A new study suggests that a group of emerging novel synthetic opioids found in illicit drugs in the United States could be more potent than fentanyl, exceeding the strength of morphine by up to 1,000 times and potentially requiring higher doses of naloxone to reverse overdoses.
The research, published recently in the journal JAMA Network Open, highlights that these opioids, known as nitazenes, though structurally unrelated to fentanyl, pose significant challenges in overdose management.
According to the study, most patients who overdosed on nitazenes required multiple doses of naloxone for reversal, whereas those overdosing on fentanyl typically responded to a single dose.
The researchers from institutions including the Icahn School of Medicine at Mount Sinai in New York and the Lehigh Valley Health Network in Pennsylvania underscored the importance of awareness among clinicians regarding these potent opioids in the drug supply.
They emphasized the need for preparedness to administer repeated doses of naloxone.
Dr. Alex Manini, a study author and emergency medicine professor at the Icahn School of Medicine at Mount Sinai, emphasized the critical implications of the findings.
He noted, “Given the alarmingly high cardiac arrest rate for nitazene overdose, this study should energize harm-reduction policies.”
The study found that patients overdosing on metonitazene, a specific type of nitazene, exhibited particularly severe clinical outcomes, including a high incidence of cardiac arrest.
Despite the small scale of the study, its findings underscore a growing concern about novel synthetic opioids exacerbating the ongoing overdose crisis in the United States.
Joe Friedman, a researcher at the University of California, Los Angeles, who was not involved in the study, highlighted the need for enhanced tracking and understanding of these substances to mitigate their impact.
Sheila Vakharia, from the Drug Policy Alliance, pointed out that users often unknowingly encounter nitazenes when purchasing drugs on the underground market, assuming them to be heroin or fentanyl due to mislabeling by dealers.
She highlighted regional increases in nitazene prevalence, reflecting their emergence in response to stricter penalties targeting fentanyl and its analogues.
The study calls for heightened vigilance and public health efforts to address the risks posed by these potent synthetic opioids as they continue to infiltrate the illicit drug supply across the United States.
