Baby Nicholas's death is a warning to Ireland of fentanyl's deadly spread

The fentanyl that killed one-year-old Nicholas Dominici was hidden in the nap room under a mat as he slept, police say.

Baby Nicholas Dominici was put down for his usual afternoon nap in childcare with his nursery friends. He never woke up.

The one-year-old died of a drug overdose.

Fentanyl residue, a synthetic painkiller that is 50 times more powerful than heroin, was discovered on the sleep mats where the children were found unresponsive just over a week ago. 

The drug is so powerful, that even a few sugar granules worth of it can kill an adult  — inhaling tiny particles proved fatal for Nicholas and resulted in three other babies being rushed to hospital.

The death of little Nicholas has struck a chord in a city that is grappling with a fentanyl crisis, and which is used to drug-related deaths. 

One person dies of an overdose in New York every three hours, the majority of which are fentanyl-related. 

Worryingly, medics say they are seeing more and more children presenting to emergency departments.

This week as the Taoiseach and other members of the coalition arrived in New York for the UN summit, updates on the Nicholas case, including reports on the kilo of fentanyl found in the daycare facility and the subsequent arrests of two people including the creche owner, ran across US new channels.

Our political leaders should take great heed of the chilling words of New York City health commissioner Ashwin Vasan: "Fentanyl is exquisitely dangerous. I use the word 'exquisitely' because I don't have another word to describe how dangerous this drug is."

Holding up a small clear bag containing the white substance, New York mayor Eric Adams appealed directly to parents at a hastily organised press conference.

"That little corner you see here is enough to kill an adult. A little corner. 

"So, if you're bringing fentanyl into your home and land it on the countertop, land it on a place where your child sleeps, land it near a crib, have it on your clothing, that little piece, that little corner... a tenth the size of a fingernail, can kill an adult, so imagine what it could do to a child.

"This is not the drugs of yesteryear. This is so dangerous."

At the same press briefing, Vasan held up another prop, a blue zip-lock case containing Narcan, the antidote administered to the nursery children, saving three of them.

In a stark indication of how out of control the problem now is, he said: "Narcan has to be everywhere, you should be carrying Narcan right now.

"Any time you see someone, walking past them, who looks like they might not be conscious, who might not be breathing, who might look more sleepy or tired than usual, think overdose, think opioid intoxication and think fentanyl," said Vasan, who later admitted that maybe his teams should now be looking for fentanyl when carrying out standard inspections on childcare facilities.

Fentanyl is already in Ireland.

Just like the US it is used as pain relief in medical settings where it is safely administered.

But, as Vasan stressed, it must be kept there.

"I remember the first patient I gave fentanyl to, a woman in her 40s who had developed metastatic breast cancer who herself was leaving a family behind and needed fentanyl to manage the pain of end-stage metastatic disease. 

"I remember ordering it for the first time and realising how powerful this substance is but how much relief it gave to someone suffering from pain unimaginable to most of us. This is where fentanyl belongs.

"It doesn't belong on our streets, and it doesn't belong in our homes. 

"It doesn't belong anywhere that trained clinicians are not, and it doesn't belong in forms like powders and aerosolised liquids. 

"It belongs in syringes, and it belongs in hospitals where they are extremely controlled substances."