"Even worse than fentanyls": nitazenes in the USA

Responding to illicit fentanyl use is challenging. Treatment standards developed for heroin users do not work as well for the synthetic opioid. Low doses of naloxone to reverse overdoses are not enough. People overdosing need more airway management. Approved limits for opioid agonist therapies do not work. “My physician colleagues are finding they’re giving doses beyond what they ever would have given for heroin. They’re having to do more outreach because it's a much more disabling condition to be addicted to fentanyl versus heroin”, explains Keith Humphreys, Professor of Psychiatry and Behavioral Sciences at Stanford University (Stanford, CA, USA).

 

Now, a class of synthetic opioid even stronger than fentanyl, nitazenes, is growing in use in the USA and has been linked to overdose deaths in several states. The strongest type of nitazene is 40 times more potent than fentanyl and thousands of times more potent than morphine. “The same challenges with fentanyl are all there with nitazenes”, says Humphreys, who led the 2022 Stanford–Lancet Commission on the North American Opioid Crisis. However, he notes, fentanyl can be used safely clinically, but nitazenes were never approved “because they were so dangerous … so they’re even worse than fentanyls”.