This update has been developed by the HSE National Clinical Lead for Addiction Services and the National Red Alert Group (NRAG) in response to the emergence of N-pyrrolidino protonitazene on the Irish drug market. This fact sheet is dated February 2024 with the content and guidance subject to change based on possible future developments in this area.

Two outbreaks of overdose clusters have occurred since the 9th of November 2023 as a result of the emergence of the substance N-pyrrolidino protonitazene on both the Dublin and Cork heroin markets. As of the date of publication, a total of 57 non-fatal overdoses were reported to the HSE during the period of the 9th – 14th of November and a further 17 were reported over a 6 day period in the Cork Region at the start of December. At this moment in time, it is too early to speculate as to what extent nitazenes will become established on the Irish drugs market, but this is an area that now requires intensive monitoring by health care providers and law enforcement given the serious public health threat posed by these compounds. Of particular concern is the emergence of nitazenes sold as falsified medicines (mainly oxycodone as blue or yellow tablets and as benzodiazepines) in the UK. While less common, they have been sold as cocaine and cannabinoids, as well as in liquid form. Since the outbreak periods, a second alert was issued by the HSE (dated 2nd February 2024) following the identification of a second and new batch of nitazenes (Protonitazene). The HSE advised that there is now a risk of nitazenes presenting in a variety of different coloured powders.