A synthetic opioid up to 40 times more powerful than fentanyl is scrambling the public health response to the addiction crisis in a growing number of U.S. cities.
The big picture: Nitazine comes in powder, pill and liquid form and requires time-consuming lab work to trace. Often laced into substances that users think is fentanyl or heroin, it’s potentially lethal or can cause a more severe onset of withdrawal symptoms.
- Its arrival comes as law enforcement and public health authorities are grappling with the increased use of “tranq dope” — a mix of animal sedative and fentanyl that’s drawn the White House’s attention and been found in at least 36 states plus Washington, D.C.
- But most hospitals and medical examiners do not regularly test for either substance, and hospital data doesn’t distinguish nitazene from cases of fentanyl poisoning.
- A Centers for Disease Control review of overdose deaths in Tennessee concluded nitazene-related overdoses could require up to four doses of naloxone, the opioid reversal drug that usually comes two to a pack.
State of play: Philadelphia health officials in December issued a public alert after detecting the opioid in four samples of street drugs. Nitazene has also been found in fake oxycodone tablets in Australia and Scotland in the past month.
- The Drug Enforcement Administration flagged the emergence of the drug mixed into heroin or fentanyl in the Washington, D.C. area last June.
- By November, the DEA said the continued evolution of synthetic opioids like nitazenes is “a public health concern.”
By the numbers: Tennessee saw its nitazene-related overdoses go from 10 to 42 between 2020 and 2021, per the CDC report, which noted the figures are likely an undercount.
- A warning from Ohio’s attorney general last April called nitazenes “Frankenstein opioids” and reported a nearly seven-fold increase of nitazene cases — 27 to 143 — between the first quarter of 2021 and 2022.
Yes, but: The data available suggests that this class of chemicals “remains very uncommon,” said Eric Dawson, the vice president of clinical affairs at Millennium Health, a testing laboratory monitoring prescription and illicit drug use.
- Philadelphia hasn’t seen widespread use of nitazene analogs yet, said Constance DiAngelo, the city health department’s chief medical examiner.
- The fact that health departments don’t receive toxicology data from hospital ERs because of privacy restrictions also limits the scope of known information.
- They could search for mentions of nitazene using syndromic surveillance, a system where medical facilities share de-identified data, such as self-reported patient complaints, with health departments.
- But people are unlikely to mention a drug to their doctor that they were unknowingly consuming.
The bottom line: New, more dangerous drugs could be entering the U.S. supply at a pace labs and clinicians aren’t equipped to keep up with, said Steven Passik, Millennium Health’s head of clinical data programs.
- And due to their potency, “they’d kill a bunch of users before they are even trackable.”
- HHS awarded more than $1.6 billion to states and tribal communities in September to target the opioid crisis through education, prevention and treatment.
What we’re watching: While nitazine is a comparatively new problem, it could add urgency to congressional debates over how to respond to the opioid crisis and fund public health efforts.