A state-funded drug checking program in Massachusetts has uncovered the presence of nitazenes, synthetic opioids that can be up to 25 times stronger than fentanyl. This finding, detailed in a bulletin from public health officials, has raised concerns as the number of drug samples testing positive for nitazenes is increasing rapidly.

Discovery and Data

Traci Green, an epidemiologist at Brandeis University working with the Massachusetts Drug Supply Data Stream, noted that the uptick in nitazene samples exceeded expectations. From January 2023 to July 2024, data collected indicated a growing presence of these powerful opioids in various communities across Massachusetts. Nitazenes are challenging to detect without specialised equipment and training, making their presence in the drug supply particularly insidious.

Nitazenes: Potency and Detection

Nitazenes vary in potency but can be much more powerful than fentanyl. The Drug Enforcement Administration (DEA) reports that these synthetic opioids first appeared in the U.S. in 2019 as international suppliers sought novel substances that were not yet illegal. Sarah Mackin, the director of harm reduction at the Boston Public Health Commission, emphasised the trend of increasingly potent drugs infiltrating the market as authorities crack down on substances like fentanyl and heroin.

Harm Reduction and Overdose Risks

Mackin’s involvement in the state’s drug checking program revealed several nitazene samples, some of which were about five times more potent than fentanyl. These samples often included xylazine, an animal tranquilliser found in 9% of overdose deaths in 2023. The combination of nitazenes and other drugs heightens the risk of complicated overdoses that require more prolonged rescue breathing and oxygen support.

Despite these increased risks, Mackin advises against giving additional doses of naloxone too quickly after an overdose. Responders should wait 2-3 minutes between doses, continue mouth-to-mouth resuscitation, and call 911. This careful approach is crucial for keeping oxygen flowing to the brain and managing the more severe sedation effects seen with nitazene use.

Public Health Concerns

Green indicated that there’s no immediate sign that nitazenes will replace fentanyl in the drug supply. However, some clinicians worry that the rising tolerance to fentanyl among drug users could drive them towards even more potent substances like nitazenes to avoid withdrawal symptoms. Dr. Miriam Komaromy, medical director at the Grayken Center for Addiction at Boston Medical Center, highlighted the dangers of new substances entering the drug market, making the landscape more hazardous for users.

Komaromy also pointed out the challenges faced by patients transitioning to treatment drugs like buprenorphine and methadone after using potent opioids such as nitazenes. This transition difficulty is already evident with fentanyl, complicating efforts to manage addiction and move towards recovery.

Source: WBUR