Is a New Deadly Synthetic Opioid from China Threatening the US?

A new synthetic opioid called nitazenes is emerging as a significant threat in the United States, reportedly up to 50 times more potent than fentanyl. As this drug, which is often mixed with other substances and manufactured in counterfeit pills, becomes more prevalent, authorities are warning of its severe risks and the challenges it poses for overdose reversal treatments.

Last updated: 10 October 2023 (BST)

Key Takeaways

• Nitazenes are synthetic opioids potentially 50 times stronger than fentanyl.
• They are resistant to naloxone, complicating overdose treatment.
• Counterfeit pills laced with nitazenes are increasingly found in the illicit drug market.
• Traffickers are mixing nitazenes with other opioids to increase potency and addiction.
• East Coast states, particularly Texas, are experiencing significant increases in nitazene-related fatalities.

What Are Nitazenes?

Nitazenes are a class of synthetic opioids that were first developed in the 1950s but have recently emerged on the illicit drug market. Originally, they were primarily of interest to researchers studying opioids; however, they began to gain traction in Europe around 2019 and have since spread to the United States.

This class of drugs includes various compounds, with protonitazene and metonitazene being the most notable. Due to their high potency, nitazenes can be extremely dangerous, especially when mixed with other opioids or substances.

The Potency of Nitazenes

One of the most alarming aspects of nitazenes is their potency. According to reports, they can be up to 50 times stronger than fentanyl, which itself is a highly potent opioid responsible for a significant number of overdose deaths. This increased strength poses a severe risk for users who may be unaware that they are consuming such a powerful substance.

Moreover, nitazenes have been linked to more than 18,000 fatal and nonfatal emergency medical service (EMS) encounters across the United States from January 2023 to April 2025. The Centers for Disease Control and Prevention (CDC) has indicated that the required doses of naloxone—an opioid overdose reversal medication—are greater for nitazenes compared to fentanyl, complicating emergency responses to overdoses.

Emergence on the Drug Scene

Authorities have noted a concerning trend: nitazenes are increasingly being found mixed with other drugs such as heroin, methamphetamine, and cocaine. Frank Tarentino, head of the Drug Enforcement Administration’s (DEA) New York Division, highlighted that these substances are often pressed into counterfeit pills that mimic legitimate prescription medications like Xanax or Percocet.

This strategy creates a false sense of security for users who believe they are consuming safer, legitimate medications. Tarentino warns that these pills are widely available on the streets and online, with traffickers leveraging social media to reach potential buyers.

Sources of Nitazenes

The production and distribution of nitazenes have been traced back to China, where companies manufacture them at a low cost. This trend has intensified as pressure on the fentanyl supply chain has increased, leading cartels to seek out alternative synthetic opioids. The DEA has indicated that some cartels are even blending nitazenes with fentanyl and other opioids to create more dangerous mixtures.

Sally Sparks, a public information officer with the DEA’s Houston Division, pointed out that these changes in drug composition are a response to recent crackdowns on the shipment of fentanyl precursor chemicals from China, forcing traffickers to innovate in their operations.

Impact on Drug Overdose Statistics

Despite a reported decline in drug overdose deaths across the United States—by approximately 25% from February 2024 to January 2025—opioids, particularly fentanyl and its analogues, remain the leading cause of death for individuals aged 18 to 44. This demographic is particularly vulnerable to the rising threat posed by nitazenes.

Dr. Stephen Loyd, who heads the Office of Drug Control Policy in West Virginia, noted that the recipes for many synthetic opioids, including nitazenes, are easily accessible online. This accessibility enables drug cartels and street-level dealers to produce potent and dangerous formulations with minimal investment and expertise.

Geographical Spread and Trends

Nitazenes have been particularly problematic in states along the East Coast, such as Virginia, South Carolina, and Georgia. Texas has also seen a spike in nitazene-related fatalities, with the DEA Houston Division reporting an increase in drug poisonings linked to N-pyrrolidino protonitazene (commonly referred to as pyro). This variant of nitazene is reported to be 25% more potent than fentanyl, exacerbating the overdose crisis in the region.

In Houston, authorities have seized counterfeit pills designed to appear like legitimate prescription medications, including hydrocodone and Percocet. In 2023 alone, there were 11 nitazene-related deaths in Houston, affecting individuals ranging in age from 17 to 59 years old, highlighting the indiscriminate nature of this crisis.

Challenges in Combating the Crisis

Efforts to combat the rise of nitazenes and other synthetic opioids are ongoing, but challenges abound. The ease of production and the low cost of these drugs make them attractive to traffickers. As Loyd mentions, the perpetual emergence of new synthetic drugs complicates law enforcement efforts. While stopping cartels is crucial, addressing the underlying issues of addiction and providing effective treatment options are viewed as essential components of any comprehensive strategy to combat the opioid epidemic.

Conclusion

The emergence of nitazenes presents a new and formidable challenge in the battle against opioid addiction and overdose. With their extreme potency and the ability to evade traditional overdose treatments, these drugs threaten to exacerbate an already critical public health crisis. As authorities continue to grapple with this evolving situation, it is imperative that communities remain vigilant and informed about the risks associated with these synthetic opioids.

How can society better address the challenges posed by nitazenes and other synthetic opioids? Engaging in community education and seeking effective treatment solutions will be vital in the coming years. #OpioidCrisis #Nitazenes #DrugPolicy

FAQs

What are nitazenes?

Nitazenes are synthetic opioids that are reported to be up to 50 times more potent than fentanyl. They have emerged on the illicit drug market and are often mixed with other drugs.

How do nitazenes compare to fentanyl?

Nitazenes are more potent than fentanyl, making them a significant concern for public health. They are also more resistant to naloxone, complicating overdose treatment.

Where do nitazenes originate?

Nitazenes are primarily produced in China and have recently been found in the illicit drug market in the United States, often mixed with other opioids.

What are the risks of using nitazenes?

Using nitazenes poses severe risks, including a higher likelihood of overdose due to their potency. They are often found in counterfeit pills, increasing the risk for unsuspecting users.

What can be done to combat the nitazene crisis?

Combating the nitazene crisis requires a multifaceted approach, including law enforcement efforts to disrupt trafficking, public education on the dangers of synthetic opioids, and improved access to addiction treatment services.