The warning was sent to senior officials, GPs and pharmacists this week from Northern Ireland's Chief Medical Officer Michael McBride.

A drug that's up to 10,000 times more potent that morphine and is used to tranquilise elephants could be present in heroin in Northern Ireland.

The warning was sent to senior officials, GPs and pharmacists this week from Northern Ireland's Chief Medical Officer Michael McBride.

He said there was now evidence “which indicates the potential presence of fentanyl/carfentanyl in heroin within Northern Ireland”.

"Those of you in contact with heroin users should be alert to the increased possibility of overdose arising from heroin cut with these synthetic opioids, be able to recognise possible symptoms of overdose and respond appropriately."

The letter says that heroin has been mixed with fentanyl or carfentanyl.

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Fentanyl is about 100 times more potent than morphine and is a licensed medicine used to treat severe and terminal pain.

While Carfentanyl is 4,000 -10,000 times more potent than morphine and principally used as an animal tranquilliser.

The letter warns: "Both of which are highly potent synthetic opioids and very small amounts can cause severe or even fatal toxicity.

"Across the UK, there is significant evidence from a small number of post-mortem results of recent drug user deaths and from police seizures that some heroin may contain fentanyl or carfentanyl added by dealers."

The symptoms in signs of overdose include loss of consciousness, shallow or absent breathing, ‘snoring’, and/or blue lips or fingertips. It adds: "Be prepared to call immediately for an ambulance if someone overdoses".

Earlier this month the Public Health Agency launched a campaign to combat prescription medicine abuse.

It said that Tramadol, Diazepam and antidepressants was responsible for 27 times more deaths than illicit drugs such as cocaine in 2015.

Joe Brogan, Head of Pharmacy, Health and Social Care Board said: "We have one of the highest rates of deaths in Northern Ireland as a result of prescription medicine abuse.

"We want people to understand that while prescription medicine can be beneficial when prescribed correctly, it can cause serious harm and, sadly, as we have seen recently, death when misused, abused or mixed with other drugs or alcohol.”

Such is the menace of drugs in Belfast that every council-owned public toilet is set to have a needle drop-off.

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Sharps boxes are being introduced to allow drug users to safely dispose of needles.

A sharps box has been installed at the Winetavern Street convenience and they will be installed at the rest of the council's 12 public toilet facilities over the next year.

Belfast Telegraph