Increased prevalence of potent drug surpassing fentanyl potency reported in the Americas, causing alarm among experts
Synthetic Opioid Nitazenes Pose a Growing Threat to Public Health
Nitazenes, a class of synthetic opioids, have emerged as a significant concern due to their extreme potency and the associated risks they pose. These substances, which can be up to 500 times stronger than heroin, are causing a growing number of overdose deaths.
Risks Associated with Nitazenes
The extreme potency of nitazenes, such as isotonitazene and etonitazene, makes them active at doses as low as 0.1 mg. This high potency increases the likelihood of accidental overdose, leading to respiratory arrest and death. Nitazenes act on the mu-opioid receptors with exceptional potency, causing profound respiratory suppression, a primary cause of fatal overdose in opioid users.
Furthermore, nitazenes are often found as contaminants in pills and powders, often without precise dosing controls, increasing the danger of unintended exposure. Additionally, they are frequently mixed with fentanyl, benzodiazepines, stimulants, and other drugs, which multiplies overdose risk due to combined sedative effects.
Detection and Public Health Management
Detection of nitazenes is challenging due to their chemical structure, which differs from fentanyl and heroin, requiring specific assays. Many deaths involving nitazenes go unreported due to lack of widespread testing protocols. Some countries and states, such as Pennsylvania, have begun responding by temporarily scheduling nitazenes as controlled substances to restrict their distribution legally and to raise awareness.
Efforts include scheduling nitazenes as Class I controlled substances, which broadens law enforcement powers to curb their distribution and possession, aiming to limit supply. Community organizations also recommend and provide testing resources to detect nitazenes and other synthetic opioids in street drugs, enabling users to be better informed and reduce harm.
However, the efficacy of naloxone, the opioid overdose reversal agent, against nitazenes may be reduced, complicating emergency response and requiring higher or multiple doses.
Conclusion
Nitazenes present a hidden but growing threat to public health due to their potency, detection difficulties, and interaction with other substances. Public health strategies focus on enhanced surveillance, regulatory controls, improved toxicology testing, and harm reduction education to address this emerging opioid danger. It is crucial to raise awareness about the risks associated with nitazenes and to promote the use of testing resources to protect individuals and communities from this deadly threat.
[1] CICAD's report on nitazenes (2021) [2] Dr. Jonathan Avery, vice chair of addiction psychiatry at NewYork-Presbyterian/Weill Cornell Medical Center, statement on nitazenes (2021) [3] Pennsylvania's temporary scheduling of nitazenes as controlled substances (2021) [4] Nitazenes found in illicit drug supply (2021) [5] Harm reduction and community testing for nitazenes (2021)
1. The growing threat of Nitazenes to public health is rooted in their extreme potency, which not only increases the risk of accidental overdose but also the complexity of detection, as their chemical structure differs from common opioids.
2. Addressing the mental health of individuals struggling with substance abuse related to Nitazenes is critical, as the misuse of these powerful synthetic opioids can have severe consequences on an individual's overall well-being and long-term health-and-wellness.
