What Are Nitazenes?

Synthetic opioids such as fentanyl and their analogs have been a leading cause of opioid overdoses in the United States since 2016. According to the CDC, overdose deaths have increased from 16,849 in 1999 to over 100,000 in 2021 as a result of these substances.

It has been reported, however, that other opioid-like drugs are being circulated to the public. There is a possibility that these drugs are even more powerful, deadly, and harder to detect than fentanyl.

As America's opioid epidemic unfolds, nitazenes, or "Frankenstein opioids," present a severe and growing challenge to public health officials, first responders, and law enforcement officers.

What are nitazenes?

As described in the CDC's Morbidity and Mortality Weekly Report (MMWR), nitazenes are a group of synthetic opioids that are synthesized in a laboratory. Unlike naturally occurring opioids, such as morphine and codeine, which come from poppy plants, they're made in a lab.

Examples of nitazines include:

• Metonitazene

• Etonitazene

• Butonitazene

• Isotonitazene

• Clonitazene

In terms of controlled substances, nitazenes fall under Schedule I. The reason? The United States does not currently accept their use for medical purposes. Because Schedule I substances are so likely to cause dependence and addiction, they aren't available even with prescriptions. As well as heroin, there is lysergic acid diethylamide (LSD) on the Schedule I list.

Nitazenes were first developed by a Swiss company working to develop morphine alternatives in the 1950s. However, their risks prevented them from being introduced to the market. In 2019, Nitazenes, nicknamed "Frankenstein opioids," were found in street drugs for the first time. As a result of their dangerous potential to cause opioid overdoses, they've been making headlines recently.

What nitazenes have caused overdoses?

As of 2020, isotonitazene, also known as "nitazene," was the main cause of deaths related to nitazene. Metonitazene, however, caused the majority of nitazene-related deaths in 2021. Isotonitazene is considerably more powerful than fentanyl, a synthetic opioid linked to overdose deaths across the country. But, the potency of metonitazene is similar to that of fentanyl.

What makes nitazenes so dangerous?

Overdoses from nitazenes are highly likely to occur due to their extremely potent nature. The effects of an opioid overdose can include losing consciousness and stopping breathing. If left untreated, they can cause death.

The majority of opioid overdose deaths are caused by synthetic opioids such as nitazenes. In 2020, synthetic opioids caused more than 80% of deaths caused by opioid overdoses.

It is possible for someone to buy nitazenes unknowingly if they think they are acquiring something else when they buy street drugs. When you buy street drugs, you don't know what you're taking because synthetic opioids are often mixed with other substances. That's why it's very important to only take medications prescribed by healthcare providers and dispensed by pharmacies. The drugs or pills you purchase elsewhere may contain dangerous substances like nitazenes, which are potentially deadly.

How do nitazenes look?

Generally, nitazenes are found as powders. Their colors can range from off-white to yellow to brown. In addition, they may be mixed with other drugs, such as heroin or fentanyl. When a nitazene is added to a drug, it makes it more potent, more addictive, and less expensive.

Nitazenes can also be manufactured into pills under different names. An example would be oxycodone, an opioid prescribed by doctors.

How do people consume nitazenes?

As well as powders, nitazenes are available in capsules and liquids. Many users are likely injecting what they think is heroin or fentanyl, but instead, they are ingesting a substance laced with nitazenes. The drugs can be injected or snorted when in powder form.

Is there an effective treatment for a nitazene overdose?

In cases of a nitazene overdose, high doses of naloxone may be needed, which is used by emergency responders to revive victims of heroin overdoses or fentanyl overdoses.

Narcan, also known as Naloxone, is a synthetic opioid overdose reversal medication that is approved by the FDA. According to the Substance Abuse and Mental Health Services Administration, it is an opioid antagonist that binds to opioid receptors to reverse and block their effects.

What’s being done to prevent harm from nitazenes?

There is a growing concern about nitazenes from the U.S. Drug Enforcement Administration (DEA). There have also been warnings about the dangers of these drugs issued by several states, including Florida, Tennessee, and Ohio. It is crucial that the public is made aware that nitazenes have been found in street drugs. Maybe this will make someone think twice about buying a drug with unknown ingredients.

People can also prevent deaths from nitazene by having Narcan easily accessible.

If you or someone you know struggles with substance use, help is available. Call SAMHSA’s National Helpline at 1-800-662-4357 to learn about resources in your area.