Serving Barnwell County and it's neighbors since 1852
A synthetic opioid found to be a thousandfold more potent than fentanyl has hit the streets. Nitazenes or novel potent opioid (NPO), a subclass of synthetic opioids known for their potency, are being found to add to overdose mortality rates.
“The opioid epidemic is an ever-changing landscape,” said Pam Rush, executive director of the Axis I Center of Barnwell.
Developed in the 1950s, nitazenes are a group of chemical compounds. Prior to recent years, the compound was not prevalent outside of academic research laboratories, according to Old Drugs and New Challenges: A Narrative Review of Nitazenes, a study published by the National Library of Medicine.
However, with the constantly changing composition of street drugs for more potent effects, these otherwise forgotten compounds are making their way back into the illegal trade.
“Synthetic opioids, such as the fentanyl analogue and nitazene drug class, are among the fastest growing types of opioids being detected in patients in the emergency department (ED) with illicit opioid overdose,” said Rush. “Sadly, each new fentanyl analog will continue to increase the number of fatal overdoses across the nation.”
According to this study, nitazenes are often found mixed with fentanyl or other drugs in street supplies – although fentanyl and nitazenes are structurally unrelated. While the motive for combining these toxins is unclear, researchers link it to a need for more potent drugs.
These synthetic agents are alleged to have morphine-like or psychoactive properties.
An August 2023 clinical study tried to test the Narcan (or naloxone) emergency departments requirements for patients experiencing NPO exposures.
In this study period, 537 patients were looked at. All of which experienced NPO overdoses that presented with opioid overdose symptoms and received multiple doses of Narcan. When compared with fentanyl overdoses, these patients required more Narcan doses overall to reverse these effects.
“These findings suggest that NPOs may have a higher potency than fentanyl due to the observed naloxone administration in the clinical setting of overdose,” states the study.
NPOs like nitazene pose a challenge in the healthcare and emergency service fields as there is little experience on how to reverse an overdose from these substances. For example, a nitazene overdose comes with a high cardiac arrest rate.
“It began with the over prescribing/overuse of pain medications, moved to lacing other substances like heroin and cocaine with fentanyl, to synthetic fentanyl pills and other synthetic forms of fentanyl like Nitazene. Persons who use illicit drugs are now more than ever at risk for overdose and death,” said Rush. “Using drugs was considered risky when I was growing up. They are now deadly.”
This new terrain of illicit drugs is causing first responders and healthcare professionals to broaden their research and find new solutions to reversing the effects of an overdose.
“The arrival of any new drug or intoxicant into the illicit drug supply creates tremendous burdens for first responders and emergency healthcare providers as they encounter the first overdose cases without the benefit of knowing much about the pharmacology, toxicology, or potential use or interactions of these novel agents. The problem is compounded by the fact that many street drug users may not be informed or aware of exactly what substances they have taken,” found the aforementioned narrative review.
Facilities like the Axis I Center and agencies like the Barnwell County Sheriff’s Office (BCSO) are making active strides to get ahead of this ‘new’ substance now being interspersed in the drug trade.
“Given the emergence of dangerous toxic drugs in the illicit opioid supply in the United States, future research should examine clinical outcomes from new potent opioids as the supply continues to evolve,” says Alex Manini, MD, MS, Professor of Emergency Medicine at the Icahn School of Medicine at Mount Sinai in New York.
Sheriff Steve Griffith explained receiving drug results from the S.C. Law Enforcement Division (SLED) after apprehension takes time, but he has not yet seen reports of this drug in Barnwell County.
The Axis I Center of Barnwell continues to offer medication assisted treatment services for persons with opioid use disorders. For more information about those services, contact the Axis I Center at 803-541-1245.
