National Patient Safety Alert

A national patient safety alert has been issued by the Office for Health Improvement and Disparities regarding an elevated number of overdoses (with some deaths) in people who primarily use heroin in many parts of the country.

Testing in some of these cases has found nitazenes, a group of potent synthetic opioids. Nitazenes have been identified previously in this country, but their use has been more common in the USA. Their potency and toxicity are uncertain but perhaps similar to, or more than fentanyl, which is about 100x strength of morphine. The nitazenes being detected vary, including some not seen in the UK before:

• Isotonitazene
• Metonitazene
• N-desethyisotonitazene
• N-pyrrolidino etonitazene
• N-pyrrolidino protonitazene

It should be noted that there are no current reports of an increase in suspected drug related deaths locally. In recent weeks there have been local unconfirmed reports of heroin and/or drugs being sold as Fentanyl that have been linked with adverse reactions and overdoses prompting targeted information to be issued.

Given the increased reports being received, it is important to raise awareness amongst staff and people who are at increased risk of these type of incidents by providing harm reduction messages.

Actions to take:

1. Please read the information provided by MHRA here:
   • NatPSA_2023_009_OHID.pdf
2. Remain alert and forward reports of incidents to drugalerts@hants.gov.uk. Where possible provide physical descriptions of drugs of concern including colour and any markings.
3. Ensure people who use opiates receive regular harm reduction reminders. Harm reduction messages are as follows.

Drug supplies change, best test first

• What’s in your drugs can change frequently and your dealer doesn’t always know what’s in them or how powerful they may be.
• Best start with a small amount or inject slowly to test the effect.

Using different drugs together significantly increases risk

• Be very careful when mixing drugs; particularly Heroin, Alcohol, Benzos (Street Valium) and Pregabalin.

Look out for your mates

• If possible, use with mates. Using alone is much more risky as there is no one to look out for you if you overdose.

Look out for the signs of overdose

An overdose won’t always look the same but some of the signs to look out for are:

• falling unconscious
• very light shallow breathing or no breathing
• loud raspy ‘snoring’ or gurgling
• blue or pale lips or fingertips

Call an ambulance (dial 999)

Naloxone - get it, carry it, use it

• If giving someone naloxone:

• if someone overdoses act fast, don’t wait to see if they will recover – you could save their life
• remember, call an ambulance immediately
• check the person is breathing
• put them in the recovery position: on their side with their head resting on their arm
• give them naloxone as soon as possible