Nitazene might jumpstart an opioid epidemic in Europe. It is highly addictive with a potency significantly higher than fentanyl or heroin. Here is everything you need to know about the drug.
The opioid crisis is far from over – and with a new player entering the game, authorities and policymakers are facing new challenges. Novel potent opioids (NPOs), such as nitazenes, are posing a threat to illicit drug users, due to their high addictiveness and toxicity. This is no longer limited to the US but has been observed in the UK as well.
Nitazene is a synthetic opioid with a high analgesic potency. It causes euphoria, has a numbing effect and can be ingested as pills, inhaled, or injected. These types of NPOs are causing a higher activation of the µ-opioid receptor than morphine or fentanyl, leading to an increased risk of addiction. Moreover, this class of drugs leads to breathing depression that lasts significantly longer than for example fentanyl, increasing the risk of suffocating when overdosing. Regular breathing only sets in around 208 minutes after use, as reported by a German pharmacological newspaper. Compared to that, regular breathing after the use of fentanyl sets in after around 67 minutes.
Nitazene was developed in the 1950s as a potential analgesic. The potency of its most potent derivate is up to 1,000-fold greater than the potency of morphine, making it highly addictive. Hence it wasn’t approved for clinical or therapeutical use and never entered the market. Nonetheless, it has made its way to black markets around 2019 and is often used as an additive in heroin or cocaine. This will only become more pronounced: with the poppy farming ban in Afghanistan – which was implemented by the Taliban last year –, the prices for opioids will increase when supply decreases. A comparatively inexpensive drug, such as nitazene, will more often be added to heroine and other drugs to decrease its price.
An investigation in the UK from 2021 tested several confiscated drugs for contaminants and found ¼ of the cocaine samples and around half the heroine samples to be contaminated with nitazenes. This increases the risk of overdose (OD) tremendously and has already led to many deaths in the past.
On a positive note: similar to fentanyl-OD, an OD with nitazenes and other NPOs can be treated with naloxone. A study analyzed the success of treating OD in patients caused by NPOs with naloxone. The patients included in this investigation presented with various symptoms ranging from respiratory depression, over low oxygen levels and depressed level of consciousness to cardiac arrest.
The dose of antagonist needed to reverse symptoms and treat OD was significantly higher in all NPOs compared to fentanyl-OD. Depending on the derivate of nitazene, up to five doses of naloxone were needed. On average two to three doses were required for successful treatment. However, naloxone couldn’t reverse symptoms in all cases. One patient presenting with cardiac arrest was treated with three doses in total, but was beyond saving.
Experts say that now is the time to act. “We know what’s coming down the line at us so this is the time to get a strategy in place”, said Gary Mc Michael, chief executive of a charity that offers alcohol and drug addiction support services across Northern Ireland, called ASCERT, in an interview with the BBC. “People who are vulnerable are becoming even more vulnerable [...]. The safety nets are under stress.”
Drug users and vulnerable groups have to be educated about the harmful and addictive potential of nitazene and how it is often used as an additive in other illicit drugs. The opioid crisis in the US has taught us that action has to be taken sooner rather than later to avoid a full-grown epidemic. Spreading awareness and educating patients are indispensable measures of prevention.
Image source: created with Midjourney
