Though devastating, it is not news that the United States is struggling with an Opioid Epidemic. Over the years, more and more synthetic Opioids, both legally prescribed and not, are making their way to the streets and into the hands of many. The presence and prevalence of Opioid abuse and eventual addiction has continued to rise due to the increased availability of substances like Methadone and Fentanyl and Fentanyl-analogs. The most recent addition to the list of deadly Opioids is that of Nitazenes. First reported to the United Nations Office on Drugs and Crime’s (UNODC) Early Warning Advisory (EWA) in 2019, this new subclass of deadly Opioids is supposedly up to 20 times more powerful than Fentanyl which is already 50 times stronger than Heroin.
What Are Nitazenes?
Early forms of this classification of Opioids have been traced back nearly 60 years where early pharmaceutical companies were attempting to create an alternative to Morphine; an effort to hinder Opioid dependencies. Nitazenes, however, proved problematic when early testing led to high rates of overdose and potential for abuse and were thus never approved for clinical treatment. Now, as the demand for illicit Opioids continues to increase, the desire for a stronger substance does, too. Because they are only recently on the global radar, their “re-discovery” and appeal is in part due to the similar effects of Fentanyl, and more importantly their less detectable nature in substance monitoring programs.
Currently, there are 10 known forms of the drug; three of the most common being Isotonitazene, Metonitazene, and Etonitazene, and with no seen potential for medical use, Nitazenes are deemed a Schedule 1 substance, the highest classification of the Drug Enforcement Administration (DEA). Of the outlook and scope of the emergence, associate director at The Center for Forensic Science Research & Education, Alex Krotulski, PhD said, “New synthetic Opioids, like the Nitazenes, are contributing to hundreds if not thousands of deaths as well each year. However, new synthetic Opioids are not routinely tested for—and even less frequently tested for if Fentanyl is present.”
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The Abuse And Effects Of Nitazenes
Perhaps more alarming than the presence of this new Opioid is the fact that many users are most likely unaware that Nitazenes are present in their chosen substance. Thus far, the chemical has been found most commonly in powder form, but is also sold as a pill or a liquid. Because of its strength and potency and “under the radar” profile, it is believed that substances like Heroin and Fentanyl are being laced and subsequently poisoning unsuspecting Opioid users.
The issue is multifaceted and far-reaching; the existing Opioid crisis continues to claim hundreds of thousands of Americans and the re-emergence of Nitazenes brings forth more unknowns both for scientists and the general population. Even without this newest addition, the number of fatal overdoses has been steadily increasing; since 1999, nearly 1 million Americans have died from substance use. In just the past year, from March 2020 to March 2021, 96,779 overdose deaths were reported, illustrating a 29.6% increase from years prior. 72% of overdose fatalities are linked to the presence of an Opioid.
Similar in base level functionality to other Opioids, Nitazenes bind to pain receptors in the body blocking the message from reaching the brain. The drug often causes feelings of euphoria and relaxation, adding to their potential for addiction.
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Treatment For Nitzazenes
As of yet, it is unknown if Narcan or Naloxone (the medication used to assist other Opioid overdose reversal) will be as effective as it is with other Opioids. Due to the intensity of Nitazenes, scientists are speculating that higher or more doses might be needed to effectively treat a Nitazenes overdose. Though without more information on the drug itself and its prevalence in the illicit drug market, it is too soon to know for certain.
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Opioids are a serious and calamitous problem, even without the prospect of a new chemical. If you or someone you love is struggling with an addiction, to Opioids or any other substance, know that you are not alone and there are people available to help you. Contact a treatment provider today to ask questions and get the assistance and treatment you need, today.
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Ashish Bhatt, MD, MRO
Doctor of Addiction Medicine
Learn about Dr. Ashish Bhatt
Dr. Bhatt has been Addiction Center's Medical Content Director for more than three years, providing his expertise to ensure quality and accuracy.
Doctor of Addiction Medicine
Expert in adult and child psychiatry
Over 20 years of professional experience