Topline
Though incidents involving them are still rare, an emerging class of drugs called nitazenes has raised concerns among health officials due to them being more potent than fentanyl, the need for several doses of naloxone in overdoses and the lack of knowledge about them among healthcare providers.
Key Facts
Nitazenes are a class of strong, synthetic opioids that were originally created to be an alternative to morphine 60 years ago, but were never commercially released due to their high risk of overdose, according to the Alcohol and Drug Foundation, an Australia-based non-profit.
Similar to fentanyl, nitazenes are mixed with other drugs, but because there’s a range of potency in its class of substances, some nitazenes are up to 43 times stronger than fentanyl, though the illicit use of the drugs remains rare.
There have been at least two nitazene-related deaths in Boulder County, Colorado since mid-2023, and one included a novel nitazene drug compound, which was sent in for further testing, a Boulder County Coroner’s Office report from Dec. 27, 2023 says.
An increased prevalence of nitazenes has been reported in other states: Ohio reported a 19% increase in nitazene-related cases in the first quarter of 2022 compared to the previous year, and Tennessee reported 42 fatal overdoses in 2021, up from 10 in 2020.
“We highly suspect this is coming from the dark web,” Boulder County Drug Task Force commander Nick Goldberger told local news station Fox 31 in reference to nitazenes’ origins—Forbes has reached out to the Boulder County Drug Task Force for comment.
The Drug Enforcement Agency handed out eight indictments to Chinese companies and employees in October 2023 for importing nitazenes, fentanyl, xylazine and other substances into the U.S. after the agency found the companies shipped two types of nitazenes to Georgia and Florida, and over 80 kilograms of synthetic drug compounds across the country.
Crucial Quote
“Nitazenes are dangerous synthetic opioids that can be as powerful, or even more powerful, than fentanyl,” Anne Milgram, administrator for the DEA, said in an October statement. “They have no legitimate use.”
Big Number
2,400. That’s how many nitazene-related reports the DEA has received since 2019, according to the agency.
Key Background
Reports of nitazene usage began to reemerge in 2019 after a period of reports between 1999 and 2004, according to the DEA. After the DEA made all fentanyl-related drugs illegal in 2018, Drug suppliers in China responded in 2020 by shifting its flow of fentanyl to Mexico and India. Because of this shift, “we saw a new class of opioids fill that void,” Alex Krotulski, an associate director and program manager for open-access drug alerting system NPS Discovery, said in a statement in reference to nitazenes. He likened the emergence of the drugs in the U.S. to the “growth and diversity” of fentanyl. Nitazenes are often mixed with fentanyl and other substances and because they’re not well known, there’s little information on how to reverse overdoses, or its interaction with other drugs and alcohol, a 2023 study published in Cureus found. This poses obstacles because drug users don’t typically know they’re taking nitazenes, and first responders and other medical professionals are tasked with treating overdoses without proper knowledge. Although overdoses can be treated with naloxone, patients may require several doses of the medication due to the opioid’s potency and the potential severity of intoxication, the Boulder County Coroner’s office report said. Over 66% of participants in a 2023 JAMA Network Open study who overdosed on nitazenes required two or more doses of naloxone, while only about 36% of patients who overdosed on fentanyl needed more than one dose.
Tangent
There are 10 known forms of nitazenes, and the most common are isotonitazene, metonitazene, and etonitazene, according to the Addiction Center. They are listed as Schedule I substances by the DEA, which is the agency’s highest drug classification—stating there is a high potential for abuse and no accepted medical usage. Nitazenes are typically a white, yellow or brown powder or a crystalline solid. They have been found in heroin, fake oxycodone tablets, synthetic cannabinoids and ketamine. They can be inhaled, injected or swallowed, and can cause pain relief, euphoria, relaxation, stress relief, itchiness, fever, sweating, nausea or vomiting and slow breathing.
Further Reading
Fighting the Uphill War Against Illicit Drugs and Overdose Deaths: Detecting Emerging Designer Drugs and Opioid Analogs (National Institute of Justice)
