A state-funded drug checking program in Massachusetts has found opioids up to 25 times stronger than fentanyl. In a bulletin, public health officials say the number of drug samples testing positive for nitazenes is small — but growing quickly.
“The numbers increased beyond what we were expecting,” said Traci Green, an epidemiologist at Brandeis University who works with Massachusetts Drug Supply Data Stream. “It’s better to learn more and be prepared than to ignore it and wait until a serious alarm needs to be raised.”
Nitazenes are synthetic opioids that can be more or less powerful than fentanyl. Green said they are difficult to detect without highly specialized equipment and training, so many people aren’t aware nitazenes may be in drugs purchased online or on the street. The DEA says the sedatives were first detected in the U.S. in 2019 as international drug suppliers and people who use drugs “look for novel opioids that are not illegal.”
Sarah Mackin, director of harm reduction at the Boston Public Health Commission, sees a pattern.
“The more that we crack down on things like fentanyl and heroin, that’s going to lead to the rise of other things that are infiltrating the drug supply,” Mackin said. “Nitazenes is just the newest thing to come through,” after xylazine, the animal tranquilizer found in 9% of overdose deaths in 2023.
Mackin participates in the state’s drug checking program and has found several nitazene samples so far this year. The variation she’s seen is about five times more potent than fentanyl. The samples were in powder, not pills, and included xylazine. Mackin said nitazenes and these combinations increase the risk of an overdose.
“These can be more complicated overdoses that require longer rescue breathing or more oxygen support,” said Mackin. “We’re seeing people who are very oversedated and take longer to bring back.”
But Mackin stressed that street outreach workers are not giving people who’ve overdosed more naloxone, the medication used to reverse an overdose. She said responders should still wait 2-3 minutes between doses of the nasal spray, practice mouth to mouth resuscitation to keep oxygen flowing to the brain and call 911.
Green, at Brandeis, says there’s no indication nitazenes are on track to replace fentanyl. But some clinicians are concerned that people using drugs are developing a tolerance to fentanyl, slipping into withdrawal faster and looking for something stronger to avoid getting sick.
“On the other hand, people are terrified of dying of an overdose,” said Dr. Miriam Komaromy, medical director at the Grayken Center for Addiction at Boston Medical Center. “So it’s this balancing act and when new substances come into the drug supply it makes it more dangerous.”
Komaromy said she also worries patients using more powerful opioids like nitazenes will have a hard time transitioning to treatment drugs like buprenorphine and methadone. She said that’s already happening with fentanyl. Nitazenes are not approved as a pain management medication for humans so there’s no research about the short- or long-term effects.
At least one company has developed a nitazene test strip, similar to the fentanyl test strips Massachusetts distributes, but they are expensive and Green said they are not yet reliable.
The state’s nitazene bulletin says the emergence of this threat is a reminder to never use drugs alone or call the Massachusetts overdose prevention hotline, Safe Spot, where someone will stay on the phone and call 911 if the person using drugs stops responding.
This article was originally published on WBUR.org.
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