THE HSE, GARDAÍ and other bodies are working behind the scenes in preparation for the use of fentanyl and other synthetic opioids becoming more prevalent in Ireland, the drugs minister has said.
Irish authorities are also working alongside their counterparts in the EU, Hildegarde Naughton said, as Europe braces itself for a potential heroin shortage.
Speaking to reporters in Dublin yesterday, Naughton noted there has been “no evidence of fentanyl seizures” in Ireland to date, but that the situation is being “constantly monitored”.
The vast majority of the heroin consumed in Europe comes from Afghanistan but a shortage of the drug is expected in 2024.
Last year the Taliban banned poppy cultivation but the 2022 crop was exempted, meaning the effect of the ban likely won’t be felt in Europe until next year.
Fentanyl is a powerful synthetic opioid that is about 50 times more potent than heroin and up to 100 times more potent than morphine.
The drug is not currently widely used in Ireland but experts fear its use could become more widespread if there is a heroin shortage.
There are two types of fentanyl: pharmaceutical fentanyl and illegally made fentanyl. The former is prescribed widely as pain relief medication in the US.
Fentanyl can be injected, snorted, smoked, or taken orally via a pill. It is highly addictive and tens of thousands of people in the US have died from fentanyl overdoses.
In countries such as the US, it is not uncommon for street drugs to be laced with fentanyl without the user realising what they are consuming.
European response
Naughton yesterday said the Health Service Executive is “working very closely at a national level” with An Garda Síochána in preparation for the drug becoming more widely available here.
“They’re also working as well at EU level, looking at the potential arrival of fentanyl coming in.
“So it is being constantly monitored at a national and European level in relation to the arrival of fentanyl coming in,” she said.
Ireland engages in this process through the Early Warning and Emerging Trends network, which has representatives from An Garda Síochána, the Irish Prison Service, the HRB, the HSE, several national laboratories, two government departments (health and justice) and civil society representatives.
The junior minister noted that part of this work includes wastewater treatment analysis, syringe analysis and engaging with emergency departments to “see if there’s any detection of people coming in with fentanyl in their systems”.
Tony Duffin, CEO of Ana Liffey Drug Project, previously said that action should be taken in Europe to prevent fentanyl becoming as destructive here as it is in the US.
Writing in The Journal in August, Duffin said: “With the foresight afforded to us, action should be taken now in Europe to offset the impact of the destruction of the Afghanistan opium crop and the significant concerns about the effects of this across Europe, where heroin made from Afghan opium makes up 95% of the market.
“If the ban is sustained and displaced production does not meet demand, then there will be an opportunity to get more people into treatment – this will depend on the capacity of each jurisdiction’s treatment system to respond to those people seeking treatment.
“There will also be the likelihood of a significant spike in poisoning deaths due to synthetic opioids (and/or other drugs) that may fill the market void.”
Overdose deaths
The most recent data shows that from 2018 to 2020 there were 20 drug overdose deaths in Ireland where fentanyl was implicated.
A spokesperson from the Health Research Board (HRB) told The Journal that most of these deaths involved “polydrug poisoning”, meaning more than one drug had been consumed.
“The source of the fentanyl is not always known in the data sources available to the National Drug-Related Deaths Index but over the three years in question, we can say that (provisionally) for at least eight deaths it was misused and/or diverted prescribed fentanyl,” the spokesperson said.
In relation to the wider issue of addiction, Naughton yesterday noted the ongoing rollout of a Naloxone programme nationwide.
Naloxone is a prescription medication used to temporarily reverse the effects of opioid drugs such as heroin, fentanyl and methadone.
“The training for naloxone is being rolled out across all of our homeless services, people who are dealing with addiction right across the country, the HSE are rolling out that training,” the junior minister said.
The HSE confirmed to The Journal that, up to the end of August, 243 uses of naloxone have been reported this year – 152 in Dublin, 39 in Cork, 18 in Limerick, nine in Carlow, seven in Louth, five in Kerry, five in Kildare and eight in the rest of Ireland.
Some 983 people have been provided with training in the use of naloxone including support service colleagues, peers, family members, nurses, doctors, pharmacists and students.
A HSE spokesperson said the executive is “not aware of any seizures of fentanyl by An Garda Síochána, nor have we any laboratory analytical confirmation about fentanyl being detected recently in Ireland”.
They added: “No hospital ED has reported presentations associated with fentanyl. No individual has presented for treatment to addiction services saying that they are dependent on fentanyl.
“The emergence of synthetic opioids on the EU drug market is an area monitored closely by the EU Drug Agency (EMCDDA) and by local officials in Ireland. There are no signals of change on the Irish drug market but it is being monitored.”
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