Well-Being

Synthetic opioids stronger than fentanyl have cropped up in the US

Story at a glance

  • More than 100,000 Americans died from overdoses between April 2020 and April 2021, primarily due to fentanyl and other opioids.
  • A group of synthetic opioids called nitazenes, even more powerful than fentanyl in some of forms, cropped up in the nation’s drug supply in 2019.
  • While there’s no indication at this time nitazenes will become more prevalent than fentanyl, the drug’s emergence has some worried more potent synthetic opioids will continue proliferating throughout the country.

Fatal drug overdoses in America are soaring as dangerous synthetic opioids continue to flood the illicit drug market with no signs of slowing down.  

In November 2021, data from the Centers for Disease Control and Prevention (CDC) revealed the nation reached a tragic milestone: More than 100,000 Americans died from overdoses between April 2020 and April 2021. It’s the first time drug-related deaths in the U.S. surpassed the six-figure mark in any 12-month period.  

While fallout from the ongoing COVID-19 pandemic undoubtedly contributed to the unprecedented spike in drug deaths, the highly potent synthetic opioid fentanyl — which is 50 to 100 times stronger than morphine — is primarily fueling the nation’s drug overdose epidemic due to ease of production and its powerful effects.  

But in recent years, there’s been a worrisome discovery in a number of states and the District of Columbia: A group of synthetic opioids called nitazenes, even more powerful than fentanyl in some of its forms, has begun to emerge.  


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A form of nitazene called isotonitazene first cropped up on the illicit drug market just a few years ago. The drug, which was first synthesized by the pharmaceutical industry in the 1950s, was identified in postmortem forensic toxicology reports and in national and international drug seizures starting in April 2019 

Since then, nitazenes have been associated with drug overdose deaths in the Midwest and found in drug seizures in many parts of the country. Protonitazene and isotonitazene — both of which are thought to be several times more powerful than fentanyl —were identified in syringes examined by scientists at the D.C. Department of Forensic Sciences in September and October of 2021.  

Alex Krotulski, associate director at The Center for Forensic Science Research and Education who works to identify emerging drugs, said Drug Enforcement Agency’s (DEA) move in 2018 to place fentanyl and fentanyl analogs into the schedule one category created a need in the drug market for a new synthetic opioid.  

“In 2019 we saw the emergence of isotonitazene and now we’re seeing a sort of cyclic pattern. A new nitazene analog emerges, it’s prevalent for a period of about six to nine months, the DEA schedules that individual drug and it goes away, and a new one pops up. Some people refer to it as whack-a-mole,” Krotulski told Changing America.  

“The scary thing is that while some of these fentanyl analogs went away we now have these nitazenes and some of them we’ve seen are actually more potent than fentanyl. Some of them are significantly more potent than fentanyl,” he said. “We’ve now seen this boom, this increase in the potency of synthetic opioids…It’s increasing so much that very small amounts of these drugs can kill someone.”  

Krotulski said current trends suggest nitazenes, or any other drugs for that matter, are unlikely to surpass fentanyl in their prevalence, as Mexican cartels have a tight hold on the drug and its production and distribution into the U.S.  

But Krotulski says nitazenes are grossly underreported as they are not routinely tested for, especially when a medical examiner discovers fentanyl was present in someone who experienced a fatal overdose. Krotulski said his lab alone has had at least 1,000 identifications of nitazenes and estimates the drug may account for about 5 percent of the 100,000 fatal overdoses last year.  

“It’s small but it’s still a considerable number of deaths, it’s still a considerable number of people and families that want answers as to why their loved one is no longer alive.”  

While there’s no indication at this time nitazenes or any other synthetic opioid will become more prevalent than fentanyl any time soon, the drug’s presence has some worried more potent synthetic opioids will continue proliferating throughout the country.  

“It does make me think it’s a little bit like COVID. COVID is a virus that has very unique properties that make it so infectious and it’s mutating. And the same thing with the synthetic drugs, they have very unique properties in that they are actually quite potent, also they can be easily manufactured,” Nora Volkow, director of the National Institute on Drug Abuse (NIDA), told Changing America.  

Volkow said the rise of new synthetic drugs can complicate surveillance and understanding about what drugs people are using and overdosing on, as many of the tests are unlikely to detect nitazene-like compounds.  

“It’s very real that these molecules could become widespread, absolutely,” Volkow said. “We need to be prepared to screen and recognize when they are emerging so we can intervene first and understand where they are coming from, where they are being distributed and educate the public about them.” 


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