What are Nitazenes? Everything You Need to Know

Fentanyl is a powerful opioid drug that is responsible for the vast majority of opioid overdose deaths nationwide. In fact, synthetic opioids, primarily fentanyl, were responsible for approximately 70,601 drug overdose deaths in 2021 alone.[1] However, another drug is being brought to light in the headlines because of its potential for overdose and death: nitazenes.

What are Nitazenes?

Nitazenes are a class of powerful synthetic opioids known as benzimidazole-opioids. They were first created in the 1950s and 1960s and were designed to be used commercially as an alternative to morphine.[2] However, they were never approved for medicinal use due to their high risk of overdose. Still, the formula for nitazenes has been used by illicit drug manufacturers to develop new illegal synthetic opioids that can mimic, and are sometimes stronger than, fentanyl.

There are ten different types of nitazenes, but the most common are:

Isotonitazene
Metonitazene
Etonitazene

Nitazenes have gained attention in recent years due to their potential for recreational use and their relatively recent emergence in the drug market. Like fentanyl, nitazenes can cause overdose in very small amounts. More concerning is the fact that some nitazenes are up to 43 times stronger than fentanyl.

Although nitazenes aren’t new, they are becoming more common in the illicit drug supply as a result of federal and state crackdowns on fentanyl and the opioid crisis.

Several states have reported incidences involving nitazenes. At least two deaths in Boulder County, Colorado have been attributed to the drug and Ohio reported a 19% increase in nitazene-related cases at the beginning of 2022 compared to the previous year. Since 2019, the DEA has received 2,400 nitazene-related reports concerning the drug.[3]

According to Nick Goldberger, a commander with the Boulder County Drug Task Force, officials suspect most nitazenes are coming from the dark web. Drugs that are sold on the dark web can come from anywhere, be manufactured by anyone, and contain any number of illicit and toxic substances. Others are suspected to be smuggled in from other countries. In October 2023, the Drug Enforcement Agency indicted eight Chinese companies and employees after finding two types of nitazenes that had been shipped to Georgia and Florida.*

The Effects of Nitazenes

Nitazines, like other synthetic opioids, work by binding to and activating opioid receptors throughout the body. They produce feelings of pain relief, euphoria, and relaxation. Other side effects of nitazenes include:

Stress relief
Muscle relaxation
Itchiness
Fever
Sweating
Nausea
Vomiting
Slow breathing
Sedation
Respiratory depression
Loss of consciousness

Understanding the Dangers of Nitazenes

Unfortunately, like fentanyl, it can be nearly impossible to determine if a substance contains nitazenes. They have been found in heroin, counterfeit oxycodone pills, ketamine, and synthetic cannabinoids. Nitazenes can come in many colors and forms, including white, yellow, or brown powder as well as crystal solids.

The reason nitazenes are so dangerous is because they can be 10-43 times stronger than fentanyl, an already powerful and deadly substance. Even small doses of nitazenes can lead to respiratory depression, coma, and even death, especially when combined with other substances or alcohol.

While nitazenes only make up a small percentage of the synthetic opioids on the black market, Dr. Wilson Compton, deputy director of the National Institute on Drug Abuse, anticipates the nation will see more and more drug seizures involving nitazenes in the coming years. According to Dr. Compton, some versions of nitazenes can be even more dangerous than carfentanyl, which is estimated to be 100 times more potent than fentanyl.

Finally, since nitazenes were never developed for medicinal use, there is a lack of scientific research on nitazenes, making their safety profile and long-term effects largely unknown.

Signs of an Overdose Involving Nitazenes

Since nitazenes produce similar effects as other synthetic opioids, a nitazene overdose involves the same symptoms as fentanyl or opioid overdose. Symptoms of nitazene overdose may include:

Difficulty breathing or shallow breathing
Extreme drowsiness or inability to stay awake
Loss of consciousness or unresponsiveness
Constricted pupils
Cold, clammy skin
Slow heartbeat or weak pulse
Bluish tint to the lips or nails
Vomiting or gurgling noises
Seizures or convulsions

If you or someone you know may be experiencing an overdose, seeking immediate medical help is crucial.

Will Naloxone Work if Someone Overdoses on Nitazines?

Naloxone (Narcan) is an over-the-counter medication that can reverse the effects of an opioid overdose. Fortunately, since nitazenes are opioids, naloxone can reverse the effects and stop an overdose. However, it’s important to note that since nitazenes are so powerful, it can take several doses of naloxone in order to reverse the effects. In a 2023 JAMA Network Open study, 66% of people who overdosed on nitazenes required two or more doses of naloxone while only 36% did.[4] This can present issues for individuals who are not equipped with multiple doses of naloxone.

The current rise of nitazenes poses a significant threat to public health, and is a devastating reminder of the constantly evolving and worsening opioid overdose crisis. If you or someone you love uses drugs or would simply like to be prepared in the event of an emergency, it would be helpful to obtain several doses of naloxone. You can get naloxone over-the-counter from your local pharmacy, a naloxone distribution organization near you, and even on Amazon.

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What are Nitazenes? Everything You Need to Know