What are nitazenes?

So, what exactly do we know about these new nitazenes? Rick Lines can help us here, he is the head of substance misuse at Public Health Wales and WEDINOS - which is the biggest public drug testing service in the UK…

Rick - Nitazenes are a group of substances. They're a class of high potency synthetic opioids. They were originally developed by the pharmaceutical industry in the 1950s as analgesics, pain killers, but the clinical development of nitazenes was abandoned because of concerns of adverse effects and harm related to them. So they are an illicit form of substance, and again, a high potency substitute for traditional opiates.

James - Why are synthetic opioids so dangerous to those who use them?

Rick - Well, quite simply because they are much more potent than the traditional opiates that they are used to substitute for. People might be purchasing a substance thinking it is heroin, for example, and in reality be purchasing something that has a much more potent form of synthetic opiate mixed in. So people's breathing, for example, gets incredibly, incredibly shallow. So it's usually linked, although not always, but usually linked to some form of respiratory system suppression.

James - Nitazenes refers to a number of different drugs. They're illegal, as you mentioned. Given these facts, how do you investigate or how does one go about investigating the prevalence of them in the UK drug supply?

Rick - It's very difficult. Probably the most effective way of doing it is obviously to have access to drug checking or drug testing, and we're fortunate that we have the WEDINOS programme here in Wales that is able to do some of that and there are other smaller projects in England, and they're looking to start one up in Scotland. But it's very, very difficult. We're talking about very tiny doses and we accept samples from a range of both partner agencies out in the community, from drug services, from nighttime economy venues, from prison services, from accident and emergency, from homeless hostels and shelters, etc., and we also accept anonymous submissions from the public. They can send in a sample of what they've purchased. WEDINOS works from the perspective that the only way to be a hundred percent sure of your own safety is not to take a substance, but if you are going to take a substance, it obviously increases your safety, decreases your risk of harm, to know what you're taking.

James - And as per your work, what's the scale of the nitazene problem here in the UK?

Rick - WEDINOS as a service does not test overall prevalence. It's a voluntary service, so we're only able to test what is submitted to us. In terms of nitazenes, we received our first sample of a nitazene in April of 2021, so about three years ago. Initially, for the first period of time, we mainly saw nitazenes in samples that were submitted as oxycodone. Leading up to the Christmas period, we were detecting nitazenes in quite a lot of samples that were being sent to us as benzodiazepines, counterfeit pharmaceutical products essentially that were probably being purchased from illicit online pharmacies. This was a concern because you wouldn't necessarily expect to see a synthetic opiate in a benzodiazepine product. There are different substances with different effects and it raised concerns of nitazenes encroaching outside of the opiate market into other substances. Although, keep in mind that of the substances that we have submitted to us, nitazenes are quite a small percentage, probably about 2 or 3%. But clearly we have seen an increase in the number of submissions that contain nitazenes. Now, whether that's because they're increasingly prevalent in the market or whether there is an increased awareness about nitazenes and an increased concern about nitazenes which is causing more people to send in substances, we don't know.