Two deaths in Boulder County, Colorado, in 2023 are the latest attributed in the United States to a powerful class of synthetic opioids called nitazenes. Most healthcare systems cannot detect these substances, so the exact number of overdoses is unknown, but they are known to be involved in more than 200 deaths in Europe and North America since 2019, including 11 in Colorado since 2021. One of The two Boulder County deaths are related to a new formulation called N-Desethyl etonitazene, which was identified by a national laboratory, and is believed to be the first death from this compound.
The Conversation interviewed Christopher Holstege, professor of emergency medicine and pediatrics at the University of Virginia School of Medicine and director of the Blue Ridge Poison Center, where opioid overdoses are increasing. The expert explains what they are, properties, varieties and why nitazenes are so powerful and so deadly.
What are nitazenes?
Nitazenes are a class of synthetic opioids that encompass more than 20 unique compounds, including isotonitazene, which was first identified in 2019 and is popularly known as ISO. Also includes protonitazene, metonitazene and etonitazene. Nitazenes are psychoactive substances or “designer drugs” that are not controlled by any law or convention, but pose a significant risk to public health. These drugs have recently appeared as illegal drugs on the streets. Researchers have relatively little information about how the human body reacts to nitazenes, since they have never been subjected to clinical trials. But laboratory tests show that some of them could be hundreds or thousands of times more potent than morphine and 10 to 40 times more potent than fentanyl. The U.S. Drug Enforcement Administration (DEA) has classified many formulations of nitazenes as Schedule 1 drugs of the Controlled Substances Act, meaning they have no medical use and pose a high risk of abuse.
(Read more: Food or remedies? In Milei's Argentina, access to medicines is a luxury)
When were they first developed?
Nitazenes were initially developed in the 1950s by the pharmaceutical research laboratories of the Swiss chemical company CIBA. This company synthesized numerous substances of this class for use as analgesics. However, they were never approved by the US Food and Drug Administration (FDA) for medical use in humans. They were virtually forgotten outside of specialized research circles until they re-emerged as street drugs in 2019.
And what happened then?
As law enforcement has cracked down on other drugs, such as fentanyl, illegal labs have used historic pharmacological research to formulate analogues of nitazenes as street drugs. As of 2019, at least six formulas come from the original patent, but others, like the one detected in Boulder, are completely new. Specialized laboratory tests are required to identify nitazenes in toxicology samples. Fentanyl test strips cannot detect nitazene analogues. Since they were first detected, these substances have been responsible for 200 drug-related overdose deaths in Europe and the United States. Although they are already identified as illegal drugs in numerous countries, many medical professionals do not even know they exist.
(Also: Mexico: the electoral race for the presidency begins with two women in contention)
Nitazenes are also mixed with other street drugs such as heroin and fentanyl and with fake oxycodone pills, without users knowing.
What types of nitazenos circulate on the streets?
Nitazene first appeared in 2019 in the US Midwest as a white, cocaine-like powder. It was later detected on the streets of Washington as yellow, brown and white powders. Since 2022, the DEA has found other types of nitazenes in both powder and blue pills. Nitazenes are also mixed with other street drugs such as heroin and fentanyl and with fake oxycodone pills, without users knowing. The Justice Department has accused several companies in China of sending chemical raw materials to manufacture them in Mexico and the U.S., where cartels and traffickers mix them and then distribute them on the streets.
What are the symptoms of an overdose?
The toxic effects of nitazene resemble those associated with other classic opioids such as morphine and fentanyl and include reduced pupils and slowing of the respiratory and central nervous systems, which can lead to death. Because of its potency, symptoms can develop quickly after someone is exposed, causing death before they can receive medical attention.
Does naloxone counteract the effects of overdose?
Naloxone, commonly known as Narcan, is supposedly effective in reversing overdoses due to nitazene, but multiple potent doses may be necessary.
CHRISTOPHER P. HOLSTEGE
THE CONVERSATION (**)
Professor of Emergency Medicine and Pediatrics, University of Virginia.
(**) The Conversation is a non-profit organization that seeks to share ideas and academic knowledge with the public. This article is reproduced here under a Creative Commons license. There was an international opioid alert since 2019 According to the report of the 44th meeting of the Expert Committee on Drug Dependence of the World Health Organization (WHO), held in Geneva (Switzerland) in 2021
,
One of the varieties of nitazenes – metonitazene – was first synthesized in the late 1950s.by a Swiss chemical company in an effort to develop painkillers and opioid alternatives to morphine, with effects 30 to 200 times greater than those of morphine.(more: Russians defy fear to attend Alexei Navalny's funeral en masse: photos)
The United Nations Office on Drugs and Crime (UNODC) had already warned years ago about another variety of the same drug. : “Isotonitazene, a nitazene that was first reported to Unodc in 2019
and was placed under international control in 2020,” the report clarifies. At the same meeting in 2021, the WHO included metonitazene in a list of five New Psychoactive Substances (NSPs),along with brorphine and eutilone, among others.
“The two synthetic opioids recommended for international control, brorphine and metonitazene, belong to a chemical group known as 'nitazenes', which have structural differences with fentanyl and, therefore,
“may fall outside the typical scope of generic legislation for fentanyl analogues.” points out the WHO.It can be purchased legitimately from pharmaceutical retailers for research, but not for human or veterinary use.
In the limited clinical studies available, according to the WHO document, metonitazene has been administered subcutaneously and intramuscularly to evaluate its analgesic effects. In patients who underwent testing,
The respiratory depressant effects of metonitazene have been estimated to be 50 times greater than those of morphine. , which produces depressed breathing with cyanosis (bluish or grayish discoloration of the skin due to insufficient oxygenation of the blood) in one fifth of patients. There are currently no drugs in this class approved for medicinal use, the document says. (Continue reading: Shock in Mexico: two pre-candidates for mayor of a municipality are murdered) “In the United States, metonitazene, also known as 'NIH 7606,'was first identified in eight blood samples associated with death investigations
and was confirmed in 20 forensic cases
postmortem ”says the document.
The fatalities associated with the abuse of this substance in the United States also mostly had a history of abuse with fentanyl (55% of cases); indicates the WHO report, and specifies that the majority of those who died had a history of opioid use disorder and were using or seeking heroin or fentanyl at the time of death.
The substance was also detected in forensic sampling in Canada and Germany since 2019, but today it is not subject to national or international controls, although in the United States, the WHO document points out,
may be subject to strict restrictions due to its structural similarity to other similar drugs.
#Nitazene #powerful #drug #streets #United #States