Super strength nitazene opioid drug linked to UK deaths

A relative of fentanyl has made it's way into the UK
13 October 2023

Interview with 

David Nutt, Imperial College London


A line of differently-shaped pills.


A coroner has said that super strength street drugs have been linked to multiple deaths across Northern Ireland. The same thing is happening elsewhere in the UK and in the US. The drugs responsible - which are called nitazenes - were first developed - and rapidly dropped - in the 1950s. They mimic the effects of natural opiates such as morphine. Like their cousin fentanyl, another powerful synthetic opioid, they are considerably stronger, meaning that it’s easy to overdose and cause a respiratory arrest. But unlike fentanyl, they’re not illegal and the chemicals you need to make them are not regulated, which is why they’re rearing their heads now, over half a century later. So what do we know about them, and their potential impacts? Professor David Nutt is a neuropsychopharmacologist and former government drug “Tsar”...

David - The problem with nitazenes and the fentanyls is that some of them are exceptionally powerful. Let's say morphine is one, and let's say heroin is two, fentanyl is a hundred. It's 50 times more potent than heroin. And the nitazenes are up there, they're alongside fentanyl and there are nitazenes which are even more potent. That potency has a huge impact because it's difficult to know how much you're taking because the amounts are so small. Even the people who are selling it don't know how to weigh it out accurately. The more potent the opiates, the more likely it is to stop you breathing. Now fentanyls have become very popular in the states because there was a heroin shortage induced by the United Nations who tried to control the misuse of heroin by reducing the production of the opium poppy. And all that did was encourage, particularly the Mexican cartels, to find alternatives. And I suppose we should be grateful because they could have found these alternatives back in the 50s when fentanyl was first discovered. But they took them till about 2000 to realise there were alternatives they could make. And the problem now is that fentanyl is easy to make. It's 50 times more potent and half the price. So you can see the profit margin for fentanyl is way better than that for heroin. So the American market, illegal market, has been flooded with fentanyls for the last 10 years and last year over a hundred thousand Americans died of fentanyl overdose. So more died last year of fentanyl than died in the whole of the Vietnam War.

Chris - So why are they exploring nitazenes if they've already got fentanyls?

David - Because the American government has been putting a lot of pressure on the Chinese to stop making the precursors for fentanyls. They've made most known fentanyls illegal. So then the market has looked to see if it can find alternatives to fentanyl that are legal because these nitazenes were never made illegal in the 50s because they weren't used. So there was no reason to make them illegal. Now they're being made and being used, but they're legal, so they can be sold more easily than the fentanyls. And that's why people have moved to them, to get around the ban on fentanyls.

Chris - And who is actually making them?

David - The precursors are usually being made in China or India, and then they're being sold onto cartels again, particularly Mexican, but also within America cartels in the USA, who are then just finalising them or importing the actual final product themselves.

Chris - Are we making it illegal here now to combat the fact that, as you've said, it's a designer agent? To an extent, it's not regulated at the moment.

David - The black market doesn't really care whether drugs are illegal or illegal. The solution is to have testing facilities so that people know what they're taking. So if they discover what they think is heroin is nitazene or it's fentanyl, they don't use it. And we need safe injecting rooms, safe overdose prevention centres. But they've just started in Scotland where people can take the drugs and if they accidentally overdose because they don't know what they're taking, they've been given too much, they can have it reversed because there are reversal agents such as Naloxone and Naltrexone.

Chris - In the past you've been quite vocal about the fact that there are, sitting on the shelf, some potentially promising agents that might help with certain forms of mental illness and so on that have been dismissed because they were written off of drugs of abuse. Are there any positives that could come out of the nitazenes that that could find their way back into clinical use? Or are they just too dangerous?

David - We have enough powerful painkillers with both the plant opioids and also with the fentanyls. We don't need new painkillers. What we need are for people not to be using painkillers recreationally.


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