For several years Irish authorities have been bracing themselves for the arrival of fentanyl, the synthetic heroin-like drug that has claimed many lives in Europe and the US.
Until recently Ireland appeared to have avoided the brunt of the danger; by the start of this year, just a handful of fentanyl seizures had ever been made in the country.
However, that may be changing. The Ana Liffey Drugs Project in Dublin has warned of increasing numbers of drug users reporting that street heroin is getting stronger, leading to suspicions that it is being cut with fentanyl.
In the UK there have been up to 80 fentanyl overdose deaths in the past eight months and authorities here know that drug trends are quick to jump across the Irish Sea.
"What happens in one country will spread to another over time," said John Power of Forensic Science Ireland, the State's drug laboratory.
The main danger comes not from the drug itself but from its highly concentrated form. Drug users are buying it in the belief that it is ordinary heroin. When they take their standard hit, they are actually injecting something many times more potent.
Seizures of fentanyl have been found to be as much as 15, or 100, or even 600 times stronger than heroin.
“There’s a big danger here, because it looks like typical heroin. And we’ve also seen it in white powder form, so people could think it’s cocaine,” said Mr Power.
Fatal overdoses
Worries about the drug began here in 2015, when Ireland was warned by the European Monitoring System for Drugs and Drug Addiction to be vigilant for a new synthetic opioid that was causing dozens of overdose deaths across the EU.
In 2016 the HSE issued a public alert about fentanyl after it was implicated in five overdose deaths in Dublin and Cork.
At the same time the general public were becoming aware of fentanyl after an American medical examiner said the pop star Prince had died from a toxic overdose of the drug.
Gardaí report that the situation seems to be getting gradually worse since then. One of the biggest problems in stopping fentanyl from taking hold in Ireland is that it is entirely synthetic, meaning it can be manufactured anywhere given the right equipment and expertise. The growth in the online drugs market also makes it far easier to distribute.
Garda advice
Two months ago, gardaí took the unusual step of issuing a public warning about fentanyl on the RTÉ programme Crimecall.
"People genuinely aren't aware of what they're taking," said Det Supt Tony Howard. "Unfortunately, the criminals that are manufacturing these drugs are putting it into heroin and cocaine. It's cheap. It's easy to add it to give the individual a stronger buzz.
"We at An Garda Síochána would support the view that we should have abstinence, but in the real world if you're taking drugs you really don't want to take them on your own because with fentanyl, the quicker you get medical assistance the better chance you have of surviving."
Even with prompt medical help, fentanyl can be deadly if doctors do not know what they are dealing with.
Naxolone, a new drug that can counter a heroin overdose, also works with fentanyl overdoses. But doctors need to know the patient has taken fentanyl and not heroin, otherwise they will administer an insufficient amount of Naxolone.
Ireland currently has the third highest rate of overdose deaths in the EU. If fentanyl takes hold, experts fear it will not be long until we are at the top of that table.
