Surging opioid nitazene could be deadlier than fentanyl, experts warn

A subclass of synthetic opioids called nitazenes could be more powerful than fentanyl — and 1,000 times more potent than morphine — according to a new study.

The small-scale study, which was published in JAMA Network Open on Tuesday, found that those patients who overdosed on nitazenes had to receive two or more doses of naloxone, a medication that reverses a drug overdose.

That is compared to those patients who overdosed on fentanyl, who only required one dose of naloxone.

Nitazenes are lab-made opioids being mixed into illegal drugs like heroin. Along with fentanyl, nitazenes are synthetic opioids, but the two are structurally unrelated.

However, they both are among the “fastest-growing classes of opioids being detected in patients in the emergency department (ED) with opioid overdose,” according to the study.

A new class of synthetic opioids could be deadlier than fentanyl, according to a new study. DEA

The small-scale study, which was published in JAMA Network Open Tuesday, found that those patients who overdosed on nitazenes were given two or more doses of naloxone, a medication that reverses a drug overdose.DEA

The drugs are called nitazenes. DEA

In order to perform the study, the researchers looked at the lab results of 537 patients who had been admitted to the hospital for a potential overdose between 2020 and 2022.

They found that 11 of those patients tested positive only for fentanyl, and that 9 tested positive only for nitazenes, such as brorphine, isotonitazene, metonitazene or N-piperidinyl etonitazene.

“Clinicians should be aware of these opioids in the drug supply so they are adequately prepared to care for these patients and anticipate needing to use multiple doses of naloxone,” wrote the study’s authors, who came from organizations like New York’s Icahn School of Medicine at Mount Sinai and Lehigh Valley Health Network in Pennsylvania.

“Clinicians should be aware of these opioids in the drug supply so they are adequately prepared to care for these patients and anticipate needing to use multiple doses of naloxone,” the study’s authors wrote. DEA

They found that 11 of patients tested positive only for fentanyl, while 9 tested positive for only nitazenes, such as brorphine, isotonitazene, metonitazene or N-piperidinyl etonitazene.CBP

The FDNY and EMTs respond to two overdoses at the same location, Mercer Street north of Houston Street, earlier this month. William Farrington

The study also showed that metonitazene overdoses were linked to cardiac arrests, as well as more naloxene doses overall. These patients also exhibited higher rates of cardiac arrest and death than those involving other substances.

Researchers found that 66.6% of the patients who overdosed on nitazenes had to receive two or more doses of naloxone, as compared to 36.4% of fentanyl patients.

Intubation, a process where a tube is inserted to keep the trachea open, was performed on 50% of those patients using metonitazenes, while only 27% of fentanyl patients were intubated.

The study’s researchers included those from Mount Sinai’s Icahn School of Medicine.via REUTERS

The study was published in JAMA Network Open. DEA

“Findings from the present study can begin to inform emergency care clinicians about naloxone administration for NPO overdose,” the authors wrote. “Our data have public health implications and may provide insight for emergency care clinicians and bystanders who administer naloxone.

“Specifically, the need for higher numbers of doses of naloxone in the NPO group, as well as the association between metonitazene OD and cardiac arrest, pose a public health threat.”

Last year, the US Drug Enforcement Administration issued a warning over the synthetic opioid, use of which was on the rise in the tri-state area and Washington, DC.

“A drug that was never approved for medical use, nitazines are being sourced from China and being mixed into other drugs,” the DEA stated at the time.

They also noted that when the drug is in powder form, it can be a yellow, brown or off-white color, and that it’s also been mixed into heroin and fentanyl.

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