Stronger Than Fentanyl: Nitazene Is a Super Opioid Already Sold by Drug Traffickers

On the afternoon of September 17, Dr. Nora Volkow, director of the National Institute on Drug Abuse in the United States, received a call she had been expecting for several days: National Public Radio journalist Brian Mann had sent her information suggesting that the fentanyl pandemic had finally entered a recession, but she was looking for corroboration.

“This is very exciting,” confirmed Dr. Volkow, named by Time magazine as one of the 100 most influential people in the world, after reading the data the journalist had provided. “The information is real. It looks very, very real.”

Her words became the lead story the following day. “Exclusive: US overdose deaths plummet, saving thousands of lives,” headlined National Public Radio on its website. Among the explanations were the already widespread use of the drug naloxone—which reverses opioid overdoses—and a drop in street sales of fentanyl due to restrictions on the sale of its chemical precursors, as well as sanctions against organized crime.

Dr. Valkow’s words were doubly relevant: because of her training as a decorated psychiatrist and because she is a native of Mexico City. The Mexican addiction specialist is well-versed in the dynamics of cartels and their formulations. If she said the fentanyl market was shrinking, it was surely true.

However, her excitement clashes with the concern of some of her colleagues, who see in fentanyl’s decline the perfect storm for the rise of a more potent, more lethal drug for which there is still no antidote.

King fentanyl is dying… Long live King nitazene!

It’s a “super opioid” stronger than fentanyl and heroin.

Nitazene is, in fact, a group. A cocktail of synthetic opioids that includes the substances isotonitazene, metonitazene, protonitazene, etonitazepine, and ethacene, all capable of stopping the most excruciating pain; they can also kill. Because it is a drug 40 times more potent than fentanyl and 2,000 times stronger than heroin, some are already calling it a “super opioid.”

Its history is short and intense, like the lives of those who become addicted to this new drug: in the late 1950s, the pharmaceutical research laboratories of the Swiss chemical company CIBA Aktiengesellschaft synthesized numerous substances to treat pain. Scientists were trying to draw something positive from the horrors of the Korean War, the Vietnam War, the Suez Crisis, and other armed conflicts of the last century, and were searching for formulas to alleviate the suffering of surviving soldiers and future combatants.

That’s how the Swiss discovered nitazenes. But both inside and outside their country, they were immediately dismissed as painkillers for human or veterinary use. Their potency represented a great risk. The recipe was forgotten. Or, at least, that’s what its discoverers believed.

With the rise of synthetic drugs, and the drawbacks posed by natural narcotics—vast expanses of fertile land, a significant number of farmers, dependence on rain, and more—organized crime stopped hiring so many day laborers and began searching for chemists who would return to the pharmacological literature in search of forgotten substances. And, somehow, experts still don’t know exactly, those specialists found nitazenes under the dust and brought them back to the present in clandestine laboratories.

Their reappearance occurred in 2019. Anti-narcotics agents in Germany suddenly heard of a new drug on the black market. The dealers called it ISO because morphine, heroin, and oxycodone were mixed with the rediscovered isotonitazene to enhance its analgesic effects.

No one imagined it would be the beginning of a new drug empire. Just as the investigations began, a new public enemy distracted the authorities: COVID-19. Nitazene advanced before the world’s eyes.

After COVID-19, nitazenes and other opioids appeared worldwide.

A year later, in the midst of a global lockdown, DEA agents found another nitazene—metonitazene—in the autopsies of 20 young people in the United States who had died from overdoses. In less than a year, the drug had traveled from Europe to the Americas, with the speed of another pandemic.

“Metonitazene was the only opioid identified in 30% of cases, but it was also found in combination with fentanyl and benzodiazepines, as well as other opioids and hallucinogens […]. Medical examiners included metonitazene as one of the drugs responsible for the cause of death, and it was always classified as accidental.

“Toxicology labs and forensic investigators must ensure they include metonitazene in their testing protocols and, at the same time, remain alert to the emergence of new synthetic opioids,” warned Dr. Alex Krotulski, director of the Center for Forensic Science Research and Education.

Despite the alarm, the red flags did not go off. In 2021, while attention was focused on the international recovery from the pandemic and the devastation caused by fentanyl, other nitazenes appeared around the world. Spain, Brazil, France, Canada, and twenty other countries cremated dozens of young people deceived by their dealers, believed they were using cocaine or methamphetamine recreationally and died in the agony of an overdose

Even in 2022, the word “nitazene” remained a mystery to chemists. As of June 9 of that year, a search on the U.S. Centers for Disease Control and Prevention website yielded no results for the keyword “nitazene,” despite the fact that these compounds are frequently mentioned in articles about fentanyl.

“Clinicians, healthcare professionals, academics, public health officials, and policymakers may be unaware of nitazenes, their growing presence in the illicit drug market, and the potential dangers of these potent synthetic opioids.

“A broad-based public health campaign targeting street drug buyers is crucial to ensure that recreational users understand that nitazenes pose a real threat,” wrote Dr. Joseph Pergolizzi Jr., one of the world’s leading experts on pain management, that year. “A threat that is currently invisible.”

The first clandestine megalabs appear in Asia.

Death from a nitazene overdose is very similar to that from fentanyl, only it occurs more rapidly. First, a cold sweat runs through the user’s body, then intense drowsiness sets in, breathing slows, lips turn blue, convulsions occur, pupils stop responding to light, consciousness fades, and the inevitable arrival of death sounds: a kind of snoring noise from the rigidity of the rib cage. Seconds later, the brain dies and the rest of the organs shut down.

Unlike fentanyl, whose progression to death can be halted with naloxone—it “revives” those who overdose—nitazene has no antidote because it is structurally unrelated to other opioid groups. For now, if someone has an adverse reaction, health professionals can only provide oxygen until the snoring noise that heralds death doesn’t appear.

Little has been achieved since 2023, when the world acknowledged the existence of this drug that was advancing like an unstoppable shadow: chemists and doctors are still studying the purity levels of nitazenes in street drugs and the risk factors for their users, for example, obesity, age, and its combination with other drugs. The delay in their findings is due, in part, to the fact that clinical trials on the effects of nitazenes on humans were never conducted.

Meanwhile, security forces around the world are trying to contain its massive production, but with little success. Because it is not controlled by any law or health regulation, the first clandestine mega-laboratories in Asia have only just begun to be located, supplying global mafias, who have calculated that it is much cheaper to buy chemical precursors to make nitazenes than fentanyl.

The profits are massive: the United Nations Office on Drugs and Crime estimates that 10 kilos of nitazenes are currently equivalent to the economic value of one ton of cocaine.

What the White House does know is who is behind the production of nitazenes in the Americas and some European countries. They are the same ones who created the fentanyl crisis in the United States: the Sinaloa Cartel and the Jalisco New Generation Cartel. This new drug is being developed right now in the drug labs controlled by Los Chapitos, La Mayiza, and Nemesio Oseguera Cervantes’ gang, El Mencho.

The Mexican formulation is macabre: a little fentanyl here, a little nitazenes there. Veterinary tranquilizers, dissociative anesthetics, appetite suppressants, and central nervous system stimulants are added to the mix, and it all goes into the batches of heroin and cocaine circulating on the streets.

Addiction sets in instantly, and the user becomes a frequent customer of the dealer until death.

Funding is lacking to study an antidote.

“The war on drugs is like a children’s game of whack-a-mole,” says researcher Jeffrey A. Singer at the Cato Institute in Washington: as one person whacks the animal emerging from the hole, three others appear in different positions. You may gain some points at the start, but in the end, the game always wins due to its speed.

Something similar is happening with new drugs: the US government has been so focused on its new visa restriction policy to deter the circulation of fentanyl that it has failed to see other holes where nitazene variants are peeking out. “Fentanyl is simply the latest example of what drug policy analysts call ‘the iron law of prohibition’: the tougher the enforcement, the stronger the drug.

“Prohibition incentivizes those who sell prohibited substances to create more potent versions that can be more easily trafficked in smaller quantities and divided into larger doses for sale. Prohibition makes the black market dangerous, because people who buy drugs there can never be sure of the purity, the dosage, or even if they’re actually buying the drug they think they’re buying,” says Dr. Singer.

Because drug policy is unlikely to change under Donald Trump’s administration and the cartels will continue to profit from the multi-million dollar black market for synthetic opioids, for now the only hope lies with scientists: to develop an antidote that will give a chance to life to those who consume nitazene, intentionally or accidentally.

So far, the best opportunity lies with a substance known as “nalmefene,” which laboratories are trying to test as an antidote. But a lack of funding and interest in treating addicts stands in the way.

As long as there is no cure, nitazene will reign on the streets with that horrible rumble that confirms that no one can take its crown.

Source: Milenio