Two deaths in Boulder County, Colorado, in 2023 are the newest within the U.S. to be blamed on the powerful class of synthetic opioids called nitazenes. Most health systems cannot detect nitazenes, so the precise variety of overdoses is unknown, but they’re implicated in greater than 200 deaths in Europe and North America since 2019, including 11 in Colorado since 2021. One of the 2 Boulder County deaths is linked to a brand new formulation called N-Desethyl etonitazene, which was identified by a national laboratoryand is considered the primary related death.
The Conversation interviewed Dr. Christopher Holstegeprofessor of emergency medicine and pediatrics on the University of Virginia School of Medicine and director of the Blue Ridge Poison Center, where opioid overdoses are increasing. He explains why nitazenes are so potent and deadly.
What are nitazenes?
Nitazenes are a category of synthetic opioids that comprises greater than 20 unique compounds, including isotonitazenewhich was first identified in 2019 and is thought on the streets as ISO. It also includes protonitazene, metonitazene and etonitazene.
Nitazenes are psychoactive substances, or “designer drugs,” that aren’t controlled by any laws or conventions but pose significant health risk to the general public. These substances have recently surfaced as illegal street drugs.
Researchers have relatively little information on how the human body reacts to nitazenes since the drugs have never passed through clinical trials. But lab tests show certain nitazenes might be tons of to hundreds of times stronger than morphine and 10 to 40 times stronger than fentanyl.
The U.S. Drug Enforcement Agency has classified many formulations of nitazenes as Schedule 1 drugs under the Controlled Substances Actmeaning they haven’t any medical use and have a high risk of abuse.
When were nitazenes first developed?
Nitazenes were initially developed within the Nineteen Fifties by the pharmaceutical research laboratories of the Swiss chemical company CIBA Aktiengesellschaft. It synthesized quite a few substances within the drug class for use as painkillers.
However, nitazenes were never approved by the U.S. Food and Drug Administration for medical use in humans. They were nearly forgotten outside of specialised research circles until they reemerged as street drugs in 2019. As law enforcement has cracked down on other drugs akin to fentanyl, illegal labs have used historical pharmacology research to formulate analogs of nitazenes as street drugs.
Since 2019, at the least six formulas have come from the unique patent, but others, just like the one detected in Boulder, are brand recent. Specialized lab testing is required to discover nitazenes in toxicology samples, and fentanyl test strips can’t detect nitazene analogs.
But since first being detectednitazenes have been blamed for 200 drug-related overdose deaths in Europe and the United States. Although nitazenes are actually identified as illegal street drugs in quite a few countries, many medical providers aren’t even aware they exist.
DEA, CC BY
What sorts of nitazenes are showing up on the streets?
Nitazene first appeared in 2019 within the Midwest as a white powdery substance much like cocaine. It later appeared on the streets of Washington, D.C., as yellow, brown and white powders. Since 2022, the DEA has found other sorts of nitazenes in each powder and blue tablet forms.
Nitazenes are also mixed with other street drugs akin to heroin and fentanyl and with fake oxycodone pills, without users knowing it.
The Justice Department has indicted several corporations in Chinaalleging that they ship the raw chemicals to make nitazenes to Mexico and the U.S., where they get mixed by cartels and traffickers, then distributed on the streets.
What are signs of a nitazene overdose?
The toxic effects of nitazene resemble those related to other classic opioids akin to morphine and fentanyl and include small pupils and slowing of the respiratory and central nervous systems, which might result in death.
Because of the potency of the nitazenes, symptoms can develop rapidly after someone is exposed, killing them before they’ll get medical care.
Does naloxone counteract the results of overdose?
Naloxone, commonly often known as Narcan, is reportedly effective in reversing overdoses on account of nitazene, but larger and multiple doses is likely to be required.