A new class of synthetic opioids, nitazenes, are hitting Australian streets
Wednesday, May 29, 2024.
Nitazanes can be up to 500 times stronger than heroin.
Signs of a nitazene overdose: unexpected drowsiness, loss of consciousness, slow breathing or snoring, and skin turning blue or grey.
A nitazene overdose may require multiple doses of naloxone (in other words: more naloxone than we usually use to reverse a heroin OD).
Fentanyl test strips cannot detect nitazenes.
A class of synthetic opioids called nitazenes, which are stronger than fentanyl, are beginning to hit Sydney streets with NSW Health issuing two recent public warnings about the drug.
In April, NSW Health linked a sharp rise in opioid overdoses in western Sydney to a nitazene. The NSW Health investigation discovered nitazenes in drug samples connected to a cluster of around 20 overdoses. Consumers believed the drug – reportedly a yellowish powder – was heroin at the time of purchase. Today, NSW Health revealed that there have been four more nitazene-related hospitalisations across the state since the last announcement. The suspected presence of a nitazene in either coke or ketamine caused one of the emergency visits, while intentional consumption of a nitazene prompted hospitalisation in the other cases.
With nitazenes beginning to pop up more frequently, both users and health services need to be extra careful. Even for seasoned heroin and opioid injectors, they’re a real danger.
Rise in nitazene detections across Australia
Nitazenes are a class of synthetic opioids, meaning they are produced in a laboratory rather than from natural substances found in the opium poppy plant. Chemists first developed nitazenes in the 1950s as pharmaceutical products but they were not suitable for clinical use due to their intensity. Even within this nitazene family of drugs their relative strengths vary wildly. While ‘metonitazene’ is 50 times stronger than heroin, ‘etonitazene’ is 500 times stronger than heroin. It means there is no safe dose for nitazenes.
Jared Brown, a manager of drug surveillance at the NSW Ministry of Health, told User’s News that nitazenes are “really potent” and look “virtually indistinguishable from heroin”, which makes it easy for drug suppliers to pass on the synthetic opioid, knowingly or unknowingly.
Pill testing data indicates that the adulteration of street drugs in Australia with more harmful (and unexpected) drugs is widespread.
Directions Health Chief Operating Officer Stephanie Stephens, who oversees operations at CanTEST, a fixed-site drug testing facility in Canberra, said that harm reduction groups in Canberra are concerned about synthetic opioids entering local illicit drug markets as both a cutting agent and a powerful standalone product.
“Whenever there is something high risk – like the nitazene that we detected in December 2022 – we do a community alert. Red alerts are released within 24 hours of a high-risk detection,” Stephens stated.
“We need to be mindful of synthetic opioids because there are roughly 100 in the global unregulated market and they all have different risk profiles”.
While North America’s fentanyl crisis has dominated the front page of the internet in recent years, thanks to the efforts of Youtube journalists like Andrew Callaghan, aka All Gas No Brakes, in Australia illicit use of fentanyl, a synthetic opioid, is largely confined to the trade of prescription fentanyl patches. There have been no publicised detections of fentanyl adulteration in NSW within the last 2 years. But it’s a different story when it comes to nitazanes.
Recent detections of nitazenes has health professionals concerned. Jared Brown from NSW Health said authorities see nitazenes as “a higher risk than fentanyl”.
In April, the National Centre for Clinical Research on Emerging Drugs (NCCRED) released a report on the increase in nitazene toxicity reporting within Australia. Detections of nitazenes have occurred in almost every single Australian state and territory across the last 12 months. Within NSW alone there were 5 public drug alerts about batches containing nitazenes during this period. The Australian Federal Police and Australian Border Force also recently published a joint media release highlighting the rise in nitazene importation and police seizures of the drug.
Worrying, nitazenes have also begun to appear in local party drugs, such as MDMA, coke and ice. Communities not usually exposed to opioid-focused harm reduction services are also now in harm’s way. So these aren’t just isolated incidents.
Peer-based services: A refuge from stigma
NUAA staff located in the Nepean/Blue Mountains region were the first health professionals in the state to recognise indications of heroin adulteration in the area in early April. NUAA peer workers received multiple anecdotal reports from clients of an increase in opioid overdoses. Clients suspected fentanyl was the cause and NUAA notified the NSW Ministry of Health.
One client told NUAA staff that he was present when 4 of his mates went down after having a shot. He described what he saw as “really scary”.
“One by one they dropped. The colour drained from their faces, and they went grey. The nasal spray naloxone was used but it didn’t work. I watched in horror as grey turned to blue and I remember thinking – I just wish the ambulance would hurry up.”
Very few of those who overdosed attended a hospital, even after encouragement by paramedics, and some didn’t even call 000 in the first place. Those who did visit a hospital “left against medical advice and before tests could be done”, NUAA staff reported. Largely, community members banded together to administer naloxone, a nasal spray designed to prevent opioid overdoses.
Naloxone comes in two forms: as a non-prescription nasal spray or a non-prescription intramuscular injection. This image shows both.
With many of those affected choosing not to engage with health services, there was little formal record of overdoses from the high strength opioids. NSW Health’s hospital-based early warning system did not pick up on the issue. But NUAA did receive reports of the overdose cluster thanks the closeness of peer workers and injecting communities.
“Police are the first to respond to overdoses in some areas, so there’s fear of legal consequences, plus there’s the stigma that surrounds injecting drug use,” Dylan, a NUAA employee, told Users News. “Mostly, people rely on their friends and peers when this sort of thing happens because they have been treated negatively by healthcare workers or first responders in the past.”
“For a lot of our clients, we are the only service they access where they don’t feel judged or discriminated against. We listen to people, we understand. We see them as real people with real stories,” Dylan continued. “We’ve invested time getting to get to know peers within our community.”
“We even have people that come into the NSP when they are no longer using – they just come in for a yarn and a cuppa.”
Herein lies the benefit of peer organisations: drug-using communities feel comfortable approaching harm reduction workers with news when those workers themselves have lived experience of drug usage. Trust is vital.
Touching on this subject, Jared Brown heaped praise on NUAA staff and described peer-run harm reduction organisation as “invaluable” in the fight to reduce drug-related harm.
Prevention measures for a nitazene overdose
In light of recent drug alerts, it’s vital that people who use opioids and party drugs always carry naloxone.
Naloxone comes in two forms: as a non-prescription nasal spray or a non-prescription intramuscular injection. Both rapidly and effectively reverse the effects of an opioid overdose. In short: it can be a life-saving medication. What’s more: some community pharmacies and needle and syringe programs in NSW supply naloxone for free.
Jared Brown from NSW Health stressed that a nitazene overdose may require multiple doses of naloxone or hospital treatment because the drug is extremely strong and it stays in the body longer than heroin. One NUAA client who experienced an overdose told NUAA staff that he required 5 doses of naloxone along with CPR before he regained consciousness.
It’s also important to note that fentanyl test strips cannot detect nitazenes.
Dylan told Users News, “I truly believe the situation could have been far worse if we hadn’t acted quickly, spreading the word through our peer networks and distributing naloxone to those we knew might be at risk. If you witness multiple overdoses in your community and suspect adulterated substances, please don’t delay in reporting it. Take proactive steps to raise awareness in your area and encourage everyone to have naloxone readily available.”
So: if you’re trying a new batch of heroin, start with smaller than usual doses and make sure you are not alone. Watch out for unexpected drowsiness, loss of consciousness, slow breathing or snoring, and skin turning blue or grey as these are signs of opioid overdose. At a time like this, with nitazenes beginning to hit Sydney streets, harm reduction practices are more important than ever.