Dear Kevin and colleagues,
Thank you for sharing your experience as an addiction specialist in the United States.
Before this I had never hearf of nitazines, which are 40X more potent than fentanyl (which is itself 50-100 times more potent than heroin).
It sounds like we are at the beginning of a possible crisis in nitazine misuse.
Nitazines are a growing threat to public health not only in the US but also the UK. 333 fatalities linked to nitazenes were reported in the UK in 2024.
From the UK website WeAreWithYou:
Nitazenes are a group of synthetic opioids which have emerged in the UK drug supply. They can be taken on their own (sometimes unknowingly), and they have been found in heroin and other illicit drugs like oxycodone and benzodiazepines. If a drug contains nitazenes, there is an increased risk of harm, overdose and death.
It seems that specialised knowledge in organic chemistry is required to make fentanyl and nitazines, and yet we are seeing these chemicals being manufactured in increasing amounts, thereby increasing risk of overdose.
To what extent are users of opioid drugs aware of this issue and what can they do to protect themselves from accidental overdose?
Best wishes, Neil
HIFA profile: Neil Pakenham-Walsh is coordinator of HIFA (Healthcare Information For All), a global health community that brings all stakeholders together around the shared goal of universal access to reliable healthcare information. HIFA has 20,000 members in 180 countries, interacting in four languages and representing all parts of the global evidence ecosystem. HIFA is administered by Global Healthcare Information Network, a UK-based nonprofit in official relations with the World Health Organization. Email: neil@hifa.org