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Nitazenes: Dangerous New Synthetic Opioids

Nitazenes: Dangerous New Synthetic Opioids

Nitazenes are a type of strong synthetic opioid that has recently been found tainting drugs like heroin. For many drug users, they are also a new addiction. But where do they come from? How dangerous are nitazines?

Nitazenes were created around 60 years ago as an alternative to morphine but were never used in US medicine due to their high risk of overdose. Despite this, they have surfaced in recent years and are responsible for numerous overdose deaths worldwide.

“They figured out that a nitazene does attach to an opioid receptor, but they actually didn’t like how potent it was, so no one ever brought it to market,” explained Jenna Nikolaides, a toxicologist and emergency and addiction medicine physician in Chicago, told The Hill about the new phenomenon. The emergency rooms are starting to see overdose victims because of it.

How Do Nitazenes Work?

Nitazenes, like heroin and morphine, attach to receptors in the brain, causing depression in the central nervous system. In overdose situations, the respiratory system slows down dangerously, leading to symptoms such as unconsciousness, slow or no breathing, and a low heart rate. About 20 different nitazenes currently exist, though none are used in the US medicinally.

Nitazenes are usually white or brown/yellow powders, crystalline solids, or even tablets disguised as other drugs like oxycodone. They can be injected, inhaled, or swallowed.

Short-term effects of nitazenes include euphoria, relaxation, pain relief, reduced stress, itchiness, nausea, vomiting, and slowed breathing and heart rate. Overdose symptoms can include shallow breathing, bluish lips, loss of consciousness, coma, and death. Somebody should call 911 immediately in cases of overdose.

Naloxone may temporarily reverse the effects of the drug, but because of its potency, it often takes multiple canisters to reverse the overdose.

Nitazenes are a class of designer drugs that are structurally related to benzodiazepines but considered designer drugs or synthetic opioids. They are a type of central nervous system depressant commonly used to treat anxiety, insomnia, and seizures. Examples of nitazenes include flualprazolam, flunitrazolam, and nitrazolam.

When taken recreationally, nitazenes can produce effects that are similar to other opioids, including sedation, relaxation, euphoria, muscle relaxation, and decreased anxiety. However, they are usually much more potent than other opioids, increasing the risk of overdose and other adverse effects.

Common Effects of Nitazene Use

Nitazenes give a similar feeling as other opioids, but can be about 20 times the potency of fentanyl. Just a tiny amount of fentanyl can kill inexperienced opioid users, and the same is true for ISO users. The potency also magnifies withdrawal effects, making it harder to quit than other drugs.


Here are some other effects of nitazene drugs like Isotonitazene:

  • Sedation and drowsiness: Nitazenes can induce significant sedation, leading to drowsiness and sleepiness.
  • Respiratory depression: Like other central nervous system depressants, nitazenes can suppress breathing, especially at higher doses or when combined with other depressants such as alcohol or opioids. It can be life-threatening.
  • Amnesia: Nitazenes may cause anterograde amnesia, where people can’t form new memories while high. This can be scary for the user.
  • Impaired coordination and judgment: Recreational use of nitazenes can impair motor skills, coordination, and decision-making abilities, increasing the risk of accidents and injuries.
  • Dependence and addiction: While the addictive potential of nitazenes has not been the subject of much research, they can lead to physical dependence and addiction with long-term or frequent use. Stopping nitazene use cold turkey can lead to withdrawal symptoms. These can include rebound anxiety, insomnia, tremors, and seizures.
  • Overdose: Due to their potency, taking high doses of nitazenes or combining them with other depressants can increase the risk of overdose, which can result in coma, respiratory failure, and death.

Overall, the addictive potential of nitazenes appears to be much higher than drugs like Oxycontin, particularly with chronic or excessive use.

Of course, individuals may become more susceptible to addiction, which can vary based on factors such as genetics, mental health status, and environmental influences.

Recreational use of nitazenes is associated with various risks and adverse effects. If you or somebody you love is experimenting with ISO, it’s a dangerous experiment. Get help for addiction or treatment to help stop using opioids.

ISO On American Streets

One such nitazene that is already on the streets is Isotonitazene or ISO. Initially discovered around 2019 in the Midwest, this hazardous substance has since expanded its reach into the Southern states and, more recently, along the East coast.

With its potency levels surpassing those of heroin and morphine, resembling fentanyl, ISO is being incorporated into and sold under the guise of other drugs, aiming to enhance potency and reduce production costs. The primary alarm stems from its potential to induce fatal overdoses in individuals unaware of its presence.

Long-Term Effects of Nitazene Use

The long-term effects of nitazenes haven’t been extensively studied. Researchers believe they are similar to other opioids, potentially leading to increased tolerance, dependence, and damage to vital organs.

Nikolaides said the new additive does not show up on standard urine screens or on the fentanyl test strips she distributes to drug users. Other drugs impossibly taint street opioids in Chicago, too, making treatment more complicated.  “You test a sample bag of heroin, and it has maybe a little bit of heroin, a little bit of fentanyl, a little bit of metonitazene, a little bit of cocaine, a little bit of sedatives, a little bit of crushed pharmaceuticals,” she said. “So sometimes quinidine is in there, Benadryl is in there. If nitazene is in there, it’s a garbage bag of drugs.”

What Do Nitazines Look Like?

Each drug can look different because they have different illicit manufacturers, and all use of them in the US is illegal. People typically use them in powder form. ISO is found in hues of yellow, brown, or off-white.

DEA regional forensic laboratories have observed this substance being blended into heroin or fentanyl, masquerading as conventional street drugs, resulting in lethal outcomes.

In different regions of the nation, ISO has also been encountered in counterfeit pills, deceptively labeled as pharmaceuticals, such as Dilaudid “M-8” tablets and oxycodone “M30” tablets.

Dangers of Polydrug Use and Nitazenes

Mixing nitazenes with other drugs can be dangerous and unpredictable. Combining opioids with substances like cannabis, MDMA, LSD, nitrous oxide, GHB, benzodiazepines, alcohol, ketamine, cocaine, or speed can lead to various health risks, including difficulty breathing, seizures, impaired coordination, memory loss, and even death.

Withdrawal from nitazenes can be severe, with symptoms such as excessive sweating, restless legs, fever, dizziness, flu-like symptoms, blackouts, anxiety, and panic attacks.

For people struggling with any substance use, it’s essential to seek help and support to address the impact on health, relationships, work, and other life aspects.

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