New opioids are entering the illegal drug market and they are stronger than fentanyl.

New opioids are entering the illegal drug market and they are stronger than fentanyl.

The Emergence of Nitazenes: A Deadly Threat in the Opioid Crisis

Opioid Epidemic

In recent years, the opioid epidemic has been further exacerbated by the infiltration of street fentanyl, an illicit version of a potent prescription painkiller. However, researchers are now warning that the threat posed by fentanyl may pale in comparison to an even more dangerous synthetic opioid, nitazenes[^1^].

The Potency of Nitazenes

A new investigation has found that nitazenes are a staggering 1,000 times more potent than morphine, making them 10 times more powerful than fentanyl[^1^]. This heightened potency poses a significantly greater risk to individuals as it only takes a smaller amount to have a profound effect and increase the likelihood of overdose[^1^].

Dr. Alexandra Amaducci, an emergency medicine and toxicology expert, explains that nitazene overdoses are more severe and harder to treat compared to fentanyl overdoses[^1^]. These factors contribute to the overall danger of nitazenes and their potential for causing harm in society.

Nitazenes: A Resurgence and a Hidden Danger

Interestingly, nitazenes were initially developed in the 1950s as a pain medication but never received medical approval[^1^]. These drugs faded from prominence until their reappearance in recent years. During the early days of the pandemic, nitazenes began to emerge in various forms, such as powder, tablets, and liquid, within the illicit drug supply[^1^].

The Growing Threat

Approximately 200 nitazene-related overdose deaths have been reported in North America and Europe. However, experts caution that this figure may be significantly undercounted due to a lack of comprehensive testing protocols[^1^].

To better understand the effects of nitazene overdoses, Dr. Amaducci’s team analyzed a small group of patients who were treated at an emergency department for nitazene overdoses between 2020 and 2022[^1^]. The study included nine patients who tested positive for various nitazene opioids and 11 patients who tested positive for fentanyl[^1^].

Severity of Nitazene Overdoses

The severity of the overdoses was assessed based on the amount of naloxone, an opioid antagonist used to counter the effects of an overdose, required to treat each patient[^1^]. The findings revealed that nitazene overdoses required significantly more doses of naloxone to reverse, highlighting their increased potency and danger[^1^].

The Ongoing Crisis: Searching for New Drugs

The passage of regulations designed to curtail illicit fentanyl production may have prompted drug dealers to search for new substances that are easier to produce undetected[^1^]. This shift in the illicit drug market could explain the resurgence of nitazenes and the subsequent increase in overdose cases[^1^].

The Importance of Public Health Initiatives

Dr. Ramin Mojtabai, a mental health professor at the Johns Hopkins School of Public Health, emphasizes the need to view this problem as a public health issue[^1^]. Harm reduction approaches, such as wider distribution of naloxone and public education on its use, can potentially save lives[^1^].



The emergence of nitazenes in the illegal drug supply poses a gravely dangerous threat to individuals struggling with substance abuse. With their potency surpassing that of fentanyl, the risk of overdose and associated complications is significantly heightened. As the opioid crisis continues, it is crucial to prioritize public health initiatives to raise awareness, provide education, and ensure access to life-saving interventions such as naloxone.

For more information on nitazenes, please visit the U.S. Drug Enforcement Administration. Stay informed and spread awareness to combat the ongoing challenges posed by the opioid crisis.


[^1^] Alexandra Amaducci, DO, emergency medicine and medical toxicology, Lehigh Valley Health Network-USF Morsani College of Medicine, Bethlehem, Pa.; Ramin Mojtabai, MD, PhD, MPH, professor, department of mental health, Johns Hopkins Bloomberg School of Public Health, Baltimore; JAMA Network Open, Aug. 29, 2023, online