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    You have likely heard of lab-made opioids like fentanyl, which have become responsible for a significant number of fatal overdoses in the United States over the past few years. However, there is a new group of opioids found in the drug supply called nitazenes, which may be even more powerful and dangerous.

    What are nitazenes?

    Nitazines are a group of lab-made opioids that were developed years ago by pharmaceutical companies as an alternative to morphine but shelved due to the risks of overdose.[1] There is still no approved medical use for nitazines today. Some names for nitazines include metonitazene and isotonitazene, which are also the two most often detected nitazines in overdoses.

    Nitazines were first detected in the U.S. drug market in 2019. Most are illegally manufactured abroad and entered the drug supply as stricter crackdowns on fentanyl have been enforced.[2] They have since been linked to a number of overdoses.

    Nitazenes come in a number of forms. They can be sold as a white or brown/yellow powder and are primarily found in illegally purchased pills, heroin and other opioids.[3] They are most frequently injected, but can also be ingested in other ways, such as smoking or snorting.[4]

    Why are they so dangerous?

    Nitazines are very potent. Research suggests that they may be over 40 times more powerful than fentanyl.[5] This varies by the type of nitazine, though, with some being closer in strength to morphine. Not only can their potency make them very addictive, but it means that people who use them for the first time with low tolerance can fatally overdose. A higher dose of naloxone (Narcan) may be needed to reverse a nitazine-involved overdose.[6]

    Much like fentanyl, people are likely consuming substances without knowing they contain nitazines. Unlike fentanyl, however, nitazines do not yet show up on drug tests or testing strips, which makes detecting them difficult.[7] Because they can only be identified after a lab test, this increases the already significant risk of using illegal substances.

    They have recently been found in fake oxycodone pills for pain management.[8] Counterfeit pills are made to look like real prescription medications that you get from a pharmacy. So, someone may think they are getting one kind of pill but are actually getting one laced with powerful nitazines or fentanyl.

    People may use nitazines for the short-term effects of relaxation, feelings of well-being or pain relief. However, there are many negative short-term effects, including nausea, slow breathing, fever and sweating. Like other opioids, long-term use of nitazines can cause dependence and increased tolerance, breathing problems, constipation, brain damage and other serious complications.

    How can I protect my loved one?

    Know the signs of an overdose:

    • Clammy face and loss of color in complexion
    • Blue lips and fingertips
    • Passed out
    • Non-responsive to their name or a firm sternum rub using the knuckles
    • Slow or erratic breathing or no breathing at all
    • Heartbeat is slow or has stopped

    Our resources can help you learn how to respond to an overdose with naloxone. It is important to note that more than one dose of naloxone may be necessary to reverse an overdose because nitazines are so powerful.

    If you know or suspect that your loved one uses substances like nitazines, there are a few strategies that can help reduce their risk of overdose:

    • Talk to your loved one to see what they know about the risks of nitazines. It’s possible they’ve never even heard of them or that they don’t know that it’s in the drug supply.
    • Have naloxone on hand and know how to use it in case of an overdose.
    • Do not combine nitazines with other opioids and substances like alcohol. These can increase the negative effects of both substances and increase the risk of overdose.
    • Start slowly. Trying a lower dose at first can help an individual judge their own tolerance and how they are affected by the substance. This also decreases the risk of taking too much and overdosing, especially if the substance’s contents are unknown.
    • Discuss other harm reduction tips, including using clean and sterile needles and never using substances alone.