Illustration: Aïda Amer/Axios
Synthetic opioids up to A drug 40 times more powerful than fentanyl is disrupting the public health response to the addiction crisis in a growing number of American cities.
big picture: Nitazine comes in powder, pill, and liquid forms that require time-consuming lab work to track down.Often mixed with what users think is fentanyl or heroin, it can be deadly or can cause Onset of more severe withdrawal symptoms.
- It comes as law enforcement and public health authorities grapple with increased use of “tranquilizers” — an animal tranquilizer and fentanyl mixture that caught the attention of the White House and has been found in at least 36 states and Washington, D.C.
- But most hospitals and medical examiners don’t routinely test for the two substances, and hospital data can’t distinguish nitrazine from fentanyl poisoning cases.
- A review of overdose deaths in Tennessee by the Centers for Disease Control concluded that overdoses related to nitrazine may have required as many as four doses of naloxone, an opioid reversal drug that usually comes in two packs.
Game status: Philadelphia health officials raised the public alert after opioids were detected in four street drug samples in December. Nitrates have also been found in fake oxycodone tablets in Australia and Scotland over the past month.
- Last June, the Drug Enforcement Administration found drugs mixed with heroin or fentanyl in Washington, D.C.
- By November, the DEA said the continued development of synthetic opioids, such as fumigazine, was “a public health concern.”
By numbers: The number of nitrazepene-related overdoses in Tennessee increased from 10 to 42 between 2020 and 2021, according to the CDC report, which noted that these numbers may be an undercount.
- Last April, Ohio’s attorney general issued a warning calling nitrazepone a “Frankenstein opioid” and reported an increase in nitrazzone cases between the first quarter of 2021 and the first quarter of 2022 nearly sevenfold, from 27 to 143 cases.
Yes, but: Available data suggests such chemicals “remain very rare,” said Eric Dawson, vice president of clinical affairs at Millennium Health, a testing laboratory that monitors prescription and illicit drug use.
- Nitrazene analogues have not been widely used in Philadelphia, said Constance DiAngelo, chief medical examiner for the city’s health department.
Between the lines: Philadelphia plans to expand its medical examiner’s office’s ability to identify synthetic opioids, but DiAngelo told Axios that the availability of the personnel and specialized equipment needed to detect the substance remains limited.
- The fact that health departments do not receive toxicology data from hospital emergency rooms due to privacy constraints also limits what is known.
- They could search for mentions of nitrazine using symptom monitoring, a system in which medical institutions share de-identified data (such as self-reported patient complaints) with health departments.
- But people are less likely to mention to their doctors a drug they’re unknowingly taking.
Bottom line: New, more dangerous drugs could be entering the U.S. supply at a pace that labs and clinicians can’t keep up with, said Steven Passik, director of clinical data programs at Millennium Health.
- Because of their potency, “they killed a bunch of users before they were even tracked.”
- HHS allocated more than $1.6 billion to states and tribal communities in September to address the opioid crisis through education, prevention and treatment.
What are we looking at: While diazoxide is a relatively new issue, it could add urgency to debates in Congress about how to respond to the opioid crisis and fund public health efforts.