Nitazenes: The New Opioids on the Block

For years, the primary villain in the opioid crisis has been street fentanyl, a synthetic opioid significantly more potent than traditional opioids like heroin and morphine. However, a new and even more dangerous class of synthetic opioids known as nitazenes is now emerging on the illicit drug market, posing an unprecedented threat to public health.

Key Takeaways

In 2021, there were around 108,000 drug overdose deaths in the United States, the most ever. Artificial opioids were a factor in more than 75 percent of those fatalities. Here’s what you need to know:

• Nitazenes, a highly potent class of synthetic opioids, poses an unparalleled threat to public health, surpassing the dangers of fentanyl.
• Overdosing on nitazenes can be deadly; even small amounts pose a high risk of overdose.
• Addressing the nitazene crisis requires a multi-faceted approach, including harm reduction, education, naloxone distribution, and supply chain monitoring. 

Keep reading to learn more about the new artificial opioids being mixed in the street supply.

Nitazenes: Origins

Nitazenes were initially created in the 1950s as a potential pain reliever but were never authorized for medical use because of their high potency and associated health risks. They remained absent and relatively hidden from the legal and illicit drug markets for decades.  

This changed, however, when nitazenes started to contaminate the supply of street drugs in the early stages of the COVID-19 pandemic. Nitazenes started appearing in various forms on the street, including powders, tablets, and liquid formulations.

Comparing Potency: Nitazenes vs. Fentanyl

Nitazenes are extremely potent, estimated to be around 1,000 times more powerful than morphine and ten times more than fentanyl. Even small amounts of nitazene can induce a powerful, opioid-like effect.

Alexandra Amaducci is an emergency medicine and medical toxicology expert at Lehigh Valley Health Network-USF Morsani College of Medicine in Bethlehem, Pennsylvania. Her and her team reviewed medical data concerning nitazene overdoses at an emergency department between 2020 and 2022. Dr. Amaducci, explains that nitazenes are dangerous because they require a smaller quantity of these drugs to produce the same effects. This makes it difficult for people to judge how much they can handle on their first use, making it easier for patients to overdose.

What’s more, Amaducci’s team also discovered that a nitazene overdose is more likely to be severe and more challenging to treat than an overdose caused by fentanyl.

Dangers of Nitazenes

Dr. Ramin Mojtabai, a mental health professor at the Johns Hopkins School of Public Health, stressed that individuals consuming illicit opioids are often unaware that the drugs they ingest may be laced with potent opioids like nitazenes. 

Synthetic opioids like nitazenes are often unintentionally consumed as they are mixed with other illicit drugs. Individuals may not be used to such potent substances, significantly increasing the risk of overdose and adverse effects. This is why harm reduction practices like purity testing can save lives.

All opioids carry a risk of respiratory and cardiac arrest, which can lead to fatalities when taken in higher doses. However, nitazenes can cause these effects even in smaller doses.

Overdose Deaths from Nitazenes

Individuals who consume illegal opioids, often without knowing, are at high risk of overdose and death due to the potency of these substances.

The investigation led by Alexandra Amaducci has revealed that nitazenes are responsible for approximately 200 overdose deaths in North America and Europe. In the study, Amaducci’s team examined a small number of individuals who received treatment for nitazene overdoses between 2020 and 2022.

The findings were alarming compared to overdoses caused by heroin or fentanyl; patients who overdosed on nitazenes required noticeably higher doses of naloxone to reverse the overdose.

The DEA Intelligence Analyst Maura Gaffney warns that many synthetic medicines are often blended, so users should always be cautious when purchasing. Only take pharmaceuticals prescribed by your doctor or given to you by your authorized pharmacist, as tablets or medications purchased from unlicensed sources are dangerous and frequently lethal.

Addressing Nitazenes Fatalities

Adopting a comprehensive public health approach is crucial to tackling nitazene risks and fatalities. Here are some strategies that can be implemented to diminish the supply and demand for these dangerous drugs:

Harm Reduction Strategies

Without necessarily demanding sobriety, harm reduction programs work to reduce the harmful effects of drug use. These initiatives include needle exchange programs, monitored injecting places, and public awareness campaigns.

Education and Awareness

Education is of utmost significance in the case of nitazenes risks. The entire public must be informed about the presence of these incredibly strong opioids in the illicit drug market. They must be aware of the increased danger of overdose from nitazenes and the importance of getting help immediately if an overdose happens.

Access to Naloxone

Naloxone, an opioid antagonist, can immediately reverse and block the effects of opioids, potentially saving those who have suffered from respiratory depression or cardiac arrest brought on by an overdose.

The number of overdose fatalities can be significantly decreased by increasing the accessibility of naloxone and ensuring the public is educated about its use. Nitazene overdoses often require a higher dose of naloxone to reverse. Naloxone is available over the counter without a prescription. After administering naloxone, call emergency medical services for further care and treatment.

Drug Checking Programs

Implement drug-checking programs to reduce the harm caused by substance use. These programs involve testing samples of drugs for dangerous additives, such as nitazenes, that may pose a health risk.

By providing individuals with information about the substances they intend to use, drug purity programs can empower people to make informed decisions about their drug use. 

Protecting Our Communities

To stop the creation and distribution of these deadly synthetic opioids, law enforcement agencies, healthcare professionals, and policymakers must collaborate.

The increased restriction and monitoring of fentanyl production may have contributed to the emergence of nitazenes. Nitazenes are easier to create without being discovered. Therefore, sellers may switch to them as a replacement as efforts to stop the production of illicit fentanyl intensify.

The emergence of this dangerous new class of opioids has a devastating impact on individuals and families worldwide and necessitates immediate and comprehensive action. Their high potency, easy accessibility, and silent lethality make them a formidable opponent in the ongoing battle against the opioid epidemic. 

However, by spreading the word about the risks, promoting harm reduction practices, and offering treatment, we can lower the risk of nitazene overdoses in our community.