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What are Nitazenes?

Synthetic opioid drugs such as ‘nitazenes’ have been detected in the Scottish and UK drug supply. There are many types of nitazenes including metonitazene, N-pyrrolidino-etonitazene (NPE), etonitazepyne, etonitazene, isotonitazene and protonitazene. Some are hundreds of times stronger than heroin.  Most often they may be sold as or found in other drugs.

They have been found been found in powders (brown/yellow/white), contaminated heroin and pills/tablets sold as oxycontin, as well as Diazepam (a benzodiazepine) and liquids, including nasal sprays. There is also a concern that nitazenes could be found in other drugs, such as cocaine, due to accidental cross contamination. We also know that nitazenes have been involved in some drug overdoses and deaths in the UK and Ireland.

Drug Alerts

Nitazene alert poster by SDF

Drug-related harms, including sudden collapse, hospitalisation, and sadly in some cases, drug-related deaths, have increased across Scotland.

This seems consistent with a national picture of increased harms over the past 7 months, linked with nitazines, found in various drugs, including those sold as heroin, benzodiazepines and oxycontin among other drugs.

Naloxone is a life-saving medicine that temporarily reverses the effects of an opiate/opioid overdose.

What you need to know

• The effects are similar to other opioid drugs such as morphine and heroin but the effects will be felt more strongly from much smaller amounts
• Nitazenes can vary in potency. Some are thought to be over 600 times more potent than heroin meaning that a fatal dose could be as small as two grains of sand
• The effects may be short-lasting with a strong urge to re-dose
• The amount of nitazene type drugs found in tablets, pills and powders varies so it would be almost impossible to judge an accurate dose
• Opioid drugs can cause your breathing and heart-rate to slow to life threatening and fatal levels
• Higher doses of opioid drugs increase this risk of overdose
• This risk is increased if mixing with any other drug, particularly any ‘downer’ type drugs such as alcohol, other opioids, benzodiazepines (e.g. vallies, Xanax), GHB and ketamine
• If you have been taking nitazenes and stop suddenly you may experience opioid withdrawal symptoms

Harm reduction 

• Test your drugs – this allows you to be more aware of unexpected contents. Visit www.crew.scot/how-do-i-test-my-drugs for more information on how you can test your drugs
• Remember that contents can vary even with in the same batch
• Start with a test dose
• Familiarise yourself with the signs of an opioid overdose so that you feel confident about what to do to help.
• Overdoses involving nitazenes can be reversed using the life-saving medicine naloxone hydrochloride
• You may need to administer multiple small doses of injectable naloxone before the overdose will be reversed
• Doses should be administered one at a time, waiting 2-3 minutes between each dose
• Prenoxad (intramuscular) and Nyxoid (intranasal) are two medical products containing naloxone hydrochloride
• In Scotland the provision of naloxone is FREE and anyone 16 or over can grab a naloxone kit from the Crew Drop-in or visit www.crew.scot/what-we-do/get-naloxone

RADAR Alert: Nitazenes: new synthetic opioids

There are also new resources available from Scottish Drugs Forum (SDF) and an alert from RADAR. Full information on the current nitazene alert and for a list of resources, please visit the ‘Rapid Action Drug Alerts and Response (RADAR) Alert: Nitazenes‘ page.

Download our leaflet about nitazenes: What are nitazenes 

In an Emergency

• In an emergency call 999 for an ambulance first saying you suspect an overdose – the call handler will tell you what to doWhen to give naloxone:
  
• Naloxone should be given to anyone who is non-responsive and displaying the signs of an overdose
• If you are unsure if the person has taken opioids, always use naloxone as this will not cause any harm and could save their life
• If someone has been taking opioid drugs and other ‘downer’ drugs such as alcohol or benzos (e.g. vallies or Xanax) then naloxone will not reverse the effects of these drugs. You should still administer naloxone as this will reverse the effects of the opioids and allow the person’s body the chance to respond to the ‘downer’ effects of any other drugs and could save their life!
• If someone has taken drugs contaminated with nitazines, they may need multiple, repeated, measured doses of injectable naloxone at 2-3 minute intervals to bring them round – avoid administering the entire syringe’s content at once.

Signs of an opioid overdose include:

• Unconsciousness – won’t wake with a shout or a shake
• Severe nausea and vomiting
• Seizures/fitting
• Difficulty breathing/snoring/raspy breathing
• Blue/pale tingeing of knees, hands and lips
• Slow or erratic pulse (heartbeat)
• Pale, cold and clammy skin for people with white skin: ashy-grey, cold and clammy skin for people who have black or brown skin
• Pin-point pupils