THE HSE HAS set up a new ‘red alert’ team involving laboratories, emergency services and a university to respond to clusters of drug overdoses around Ireland, after dozens of people overdosed on a powerful synthetic drug in Dublin and Cork before Christmas.

It will see ambulance and fire service crews notify the HSE when and where they deal with overdose episodes. At the same time, each HSE region is now expected to form its own localised response teams in case dangerous batches end up on the market in their area.

They are to contact the HSE about suspected clusters and get in touch with local hospitals and gardaí, while the national response group will also source and test paraphernalia involved in ‘overdoses of concern’.

The HSE and drug addiction experts have serious concerns about the arrival of the synthetic opioid nitazene in Ireland, amid a warning that its strength can be multiple that of other substances.

It’s on foot of a HSE investigation which found that it was nitazene, not heroin, behind clusters of overdoses in Dublin and Cork in recent weeks.

The drug, which is created in a lab, was mixed with paracetamol and caffeine for batches that hit the streets of Ireland late last year.

Across a five-day period in November, the batches resulted in 57 heroin overdoses in Dublin. In Cork, there were 17 cases in a six-day period.

The overdoses were non-fatal due to the administration of Naloxone, a drug which reverses the effects of overdoses. The government announced plans to extend the availability of naloxone this week after its vital role in saving lives during the recent overdose clusters. 

The drug found in Dublin and Cork was a light brown powder which can behave differently to regular heroin when cooked, forming a jelly-like substance.

The head of emerging drug trends with the HSE, Nicki Kileen, said new measures are being introduced to increase the HSE’s monitoring capacity of the drugs market.

She added that while European data shows there is increased production of synthetic opiate nitazene, it’s too premature to say if this is a trend that is here to stay or if this trend may change.

“We’ve put in place a monitoring system and we’re continuing to monitor the heroin market nationally, and are asking services nationally to begin monitoring in each area,” Kileen said.

This will involve finding out whether there are any changes detected in the drugs market in Dublin, Cork and other regions, as a way of preparing for potential future clusters.

“We’re asking for overdoses of concern to be reported directly so we can investigate. But we’re also asking services nationally to ask their service users who are using heroin or other drugs whether there are drug market changes.

“So we’re asking services to report if there are new products being sold, are there products of concern, or are there new suppliers in the area? We’re asking for all of that information to be reported directly to us and then we can further review.”

The National Red Alert Group will consist of the HSE, the National Ambulance Service, An Garda Síochána, Dublin Fire Brigade, the National Drug Treatment laboratory as well as Trinity College Dublin to assist examinations of overdose samples.

Kileen said the HSE has issued interim guidelines to all HSE and Community Health Organisation (CHO) areas, which are HSE health bodies spread across the regions.

“What we’re asking is that they form local groups so they know who the local hospital contact is, who their garda contact is. We will review cases reported to us and escalate that then to the National Red Alert Group,” Kileen said.

It’s so that each rural and city location knows how they would prepare how their services will respond and form their own localised response. We’re asking them to look at those preparations in case there is an outbreak, to know what the emergency plans would be and to link with the people who use drugs and ask where would they reach them

Kileen added that the HSE is working on whether recent batches of nitazenes have gone beyond the Dublin and Cork regions.

“At the moment, we have no further updates beyond the outbreaks in Dublin and Cork. But from here on in we will continue to monitor this situation until we know which direction the drug market will take,” she said.

Fentanyl

Kileen said that while there had been focus on fentanyl hitting Ireland, an opioid which had hit communities in parts of America, it may have “distracted” from the presence of nitazene.

Fentanyl itself can be highly dangerous for drug users but the HSE found that the nitazene detected in the batches behind the recent clusters were up to 15 times stronger than fentanyl.

“We were quite concerned about the fentanyl narrative. Some people may have believed that fentanyl had already been here when there was none detected, and I think it’s important to state that the nitazenes are as potent if not more potent.”

It’s thought the emergence of new lab-based opioids could be linked to moves by the Taliban in 2022 to ban opium poppy cultivation in Afghanistan which accounts for at least 90% of the global market for heroin.

However, Kileeen said it’s too soon to say what impact such moves have had yet on Europe. “I think it’s fair to say we don’t have a heroin shortage, but there are international concerns with that over the next few years,” she said.

She said that 2023 saw three localised outbreaks of nitazene in Europe – two of these were the recent overdose clusters seen in Dublin and Cork. The other nitazene outbreak was in France.

Concern for services

Tony Duffin, lead coordinator of the Ana Liffey Project which works with drug users and collaborated with the HSE during the recent clusters, told The Journal that service providers and their clients are frightened by the outbreaks.

“I think we will see peaks and troughs most likely in the the weeks and months to come around the use of nitazene and possible overdoses,” he said. 

Duffin said there remains worry over the potential consequences of changes to the heroin market for vulnerable drug users.

“Anybody who works in this field was concerned that if there was a dip, if your heroin market supply has been removed, what would happen next? Some people might think it would be a really good thing. But actually, there are more dangerous substances out there.

“People are frightened. We’re talking about a group of people who use opiates and predominantly they are people who are addicted. So they’re not well, in the sense that they are dependent or addicted, whichever language people prefer.

“They find that there’s actually this other substance now out there and they find that they could overdose and die. That is always a reality for people who use illicit drugs but I think it’s more so with synthetic opiates because they’re so much more potent.

“We need to make sure that there’s as much information and tools to reduce that risk to themselves, either by getting people through to treatment or rehabilitation.”