⚠️ Someone who is "snoring" heavily and cannot be woken is not asleep. That is an emergency.
Call 112 now⚠️ Warning still current (Trimbos, April 2026): counterfeit oxycodone containing nitazenes is still circulating.
Read the warning →Counterfeit pills on the illegal market increasingly contain synthetic opioids many times stronger than oxycodone. They are indistinguishable from real medication. One pill can be fatal. This page explains how to recognise an overdose and what to do at that moment.
In March 2025 someone in the Netherlands died with counterfeit 80 mg oxycodone tablets in their possession. Analysis by the Netherlands Forensic Institute showed there was no oxycodone in them, but the nitazene isotonitazepyne. The pills had been bought online as pain medication without a prescription.
The Trimbos Institute issued a Red Alert. In September 2025 the Dutch government placed all nitazenes under the Opium Act. And on 8 April 2026 Trimbos confirmed once again that the warning is still relevant: these pills are still circulating.
Someone who is "snoring" heavily and cannot be woken is not asleep. That is an overdose. Call 112, stay with them, and do not leave them alone. Put them in the recovery position if they are unconscious but breathing. If naloxone is at hand, give it and still call 112.
Nitazenes are not a variant of oxycodone. They are a separate group of synthetic opioids, once developed as painkillers but never approved as medicine. Some variants are so much stronger than you expect that the difference between "it works" and "breathing stops" is a few milligrams.
| Aspect | Oxycodone from the pharmacy | Counterfeit pill from the illegal market |
|---|---|---|
| Active substance | Oxycodone, controlled strength | Unknown; may be nitazenes or fentanyl analogues |
| Dose per pill | Constant and controlled | Varies within the same bag; not evenly pressed |
| Appearance | Recognisable, with package leaflet | Identically copied, including colour, score line and box |
| Margin before overdose | Wide with correct use | Very narrow; one pill can be too much |
| Recognisable without a lab | Yes | No, in no case whatsoever |
Counterfeit pills are industrially pressed. Colour, shape, score line and packaging are convincingly copied. There is no home test that reliably rules out nitazenes. That is why "just one pill from someone I know" is not a safe exception.
On top of that: the mixture in a batch is often unevenly distributed. The first pill may feel mild and the third from the same bag can be fatal. Experience with the previous pill says nothing about the next one.
What these substances are, why they appear in counterfeit medication, and what that means for anyone obtaining pills outside a pharmacy.
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You do not need to be a doctor to see this. You only need to know that heavy snoring in someone who has just taken opioids is not sleep.
Does not respond to being spoken to, shaken, or to a pain stimulus such as firm rubbing on the breastbone.
A deep, gurgling sound. This is the most underestimated sign and often the last one before breathing stops.
Long pauses between breaths, or shallow gasping. Sometimes breathing seems to have stopped altogether.
Grey or bluish discolouration of lips, fingertips and skin. Pupils as small as a pinprick.
Unsure? Then act as if it is an overdose. Calling 112 unnecessarily costs nobody anything. Calling too late does.
Say literally that it involves synthetic opioid painkillers and ask for naloxone. That is exactly what the Trimbos Institute advises. Give the address first, in case the connection drops.
Never leave the person to "sleep it off". Talk, stimulate, rub firmly on the breastbone. If they are unconscious but breathing: recovery position, so they cannot choke on vomit.
Naloxone temporarily reverses the effect of opioids and is often available as a nasal spray. It wears off sooner than the opioid itself, so someone can relapse. So always call 112 as well, even if the person comes round.
Tell them what was taken, how much and when, even if it was obtained illegally. That determines the treatment. You will not be arrested for saving someone's life.
Nitazenes are a group of synthetic opioids originally developed in the 1950s but never approved as medicines. They act on the same receptors as oxycodone and morphine, but some variants are many times stronger. They turn up in counterfeit pills that look like pharmacy medication.
Yes. In March 2025 someone in the Netherlands died with counterfeit 80 mg oxycodone tablets in their possession. The Netherlands Forensic Institute established there was no oxycodone in them but the nitazene isotonitazepyne. Since September 2025 all nitazenes fall under the Opium Act, and in April 2026 the Trimbos Institute confirmed the warning is still relevant.
No. Counterfeit pills are pressed with the same colour, shape and score line as real medication. The packaging can also be convincingly copied. Only laboratory analysis gives certainty. That is exactly why pills from an unknown source are never safe, however genuine they look.
Watch for: the person cannot be woken, breathes slowly or irregularly, makes a heavy snoring or gurgling sound, has blue or grey lips and fingertips, and very small pupils. Heavy snoring from which someone cannot be woken is not deep sleep but an emergency.
Call 112 immediately and say it is a possible opioid overdose. Stay with the person. Put them in the recovery position if they are unconscious but breathing. If naloxone is available, administer it according to the instructions. Never leave the person alone to sleep.
Three things greatly increase the risk. First, alcohol, sleeping pills or tranquillisers on top: these amplify the suppression of breathing. Second, using alone, because then nobody calls 112. Third, relapsing after a period without use: your tolerance drops quickly, so your old dose can suddenly be too much.
Naloxone temporarily reverses the effect of opioids and can save lives. In the Netherlands it is available on prescription, often as a nasal spray. Ask your GP or an addiction service about it if you or someone close to you uses opioids. Naloxone does not replace 112: always call anyway.
Then this is the moment to involve someone. The help page lists who you can call today, and what to say if you don't know how to begin.