Overdoses will reach record levels in 2023 due to an increase in the amount of synthetic drugs sold on the Irish market, leading to an increase in people seeking help for mental health problems, a senior health official has said.
Batches of what was initially thought to be heroin laced with the synthetic opioid nitazine produced in a lab led to multiple overdoses in the Dublin area and then in Cork city from early November last year.
Subsequent chemical testing of the substance revealed that it contained no heroin at all, only the lab-synthesized nitazene, along with caffeine and paracetomol.
“They were sold as new heroin or hard heroin, but when we analyzed them, we found that they actually contained no heroin.
“It was a drug that was a mix of paracetomol and caffeine, and it was being sold, so I wondered if in a sense the dealers were introducing this new drug to test the market,” HSE said. Professor Eamonn Keenan, National Clinical Lead for Addiction Services, explains:
He said an investigation into overdose deaths linked to the drug was being carried out in conjunction with coroners in Dublin and Cork.
“We need toxicology and test results to determine if drug-related deaths may have occurred during that period, and they prioritized those,” Professor Keenan added.
The HSE expects to have further information on this early this year.
In October last year, the BBC in Northern Ireland reported coroner Joe McCrisken’s findings that six deaths in Belfast were linked to drug use, and the number was expected to rise.
There have also been deaths linked to the substance across the UK.
“What we do know is that nitazene has been linked to deaths in drug users in the UK and it is a powerful substance.”
Much higher risk than heroin – HSE
Nitazen first appeared in very small quantities in Ireland in 2022, but by the Christmas period in 2023 it had been linked to 57 overdoses in Dublin and 17 in Cork.
“In 2023, Nitazene has emerged as a real drug of concern to the HSE Addictions Service,” Professor Keenan explained, adding that synthetic opioids have been found to be extremely harmful and life threatening to those who use them. Says.
A decline in the supply of heroin through more traditional routes from Afghanistan has been reported across Europe.
According to a United Nations report, heroin production in Afghanistan fell by 95% in 2023 compared to the previous year due to a crackdown by the Taliban.
“Heroin production has fallen significantly since the Taliban took control of Afghanistan, and our colleagues at EMCDA, the European Monitoring Center for Drugs and Drug Addiction, report that heroin production in Afghanistan has fallen by 95%. “We found that … so we think drug dealers are looking at novel ways to get their products to people,” Professor Keenan said.
Nitzen is not a completely new drug. They were first synthesized about 60 years ago as a substitute for morphine, but were never brought to market because they were too potent and posed a significant risk of overdose.
“The formulations to make them have been shelved and I think we’ve seen these drugs emerge in Europe over the last three years, first in Eastern Europe, then more recently in France, the UK and now is also used in Ireland. ”
Professor Keenan said it was unclear where the laboratories making the Nitzens were based, but some could be as far away as Asia.
The HSE says the risks associated with these drugs are much higher than heroin or fentanyl, which is 20 to 40 times more potent and has caused a huge problem in the US.
He said the particular type of nitazene identified on the Irish market was “15 times more potent than fentanyl”.
“We hear a lot about fentanyl, but we have yet to see any evidence that it exists on the Irish market.
“We’ve seen the identification of nitazenes, drugs that are actually more potent… So our concern is that all the talk about fentanyl is distracting people. about it.
“They hear us talking about Nitazene and often say at least it’s not fentanyl, and they might be tempted to take Nitazene, but actually Nitazene is more powerful than fentanyl,” Keenan said. the professor said.
The light brown powder behaves differently than regular heroin when cooked, forming a more jelly-like substance.
The drug acts on the body very quickly, and some people who took Nitazen collapsed almost immediately and their breathing was affected.
To address the levels of overdoses, those working with drug users, including the HSE and homeless services, have increased the availability of the prescription drug naloxone.
Nearly 6,500 units of naloxone will be available in 2023, and it was used more than 200 times last year even before overdoses spiked in November. Usage is expected to increase further.
In 2022, there were also more than 300 reported cases of its use, but the increase in use at that time is due to improved reporting and how well the drug helps reverse some of the effects of overdosing on synthetic drugs such as heroin and nitazene. This may be due to increased awareness of how it can help.
“What we find with naloxone and Nitazene is that you probably need an additional dose of naloxone, or maybe two doses of naloxone, to create a reaction and get you out of an overdose.”
Professor Keenan said the drug had saved lives in some cases, even before ambulances arrived at the scene, and was now being used regularly.
Overdose response training program launched
This month, the HSE is recruiting drug users themselves, their families, and people who work in homelessness and other support services to be trained in how to respond to overdoses, including teaching them how to administer naloxone to people who have overdosed. .
Around 130 people who regularly use opioids and come into contact with them on a daily basis are being recruited by the HSE to learn about the risks of overdose and how to prevent it.
It is hoped that this peer-to-peer training will help get the message across to communities that sometimes lack trust in authorities.
Jenny Smith, the HSE’s naloxone project leader, said between six and eight colleagues would take part in each of the 16 programs starting later this month.
“When I say peers, I mean they may be opioid users or have regular contact with opioid users. You will have skills to learn.”
Ms Smith said naloxone is easy to administer and comes in two forms: a nasal spray and an injection.
She says if someone has overdosed and you don’t know what to do, you can call 999 and emergency services personnel will take the necessary steps.
Those trained on how to administer naloxone include those working in homelessness services and the Anna Liffey drug project in Dublin city centre.
One of the team leaders, Damy Ganivin, said many people who use heroin are trying to numb the pain, and this group of users try new substances like Nitazen, despite the obvious risks. He said that there is a possibility that it is particularly weak.
“People use substances to relieve pain, whether it’s heroin or sex. Whatever the substance is, it touches on the nature of addiction and makes sure that people suffering from it have access to the right support and access. We just need to make sure that we have quality care.”
Mr Ganibin said Anna Liffey, who has worked with drug users for the past 40 years, urged those she met not to take any new drugs.
However, multiple drug use is often a problem among the users the service serves, and if people choose to take drugs, they may not be able to take them themselves, especially if they buy from a new supplier. It shouldn’t, he added.
“We know that people may be receptive to it, and it’s just a matter of providing them with the appropriate harm reduction information.
“Be aware of the risks and make sure you are with someone or take it in small doses rather than all at once.
“This is really hardcore harm reduction advice and certainly this is the message we try to get across to our customers,” Ganivin said.