Nitazenes: A New Factor in the Opioid Crisis

By Lori Ryland, Ph.D., LP, CAADC, CCS, BCBA-D, Chief Clinical Officer, Pinnacle Treatment Centers

 

Nitazenes are a class of opioid drug invented in the 1950s so strong scientists determined they had a high potential for misuse/abuse and no real practical medical use or application, but now, close to 75 years later, drug cartels mix nitazenes – known by the street name “iso” – with opioids and other illicit drugs, increasing risk of addiction and driving up the number of fatalities associated with the decades-old, nationwide opioid crisis.

Nitazenes are a stark reminder that the opioid crisis in the U.S. is not going away.

They join fentanyl as the latest complicating factor in the opioid crisis, which is also known as the overdose crisis, partially because illicit opioids like fentanyl are now present in non-opioid drugs, which increases risk of addiction and fatal overdose.

If you’re not familiar with the opioid crisis, please navigate to the blog section of our website and read about the current nationwide efforts underway to mitigate harm, reduce overdose deaths, and offer treatment and support to communities and families impacted by the crisis:

The Opioid Crisis: A New National Strategy

To learn about the impact of opioid derivatives on the opioid crisis, please read this article:

Emerging National Security Threat: Xylazine Laced With Fentanyl Exacerbates Opioid Crisis

If you’re not familiar with the impact of fentanyl on the opioid crisis, or you’ve never heard of fentanyl, please read this article:

Opioid Crisis Report: Need for Fentanyl Detox Increases

Before we discuss nitazenes and their impact on the opioid crisis, we’ll share the final, confirmed statistics on opioid use disorder and opioid fatalities in the U.S., published in the 2022 National Survey on Drug Use and Health (2022 NSDUH) and the Centers for Disease Control (CDC):

Opioid Use Disorder (OUD) and Opioid Overdose Fatalities, 2022

• Opioid use disorder (OUD):
  • Age 12+: 6.1 million
  • 12-17: 265,000
  • 18-25: 424,000
  • 26+: 5.4 million
• Total overdose fatalities:
  • All drugs: 110,757 (DEA)
  • Opioids: 79,770
  • Synthetic opioids (e.g. fentanyl, nitazenes, others): 75,125

That’s the data – and it clearly demonstrates the increasing problems and complications caused by the presence of illicit, synthetic opioids in the illicit drug supply. Let’s take a closer look at the latest drug that threatens the health and well-being of communities and families across the U.S.: nitazenes.

Nitazenes and the Opioid Crisis: What Are Nitazenes?

In a press conference held in October 2023, DEA administrator Anne Milgram made the following comments about the presence of nitazenes in the illicit drug supply in the U.S. She talks about nitazenes and how the joint DEA/Department of Justice (DOJ) taskforce is working to address the problem.

“Nitazenes are dangerous synthetic opioids that can be as powerful, or even more powerful, than fentanyl. They have no legitimate use. Today, we announce 8 indictments, charging 8 companies and 12 individuals, for importing into the United States fentanyl precursors [e.g., nitazenes], xylazine, and other man-made or synthetic chemicals.”

Law enforcement and laboratory analysts report at least ten types of nitazenes found in the drug supply in the U.S. The three most common include:

• Isotonitazene
• Metonitazene
• Etonitazene

To reiterate, these chemicals have no legitimate medical use. Currently, they exist only to increase profits for drug cartels and distributors to maximize profit from the sale of illicit drugs. Several types of illicitly produced drugs may include nitazenes:

• Opioids/opiates:
  • Fake prescription medications such as oxycodone, oxycontin, Vicodin, Percocet, and others
  • Fentanyl and derivatives
  • Heroin
  • Morphine
  • Dilaudid
• Methamphetamine
• Amphetamine
• MDMA, a.k.a. ecstasy
• Cocaine
• Benzodiazepines
• Ketamine
• Synthetic cannabinoids

Nitazenes appear in different forms:

• White, yellow, or brown powder
• White, yellow, or brown crystalline solid
• Liquid form

Ingesting nitazenes causes the following:

• Pain relief
• Euphoria
• Fever
• Sweats
• Nausea/vomiting
• Respiratory depression (slow breathing)

These symptoms/consequences/effects are one reason nitazenes are a real threat. They’re similar to the effects of opioids and other drugs. However, person who takes one of the illicit drugs containing nitazenes may have no idea they ingested nitazenes or a nitazene derivative. It’s similar to the problem posed by fentanyl, carfentanil, and other chemicals drug traffickers use to increase both the volume and potency of their products.

Think of it this way. If a person takes methamphetamine, or something different, like benzodiazepine, they won’t be on the lookout for signs of an opioid overdose. And when they realize what’s happening, it may be too late to administer Narcan. It may also be too late to get to an emergency room for lifesaving medical care.

So what can we do about nitazenes?

Nitazenes, the Opioid Crisis, Law Enforcement, and Evidence-Based Treatment

Here’s what we know, so far, about nitazenes, as reported by the DEA in the press conference we link to above:

• Drug manufacturers in China produce drugs such as xylazine and nitazenes, and sell them to drug traffickers in Mexico and Central America
• The DEA identifies the Sinaloa and Jalisco cartels as primary manufacturers and distributors of the nitazenes that reach the U.S.
• In October 2023, the DEA announced 8 indictments that charged 8 companies and 12 individuals responsible for importing nitazenes, xylazine, and other chemicals related to illicit drug manufacturing into the U.S.
• Chemicals like nitazenes are inexpensive
• It’s relatively easy for chemists working for drug cartels to turn fentanyl precursors into fentanyl. It’s also easy for them to use nitazenes to increase the potency of fentanyl

The first step in mitigating the harm caused by these drugs is awareness. DEA Special Agent Jarod Forget confirms this approach:

“We want to get this info out and warn people. If we can educate and inform our communities about the dangers of taking counterfeit prescription pills or other drugs, we stem the proliferation of these deadly opioids, stop all of these senseless deaths, and help keep our neighbors and loved ones safe.”

Although nitazenes are not yet as prevalent as fentanyl, they present a danger that we need to understand before their prevalence increases, and drives rates of fatal overdose even higher than they are now. It’s also important to understand two more things:

1. Evidence-based treatment for opioid addiction, methamphetamine addiction, cocaine addiction, and tranquilizer addiction – all drugs that may contain illicit nitazenes – is effective. Treatment can decrease risk of overdose and death.
2. Narcan can reverse a nitazenes overdose, but effective reversal may take more than one dose. Scientists currently don’t know enough about nitazenes to offer specific guidance on reversion nitazenes overdose, but they do know that Narcan can reverse a nitazene-related overdose.

We’ll keep any eye on any developments on nitazenes, and report the news on nitazene-related overdose prevention and the opioid crisis here as soon as it appears.