Deadlier Than Fentanyl: The Alarming Rise of Nitazenes and What It Means for Public Health

On June 26, World Drug Day, the world paused to reflect on the escalating drug crisis. This year’s theme underscored the necessity for evidence-based policies rooted in science, human rights, compassion, and a comprehensive understanding of the social, economic, and health implications of drug use.

According to the latest UNODC report, the global number of illicit drug users has surged to 292 million as of 2022. Among the substances, cannabis tops the list with 228 million users, followed by opioids (60 million), amphetamines (30 million), cocaine (23 million), and ecstasy (20 million). The report also highlighted a concerning rise in overdose deaths attributed to a new class of synthetic opioids known as nitazenes, which have emerged as a significant threat, particularly in high-income countries.

Nitazenes, a group of synthetic opioids potentially more potent and dangerous than fentanyl, have rapidly infiltrated the drug market. Unlike fentanyl, which was initially developed for legitimate medical use, nitazenes have no recognized medical application, making their presence in the illicit drug trade even more alarming. Their high potency and the lack of public awareness contribute to a growing number of fatal overdoses.

Ghada Waly, Executive Director of the UNODC, emphasized the urgent need for evidence-based treatment and support for those affected by drug use, while also targeting the illicit drug market. "Drug production, trafficking, and use continue to exacerbate instability and inequality, while causing untold harm to people’s health, safety, and well-being," she stated.

The rise of nitazenes has been linked to an increase in overdose deaths in several high-income countries. These synthetic opioids are often mixed with other substances, making them particularly hazardous. Users may unknowingly consume lethal doses, leading to sudden and severe health crises.

The public health impact is profound, with emergency services and healthcare systems facing unprecedented strain. Overdose incidents require immediate and intensive medical intervention, often involving multiple doses of naloxone, a medication used to reverse opioid overdoses. However, the potency of nitazenes can render standard treatments less effective, posing additional challenges for healthcare providers.

The proliferation of synthetic opioids like nitazenes extends beyond immediate health risks. These substances contribute to broader social and economic instability, exacerbating inequality and fueling cycles of addiction and crime. In regions like the Golden Triangle in Southeast Asia, drug traffickers have integrated into other illegal markets, such as wildlife trafficking and financial fraud, further complicating efforts to combat these networks.

World Drug Day serves as a poignant reminder of the collective responsibility to address the global drug crisis. The UNODC report calls for governments, organizations, and communities to collaborate on establishing evidence-based plans to fight drug trafficking and organized crime. Emphasizing the right to health as an internationally recognized human right, the report advocates for comprehensive strategies that encompass prevention, treatment, and rehabilitation.

As the world grapples with the rise of synthetic opioids like nitazenes, the path forward requires a balanced approach that combines scientific research, compassionate care, and robust law enforcement. By fostering resilience against drug use and promoting community-led solutions, we can hope to mitigate the impact of this growing menace and move towards a healthier, safer world.

o you think enough is being done to combat the threat of synthetic opioids like nitazenes?