Although incidents related to it remain rare, an emerging class of drugs called nitazenes has raised concerns among health officials due to its greater potency than fentanyl, the need for multiple doses of naloxone in overdose cases, and the lack of awareness about it among healthcare providers.
Key Facts
Nitazenes are a class of potent synthetic opioids originally created as a morphine substitute over 60 years ago, but they were never commercially released due to a high risk of overdose, according to the Alcohol and Drug Foundation, a nonprofit organization based in Australia.
Like fentanyl, nitazenes are mixed with other drugs, but due to a range of potency within its class, some nitazenes can be as much as 43 times stronger than fentanyl, even though the use of illicit drugs remains rare.
At least two deaths related to nitazenes have been reported in Boulder County, Colorado, since mid-2023, one of which involves a new nitazene compound that has been sent for further testing, according to the Boulder County Coroner’s Office report dated December 27, 2023.
There has been an increase in the spread of nitazenes in other states: Ohio reported a 19% increase in nitazene cases in the first quarter of 2022 compared to the previous year, and Tennessee reported 42 overdose deaths in 2021, up from 10 in 2020.
“We strongly suspect this is coming from the dark web”, said Nick Goldberg, the commander of the Boulder County Drug Task Force, to local news station Fox 31, referring to the origin of nitazenes – and Forbes has reached out to the Boulder County Drug Task Force for comment.
The Drug Enforcement Administration issued eight charging directives against Chinese companies and employees in October 2023 for importing nitazenes, fentanyl, xylazine, and other substances into the United States after the agency found that the companies had shipped two types of nitazenes to Georgia and Florida, and over 80 kilograms of synthetic pharmaceutical compounds across the country.
Important Quote
“Nitazenes are dangerous synthetic opioid drugs that can be potent, or even stronger than fentanyl”, said Anne Milgram, the administrator of the Drug Enforcement Administration, in a statement released in October. “They have no legitimate use”.
Main Background
Reports of nitazene use began to resurface in 2019 after a period of reporting between 1999 and 2004, according to the Drug Enforcement Administration. After the Drug Enforcement Administration made all fentanyl-related drugs illegal in 2018, drug suppliers in China responded in 2020 by rerouting the fentanyl flow to Mexico and India. As a result of this shift, “we saw a new class of opioids fill that gap”, according to Alex Krutulsky, co-director and program director of the NPS Discovery open alert system for drugs, who stated, referring to nitazenes. Nitazenes have often been mixed with fentanyl and other substances, and due to limited knowledge about nitazenes, there is little information on how to reverse overdoses, or their interactions with other drugs and alcohol, a study published in Cureus in 2023 found. This poses hurdles as drug users are often unaware they are taking nitazenes, and paramedics and other medical professionals handle overdose cases without appropriate knowledge. Although overdoses can be treated with naloxone, patients may require multiple doses of the medication due to the potency of the opioid drugs and the severity of poisoning, according to the Boulder County Coroner’s Office report.
More
66% of participants in a study conducted in 2023 in JAMA Network Open who experienced nitazene overdoses required two or more doses of naloxone, while only about 36% of patients who experienced fentanyl overdoses needed more than one dose.
Side Note
There are 10 known forms of nitazene, with the most common being isotonitazene, metonitazene, and etonitazene, according to the Addiction Center. They are classified as Schedule I substances by the Drug Enforcement Administration, which is the highest classification for drugs by the agency – indicating a high potential for abuse and no accepted medical use. Nitazenes usually appear as white, yellow, or brown crystalline powder. They have been found in heroin, fake oxycodone pills, synthetic cannabinoids, and ketamine. They can be inhaled, injected, or swallowed and can cause pain relief, euphoria, relaxation, stress relief, itching, fever, sweating, nausea or vomiting, and slow breathing.
Further Reading
The hard fight against illegal drugs and overdose deaths: the emergence of novel designer drugs and opioid derivatives (National Institute of Justice)
Follow me on Twitter or LinkedIn. Send me a secure tip. Ariana Johnson
Editorial Standards
Print Reprints and Permissions
Leave a Reply