Rising Concerns Over Nitazenes, Stronger Than Fentanyl

In recent years, overdose deaths linked to lesser-known opioids, particularly nitazenes, have surged. Surprisingly, these substances are considered even more dangerous than fentanyl.

Nitazenes, a synthetic opioid class, was engineered as a painkiller back in the 1950s. However, a report from the Inter-American Substance Abuse Control Committee (CICAD) noted it was never approved due to its risky potential for overdose. Since around 2019, nitazenes like benzimidazole-opioids have made their way into the European illegal drug scene, with reports emerging from multiple continents.

CICAD indicates that the use of nitazenes is climbing in North America, suggesting that they are likely widely accessible across the U.S. The most prevalent form of nitazenes is isotonitazen (ISO), although numerous variants have been identified.

According to the Drug Enforcement Administration (DEA), ISOs, along with other nitazenes, are classified as Schedule 1 drugs. Corey Gamberg, a licensed alcohol and drug counselor and executive director at the Massachusetts Center for Addiction, indicated that nitazenes are primarily produced in illicit labs in countries like China and India and smuggled into the U.S. using the same routes as fentanyl.

Experts point out the appeal of these synthetic opioids—They’re inexpensive to produce, making them attractive to illegal manufacturers. As authorities clamp down on fentanyl, drug traffickers tend to shift towards newer synthetic opioids like nitazenes to evade law enforcement. “These substances are cost-effective to manufacture and simple to distribute,” Gamberg noted, highlighting a troubling trend that’s becoming all too familiar.

Nitazenes come in various forms including tablets, powders, and sprays, and can be snorted, smoked, injected, or ingested. Alarmingly, some nitazene types are reported to be significantly stronger than fentanyl, which raises serious concerns over their potential for harm.

Dr. Jonathan Avery, vice-chairman for addiction psychiatry at NewYork-Presbyterian/Weill Cornell Medical Center, confirmed that some nitazenes can be hundreds of times more potent than morphine and ten times stronger than fentanyl. The risk of a fatal overdose, along with symptoms like addiction and severe physical effects, including dizziness and seizures, has been documented.

Moreover, many users are unaware they’re consuming nitazenes since they are often mixed with other drugs like heroin or pressed pills. This unpredictability significantly heightens the risk of overdose.

Dr. Ryan Marino, a medical toxicologist, also mentioned that while test strips exist to help check for nitazenes in various substances, comprehensive testing is only available at advanced toxicology labs and can be costly and time-consuming.

Although naloxone (Narcan) can reverse a nitazene overdose, it sometimes requires multiple doses. As Dr. Avery emphasized, public education, widespread distribution of naloxone, and quick drug testing are essential in fighting this growing crisis.