If you have never heard of nitazenes, you are not alone. While these synthetic opioids have been around for nearly 60 years, they have only recently become a significant cause of overdoses in several states. At Cottonwood, in Tucson, Arizona, we treat people who are struggling with substance use disorders. We want loved ones to have the tools they need to recognize dangerous drugs, so they can get help for their friends and family members who might be misusing them.

Facts About Nitazenes

These drugs are starting to catch the attention of law enforcement because they are quickly becoming as dangerous as fentanyl. It is important to remember that:

• While nitazenes were developed to be pain relievers, they were never approved for use in the United States. This means that they are being sourced from other countries and mixed into other drugs, often without the knowledge of the person using the drugs.
• Nitazenes come in 13 different varieties, including isotonitazene (ISO), protonitazene and metonitazene.
• Nitazenes initially appeared in the midwestern United States in 2019 and have since moved into the South and the Eastern seaboard.
• Nitazenes are more potent than heroin or morphine and cheaper to make. Some variations are even more powerful than fentanyl.
• When a person who is used to taking opioids like heroin or morphine is given a nitazene without their knowledge, they may accidentally overdose as a result of how much more potent it is. Drug overdoses are at their highest levels ever, and 75 percent of overdoses now involve a synthetic opioid.

What Nitazenes Look Like

Nitazenes can be injected, inhaled, or swallowed, and they have a variety of different appearances:

• Powder – yellow, brown, or off-white in color
• Crystalline solids
• Tablets – falsely marked to look like pharmaceutical medications like Dilaudid or oxycodone 

Signs of Nitazene Use

The signs that someone has been using nitazenes are similar to the symptoms of using other opioids, which can include:

• Euphoria
• Drowsiness
• Decreased awareness of pain
• Nausea/vomiting
• Fever
• Slower breathing and heart rate

Signs of Withdrawal from Nitazenes

As with the signs of use, the signs of withdrawal from nitazenes are also the same as with other opioids:

• Sweating a lot
• Dizziness
• Flu-like symptoms
• Blackouts
• Anxiety/panic attacks
• Restless legs

How to Protect Yourself and Others From Nitazene Overdoses

Nitazenes are only starting to reach most of the United States, but they are already proving fatal. It’s important to keep yourself and others safe:

• It is impossible to distinguish nitazenes from other opioids and pharmaceutical medications they could be impersonating or blended with just by looking at them, and there are not yet reliable ways for people outside of a laboratory to test for nitazenes. For this reason, the best way to avoid an overdose is to only take medication that is prescribed for you, as directed, by a doctor.

• Mixing alcohol with other drugs is a recipe for disaster, and nitazenes are no exception. Do not drink if you have been or will be using opioids of any type, as it may intensify their impact.

• Naloxone has been effective in reversing overdoses from nitazenes. Naloxone is available as a nasal spray or an injection. People who use opioid drugs should never use alone. They should always have someone with them who possesses multiple doses of naloxone and who remains sober.  

• When giving someone naloxone, which is also known as Narcan, it is important to remember that multiple doses may be needed, and emergency services should be contacted immediately. A person who has been rescued from an overdose can begin to overdose again if they do not receive enough naloxone. Never leave an overdosing person alone, even after you call 911 and request an ambulance.

Signs of Opioid Overdose

If you suspect a loved one could be misusing opioids, such as heroin, fentanyl or nitazenes, it is a good idea to familiarize yourself with the symptoms of an overdose from these drugs:

• Clammy, colorless skin
• Blue lips and fingertips
• Inability to wake up
• Unresponsiveness to their name or a firm rub of knuckles on their breastbone
• Slow, erratic, or stopped heart or breathing 

At Cottonwood, we believe that our guests can become happy, confident people with balanced lives. In order to get there, they need to stay safe long enough to receive treatment. Family members and friends are often the first to recognize that a person needs help, and we value their role in helping the people we treat start their recovery journey.