Europe faces an escalating challenge as nitazenes (highly potent synthetic opioids) emerge across the continent, prompting urgent calls for comprehensive monitoring systems that combine multiple data sources to protect public health. Moreover, recent analysis reveals that single-source surveillance approaches risk missing critical local outbreaks of these dangerous substances.

The Growing Nitazene Threat

Since 2019, the European Union Early Warning System has identified 23 different nitazenes detected in at least 21 European countries. Furthermore, the scale of the problem is accelerating rapidly: nitazene seizures tripled in 2023 compared to 2022, whilst tablet seizures containing these substances doubled in 2024 compared to the previous year.

The potency of nitazenes presents unique challenges for synthetic opioid monitoring systems. Consequently, their extremely low use doses and relatively small number of regular users in most countries make detection particularly difficult when relying on single surveillance methods.

Multi-Layered Approaches to Detecting Synthetic Opioids

Recent cases from Germany, France, Ireland and the Netherlands demonstrate that effective synthetic opioid monitoring requires triangulation of multiple data sources. Indeed, the European Union Drugs Agency monitoring framework now integrates diverse information streams to create a comprehensive picture of emerging threats.

Key Surveillance Methods

Wastewater Analysis: Although useful for capturing early population-level signals, wastewater analysis alone may miss nitazene presence due to high potency and catchment area dilution. Nevertheless, when combined with other methods, it provides valuable complementary data for detecting synthetic opioids.

Syringe Residue Analysis: This approach has proven particularly revealing. For instance, analysis in Tallinn, Estonia, identified nitazenes in 34% of syringes in 2023 and 35% in 2024. Similarly, Riga, Latvia, showed detection rates of 74% and 33% respectively, whilst Klaipeda, Lithuania, recorded 4% in 2024. Importantly, most syringes contained additional substances, signalling common polysubstance use patterns.

Drug-Checking Services: Throughout 2023 and 2024, these services sporadically detected nitazenes in samples brought by users seeking content confirmation. Therefore, these facilities serve dual purposes: protecting individuals whilst providing crucial intelligence for synthetic opioid monitoring systems.

Hospital Surveillance: The European Drug Emergencies Network hospital in Riga reported 21 nitazene presentations during 2023 and 2024. Additionally, hospitals in Munich and Utrecht each reported cases in acute drug toxicity presentations. These clinical encounters provide vital real-time data for detecting synthetic opioids affecting communities.

Population Surveys: The 2024 European web survey on drugs revealed participants in Germany, Austria, Latvia, Sweden and Spain reported nitazene use within the past 12 months, offering broader epidemiological insights.

Devastating Mortality Impact

The human cost of inadequate synthetic opioid monitoring has become tragically apparent. Specifically, nitazenes drove significant increases in drug-related deaths across Baltic states during 2022 and 2023.

In Latvia, nitazenes were implicated in 101 of 154 deaths (66%) in 2023, though this decreased to 33 of 76 cases (43%) in 2024. Meanwhile, Estonia experienced peak mortality in 2023 with nitazenes involved in 61 of 119 deaths (52%), remaining at 42 of 100 cases (42%) in 2024. Furthermore, Norway and Sweden reported 34 and 30 nitazene-associated deaths respectively during their monitoring periods.

These substances commonly appeared alongside benzodiazepines, cannabis and cocaine, underscoring the complexity of detecting synthetic opioids within polysubstance use contexts.

The Counterfeit Medicine Dimension

Alarmingly, nitazenes have been discovered in counterfeit medicines, expanding the risk beyond traditional drug-using populations. Consequently, this development necessitates broader public awareness and enhanced pharmaceutical vigilance as part of comprehensive synthetic opioid monitoring strategies.

Building Resilient Detection Systems

The identified nitazenes include isotonitazene, metonitazene, protonitazene, N-Desethyletonitazene, protonitazepyne and etonitazepyne. However, experts warn that over-reliance on any single data source increases the risk of missing local poisoning outbreaks.

Effective preparedness for detecting synthetic opioids requires several critical elements:

Enhanced Toxicology Capacity: Expanding post-mortem analysis, drug-checking services, wastewater analysis and confirmations from forensic and clinical laboratories ensures robust detection capabilities.

Integrated Data Triangulation: Combining seizure data, mortality registries, toxicology results and information about drug availability, purity and prices creates actionable intelligence. Nevertheless, transforming sparse signals into evidence-based policy recommendations remains a key challenge.

City-Level Surveillance: Granular, timely data collection at municipal level enables rapid response to emerging threats, complementing national epidemiological indicators.

Direct User Input: Integrating analysis received directly from people using drugs provides ground-level intelligence that laboratory methods alone cannot capture.

Europe’s Flagship Response Mechanism

The European Union Early Warning System on new psychoactive substances serves as the continent’s primary detection mechanism for nitazenes and similar threats. Additionally, it draws on multiple information sources to provide comprehensive synthetic opioid monitoring across member states.

This system exemplifies the multi-layered approach necessary for detecting synthetic opioids in an era of rapidly evolving drug markets. Moreover, its integration of diverse data streams enables policy makers to respond swiftly to drug-related problems.

The Path Forward

Addressing the nitazene crisis requires integrated approaches combining robust surveillance with evidence-based prevention, treatment and harm reduction services. Furthermore, sustainable funding streams must support these interconnected systems.

As potent synthetic opioids continue emerging with alarming speed, Europe’s preparedness depends on maintaining agile, resilient detection capabilities. Therefore, investment in toxicology infrastructure, data integration systems and rapid alert mechanisms represents not merely a technical challenge but a fundamental public health imperative.

The stakes could not be higher. Consequently, effective synthetic opioid monitoring systems (capable of analytical triangulation and generating timely alerts) stand as Europe’s essential defence against these devastating substances. Only through comprehensive, coordinated efforts can communities protect vulnerable populations from the escalating nitazene threat.

Source: Online Library