A group of novel synthetic opioids emerging in illicit drugs in the United States may be more powerful than fentanyl, 1,000 times more potent than morphine, and may even require more doses of the medication naloxone to reverse an overdose, a new study suggests.
Nitazenes are a synthetic opioid, like fentanyl, although the two drugs are not structurally related. Nitazene compounds were first synthesized in the 1950s for pharmaceutical research, and more recently, began to crop up in the illicit drug market in 2019. In the small study published Tuesday in the journal JAMA Network Open most of the patients who overdosed on nitazenes received two or more doses of the opioid overdose reversal drug naloxone, whereas most patients who overdosed on fentanyl received only a single dose of naloxone. The inexpensive drugs are usually combined with other drugs like fentanyl, cocaine and heroin as they’re cheap to manufacture and pack a powerful punch.. Authorities say they’ve also seen a rise in the number of individual compounds within the nitazene family, prompting fears various forms of stronger synthetic opioids will continue to proliferate.
Nitazenes, a subclass of synthetic opioids, appear to be even more potent and the new study suggests they may be associated with an increased rate of cardiac arrest when people overdose.
The study included data on 537 adults who had been admitted to an emergency department for suspected overdose between 2020 and 2022 and who had completed lab testing. Of them, 11 tested positive for only fentanyl, and nine tested positive for nitazenes only, such as brorphine, isotonitazene, metonitazene, or N-piperidinyl etonitazene.
The researchers found that 66.6% or six of the patients who overdosed on nitazenes received two or more doses of naloxone, compared with only 36.4% of the 11 patients who overdosed on fentanyl.