What Are Nitazenes and Why Are They Dangerous?

Nitazenes are a dangerous class of synthetic opioids, significantly more potent than morphine and heroin, and are increasingly found as contaminants in the illicit drug supply. These substances pose a high risk of overdose, although naloxone can be effective, often requiring multiple doses. Harm reduction strategies, including drug checking, cautious dosing, and never using alone, are crucial to minimize risks associated with nitazene use.

One of the most concerning new synthetic substances is the rise of nitazenes, a class of synthetic opioids that pose a significant risk to people who use drugs. These substances, initially developed decades ago, have resurfaced as dangerous contaminants in the illicit drug supply, creating unprecedented opioid dangers. If you or someone you know is struggling with substance use, understanding nitazenes is crucial for staying safe.

What Are Nitazenes and How Are They Different from Fentanyl?

So, what are nitazenes, and how are they different from fentanyl? Nitazenes are a class of benzimidazole-opioids, meaning they have a different chemical structure than fentanyl and other more traditional opioids. While they were initially explored as a fentanyl alternative for pain relief in the 1950s, they were ultimately deemed too dangerous for medical use. This is why they never made it to pharmacies and exist today as new street drugs only. The chemical structure of nitazenes enables clandestine chemists to easily create numerous different versions, known as analogs, which further complicates the issue.

How Potent Are Nitazenes Compared to Heroin and Morphine?

The extremely potent synthetic opioids’ risks associated with nitazenes stem from their sheer strength. These substances can be many times more potent than morphine and even heroin. To put it in perspective, some nitazenes are 25 to 4,300 times stronger than morphine. For example, considering the isotonitazene vs metonitazene potency: isotonitazene is about 250 times stronger than morphine, while metonitazene is around 50 times stronger than heroin. This extreme potency means that even a tiny amount, invisible to the naked eye, can cause a fatal overdose.

Where Are Nitazenes Being Found in the Illicit Drug Supply?

One of the most alarming aspects of the nitazene crisis is its presence in unexpected places. Nitazenes are increasingly being found as hidden contaminants in a variety of substances, including

• Heroin and fentanyl samples
• Counterfeit prescription pills (often disguised as oxycodone, Xanax, or Adderall)
• Cocaine and methamphetamine
• Illicit benzodiazepines

This widespread contamination creates a significant drugs laced with nitazenes overdose risk. People may unknowingly consume the substance, believing they are taking a different, less potent drug. The difference between nitazenes and prescription opioids is that prescription opioids are regulated and dosed precisely, while nitazenes are produced illegally with no quality control.

What Are the Signs of an Overdose?

Recognizing the signs of an overdose is critical and can save a life. The symptoms of a nitazene overdose are similar to those of other opioid overdoses, but they may appear more rapidly due to the drug’s potency. Key signs include

• Slow or shallow breathing (respiratory depression)
• Unresponsiveness or loss of consciousness
• Blue or grayish lips and skin
• Pinpoint pupils
• Gurgling sounds or vomiting

If you observe these signs in someone, it is crucial to act quickly.

Does Naloxone Work on Nitazene Overdoses?

Yes, naloxone (Narcan) can reverse a nitazene overdose, but there are important considerations. Due to the high potency, an increased naloxone dose for nitazenes is often necessary. You may need to administer multiple doses to fully reverse the effects of the drug. It’s also important to remember that the effects of naloxone may wear off faster than the effects of the nitazene, so continuous monitoring is essential. Always call emergency services immediately after administering naloxone, even if the person seems to recover.

What Are the Long-Term Effects?

While research on the long-term effects of nitazenes is still emerging, we can infer some of the potential consequences based on what we know about other potent opioids. These may include:

• Rapid development of tolerance and physical dependence
• Severe withdrawal symptoms (muscle pain, anxiety, insomnia)
• Increased risk of respiratory and cardiovascular damage
• Mental health deterioration (depression, psychosis)
• Cognitive impairment with chronic use

The “Why were nitazenes never approved for medical use?” question is answered by these severe risks. The potential benefits simply did not outweigh the dangers.

Harm Reduction Strategies for Nitazene Use

Given the dangers of nitazenes, harm reduction strategies for nitazene use are essential. These strategies aim to minimize the risks associated with drug use without requiring abstinence. Here are some steps you can take to stay safer:

• Drug checking: Use specialized test strips to check your drugs for the presence of nitazenes. Keep in mind that standard fentanyl test strips may not detect all nitazenes.
• Dose cautiously: If you choose to use drugs, start with a very small amount, especially when using a new batch.
• Never use alone: Have someone present who can administer naloxone and call for help if needed.
• Multiple naloxone doses: Carry at least three to four doses of naloxone, as more than one dose may be needed to reverse an overdose.
• Avoid mixing: Avoid mixing drugs, especially with alcohol, benzodiazepines, or other depressants, as this can increase the risk of overdose.
• Access medical support: Seek professional help for withdrawal management and treatment options.

Public health agencies have issued a public health warning due to the rising number of overdoses and deaths associated with these drugs. In the UK, there were 284 confirmed nitazene-related deaths between June 2023 and May 2024.

The rise of nitazenes is a serious concern, but by staying informed and taking precautions, you can reduce your risk. If you or someone you know is struggling with substance use, Mountainside can help. We offer comprehensive, individualized treatment programs to meet every person where they are. Speak with an admissions specialist today to discover your options.