Much Stronger Than Fentanyl, Nitazenes Present Looming Crisis

Overdose victims require multiple doses of Naloxone due to strength of nitazene opioids.

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A new killer has emerged in the illegal drug market, leaving a trail of bodies in its wake. Synthetic opioids called nitazenes—as much as 20 times more potent than fentanyl—have infiltrated street drugs from heroin to benzodiazepines, catching unsuspecting users in a web of addiction and overdose death.

These opioids have evaded authorities and fueled a silent epidemic, presenting novel dangers that law enforcement is only beginning to grasp.

No Medical Use, High Addiction Risk

Nitazenes belong to a class of synthetic opioids called isotonitazenes, or ISOs. These compounds have gained attention because of their powerful painkilling properties. First developed in the 1950s, nitazenes were never approved for medical use and long remained obscure, known only in academic circles.

A defining trait of nitazenes is their extremely high potency—hundreds to thousands of times more potent than morphine and other older opioids and 10 to 20 times more powerful than fentanyl, which is already fueling the nation’s current drug crisis.

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Although it’s theorized that these compounds are coming from China, “nobody really knows for sure,” Dr. Jarid Pachter of Stony Brook Medicine, who specializes in family medicine and addiction medicine, told The Epoch Times.

So far, 20 distinct types of nitazenes have been detected in illegal street drugs, turning up with increasing frequency. As Schedule I drugs in the United States, a class that includes drugs with no accepted medical use and high abuse and addiction potential, all nitazenes are illegal.

Nitazenes are being used to spike and strengthen illegal drugs while also making them cheaper to produce, according to the U.S. Drug Enforcement Administration (DEA). This chemical tampering has already led to deadly overdoses.

UK Sounds Alarm on Spiking of Drug Supplies With Nitazenes

Like the United States, the UK is grappling with its own drug crisis. Recently, nitazenes have been detected in substances peddled as other opioids, benzodiazepines, or cannabis products.

Data from Scotland’s Rapid Action Drug Alerts and Response (RADAR) early warning system showed nitazenes directly caused 25 deaths between 2022 and 2023—compared to none before—as identified in postmortem toxicology tests.

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“Because nitazenes have been found in various street drugs like benzodiazepines and fake pharmaceuticals, people may not be aware they are taking nitazenes or the increased risk,” Tara Shivaji, a consultant in public health medicine at Public Health Scotland, said in a statement. Compounding the risk, the concentration of drugs in tablets, powders, and blotters can fluctuate dramatically even within the same batch, she noted.

Nitazenes Require Multiple Naloxone Doses

Synthetic opioids, including the nitazene class, are among the fastest-growing opioids that are causing emergency hospitalizations for overdoses.

However, evidence suggests that nitazenes inflict more severe health impacts. Most patients overdosing on nitazenes or other novel opioids need two or more naloxone doses, whereas fentanyl overdoses require just one, according to research published in JAMA Network Open.

Their extreme potency and pharmacological profile also heighten overdose and death risk, especially when combined with other central nervous system depressants such as benzodiazepines or alcohol.

“The risk is that you can not only have a horrible substance use disorder, but you can die of an overdose,” Dr. Pachter said.

More Than 106,000 Overdose Deaths in 2023 Alone

Opioids have driven a growing share of overdose deaths since 2009, accounting for nearly 71 percent of all fatal overdose deaths in 2019. Provisional data from the U.S. Centers for Disease Control and Prevention (CDC) show more than 106,000 overdose deaths nationwide through September 2023—an undercount because of incomplete reports.

More than 40 percent of U.S. adults know someone who fatally overdosed, according to a recent survey by the RAND Corporation think tank. Additionally, 13 percent said an overdose death substantially disrupted their life.

With so many synthetic drugs and unpredictable combinations, buyers can never know precisely what they’re getting, DEA intelligence analyst Maura Gaffney said in a statement.