
The good news is that naloxone, a prescription-only medication used as an antidote to temporarily reverse the effects of opioid drugs, works for treating overdoses from nitazenes.
The HSE is encouraging homeless agencies and other organisations to register so they can stock and use the medication in the event of overdoses, and the hope is that gardaí can soon carry it as well.
“The awareness messaging is working, but I think this is going to be an ongoing problem we’re facing over the next while,” Prof Keenan said.