Nitazenes: A Rising Threat in the Opioid Crisis
Nitazenes, a class of highly potent synthetic opioids, are rapidly emerging as significant contributors to the ongoing overdose crisis. This assertion is supported by a recent review published in Pain Medicine on September 14, authored by specialists from Vanderbilt University Medical Center and the University of Pittsburgh Medical Center.
Background and Potency
Originally developed in the 1950s, nitazenes were never approved for clinical use. These substances exhibit a potency over 20 times that of fentanyl and hundreds to thousands of times more than morphine. Available in liquid, pill, or powder form, nitazenes have been identified in illicit drugs sold through social media platforms since 2019.
Clinical Concerns
Intended as potential pain relievers, nitazenes have never undergone clinical trials for human use and are classified as illegal Schedule I drugs. Their presence in counterfeit pills and other street drugs poses substantial risks as they can be challenging to detect using standard drug tests.
“For patients, particularly those with opioid use disorder or those exposed to illicit substances, nitazenes represent a concealed yet profound threat,” emphasizes co-author Dr. Shravani Durbhakula, an associate professor in the Division of Pain Medicine at Vanderbilt University Medical Center. “Routine toxicology screens may not reveal these drugs, causing clinicians to overlook critical diagnostic components during overdose treatment. Additionally, patients may require higher or repeated doses of naloxone to counteract their effects,” she adds.
Overdose Data and Implications
The Tennessee State Unintentional Drug Overdose Reporting System (TN SUDORS) recorded 92 fatal drug overdoses involving nitazenes among Tennessee residents from 2019 to 2023. In this context, naloxone was administered in only one-third of nitazene-related fatalities, and all of these incidents involved the presence of other substances, with fentanyl and methamphetamine being the most common.
“Many individuals consuming nitazenes are often unaware of their intake,” Dr. Durbhakula notes. “These substances frequently appear as adulterants in pills marketed as other opioids, underscoring the necessity for public education.”
Urgent Public Health Measures
Dr. Durbhakula stresses that this issue transcends mere drug abuse; it constitutes a public health emergency requiring cohesive efforts from clinicians, public health officials, law enforcement, and community organizations. Comprehensive strategies must be implemented in harm reduction, addiction treatment support, and awareness-raising regarding these evolving threats.
The authors advocate for the proliferation of test strips capable of detecting nitazenes, as well as the provision of take-home naloxone, addiction treatments, and education regarding counterfeit pills for at-risk individuals.
Call for Further Research
“Nitazenes represent an emerging class of synthetic opioids that surpass fentanyl in potency and are often undetectable through conventional drug tests,” states Dr. Ryan Mortman, the corresponding author and resident in the Department of Physical Medicine and Rehabilitation at the University of Pittsburgh Medical Center. “Their swift proliferation in the illicit drug market, coupled with the complexities of overdose reversal, highlights the urgent need for public education, early recognition, and broadened access to harm reduction tools like naloxone,” he emphasizes.
Co-author Dr. Trent Emerick, an associate professor of Anesthesiology and Perioperative Medicine and Bioengineering at the University of Pittsburgh’s School of Medicine, discusses the next steps: generating human clinical data to more comprehensively understand nitazenes’ effects, particularly their long-term health implications, metabolism, and responses to treatments like naloxone. “The evolving nature of the opioid crisis necessitates a thorough understanding of the mechanisms and risks associated with nitazenes, which is essential for pain physicians, anesthesiologists, and other healthcare providers,” Dr. Emerick concludes.
Key Health Takeaway
As nitazenes pose a significant risk in the opioid crisis, healthcare professionals and community organizations must prioritize education, early detection, and access to harm reduction resources to mitigate their impact on public health.
