Share on Pinterest
Shape Charge/Getty Images
  • A potent synthetic opioid class called nitazenes has been discovered after people overdosed on them.
  • The nitazene class of medication was created over 60 years ago as a potential pain-relief medication, according to the WHO.
  • Medical experts say this opioid may be up to 20 times more powerful than fentanyl.

Despite the global COVID-19 pandemic, the opioid epidemic persists and seems to be worsening.

In areas throughout the United States, a highly potent new synthetic opioid is starting to show up on the streets and is having devastating effects on its users. A class of opioids called ‘nitazenes’ has recently been found in syringes examined by scientists throughout the country.

Forensic experts have found that the syringes used in some overdoses contain a potent synthetic opioid class — nitazenes — which is up to 20 times more powerful than fentanyl — a drug that is already 50 times more powerful than heroin and 80 to 100 times more potent than morphine.

The first wave of the epidemic was associated with prescription pain medications. This was replaced by heroin in opioid-related deaths. Now, we’re on to a new form of synthetics.

Alex Krotulski, PhD, associate director at The Center for Forensic Science Research & Education, said “nitazenes are the most popular subclass of new synthetic opioids.”

Over time, opioids have evolved as people’s addiction to them has changed. “Every time a cheaper, more potent drug is introduced into the illegal drug market, the number of overdose deaths increases,” said Dr. Rebecca Donald, assistant professor of anesthesiology and pain medicine at Vanderbilt University Medical Center in Tennessee.

“Synthetic opioids, such as fentanyl, overtook heroin, and in the past year our country saw more opioid overdose deaths than ever before,” said Donald.

The nitazene class of medication was created over 60 years ago as a potential pain-relief medication, according to the WHO. They were thought to be a potent pain medication without dependency-related effects of other opioids, but they were never approved for clinical use in the United States.

However, in recent months, synthetic pain medications have started to crop up throughout the world including Canada, Germany, the United Kingdom, and domestically in the United States.

Although the extent that these new opioids are being used by people in the United States is not entirely understood, scientists have seen cases appearing throughout North America including Washington DC, Toronto, and Maryland in the most recent weeks.

“General lack of awareness of these agents may result in unforeseen deaths, especially when combined with other agents such as benzodiazepines and fentanyl,” said Dr. Scott Krakower, attending psychiatrist at Zucker Hillside Hospital in Glen Oaks, New York.

There has been a large increase in drug-related deaths over the past 12 months, according to the Centers for Disease Control and Prevention. This milestone brings a 29 percent increase from about 78,000 in April 2019 to over 100,000 in 2020. Experts believe that almost 75 percent of these deaths involve fentanyl use or mixing it with a drug such as cocaine or methamphetamines.

“There are many factors that play into the increase in opioid overdoses,” said Krotulski. However, it’s not as easy to always understand the extent of a new opioid’s impact.

“New synthetic opioids, like the nitazenes, are contributing to hundreds if not thousands of deaths as well each year. However, new synthetic opioids are not routinely tested for — and even less frequently tested for if fentanyl is present,” he said.

Some experts believe that the overdoses throughout the country are in part related to the pandemic as there have been several shutdowns, loss of jobs, and have isolated many drug users from support systems and family members.

Fentanyl currently remains the primary source of opioid misuse throughout the United States. However, the emergence of nitazenes creates additional concern as people with substance use disorder seek more potent drugs to satisfy addiction.

“Since most nitazenes are largely unregulated, they are not subject to the same scrutiny by law enforcement officials as other controlled substances. This, along with the fact that they can be made inexpensively from legal substances, makes them very appealing for drug traffickers,” said Donald.

Because of the potency of this medication, forensic scientists are not entirely sure if the traditional reversal medication, Narcan, will be as efficient in reversing overdoses. Because of the potency and the way the medication works, Narcan may need additional dosing or even higher dosing when dealing with nitazene related overdoses.

Experts say there needs to be a multilevel approach to fighting against opioid misuse.

“More can be done to decrease the number of deaths caused by drugs each year, but the effort needs to be overarching and widespread with contributions from federal, state, local, and nonpublic entities,” said Krotulski.

Rajiv Bahl, MD, MBA, MS, is an emergency medicine physician and health writer. You can find him at