Key Points
- Nitazenes were developed for pain relief but were not approved for human consumption due to their risks.
- The highly potent opioid can be up to 50 times stronger than fentanyl and heroin.
- Traces of nitazenes have been detected in a range of recreational drugs across Australia.
Health experts are warning that nitazenes — a group of drugs up to 50 times more potent than fentanyl — are increasingly present in Australia.
Mark, a former heroin user, said the prospect is "scary" after having tried cocaine laced with nitazenes.
"It affected me way more than what that much of heroin would normally do," he told reporters on Monday.
"If that gets mixed into the supply here in this country, the overdose deaths will skyrocket."
Nitazenes are alarming experts worldwide, having contributed to a crisis in the United States where 106,699 overdose deaths were reported in 2021 alone.
What are nitazenes?
Nitazenes were developed by a Swiss pharmaceutical company in the 1950s as an analgesic for pain relief but were not approved for human consumption due to their risks.
Sione Crawford, CEO of Harm Reduction Victoria, a not for profit that aims to reduce drug-related harm, said the highly potent synthetic opioids are more dangerous than fentanyl and heroin.
"Nitazenes are around 25 to 50 times stronger than fentanyl," he said at the World Health Summit in Melbourne on Monday.
A 2023 study on rats found a nitazene called N-desethyl isotonitazene provided pain relief at a tenth of the dose needed using fentanyl and 1,400 times less than morphine.
While the effects on pain were similar, the increase in purity has sparked concern over the likelihood of opioid overdoses due to the small amount required to be fatal.
Adverse reactions to opioids include being unconscious, unable to talk, small pupils, slow or stopped breathing, bluish purple skin, and a limp body, according to the Department of Health.
How common are nitazenes?
Crawford said it's "difficult to know" the prevalence of nitazenes in the Australian community.
"It's still rather rare," he said.
"But we tend to only find them when there's been some kind of a disaster where someone's died or where someone has overdosed and ended up in hospital."
In September, the Therapeutic Goods Administration (TGA) warned about the public danger of nitazenes being unknowingly consumed in recreational drugs.
“While these reports are largely limited to overseas jurisdictions thus far, I note with concern the recent reports of the detection of nitazenes in seizures of heroin and other illicit and counterfeit drugs in Australia," the drug regulator said.
Where have nitazenes been discovered in Australia?
Different nitazenes have been detected in a range of drugs across Australia.
In January, three people were hospitalised in Sydney after they ingested pills sold as MDMA.
The Red Bull-stamped pills contained no traces of MDMA, however, nitazenes were detected.
Traces of nitazenes have been found in people hospitalised after heroin and ketamine use across NSW, Victoria, Queensland and the ACT. They have also been sold in ketamine in Queensland, Victoria, and Western Australia.
In March, the Victorian Coroners Court noted nitazenes had been found in at least 16 overdose deaths since the start of 2021, as it advocated for a drug-checking service in the state.
What are the fears around nitazene use?
Nitazene has higher rates of apnea or reducing people's breathing, with the experts warning they pose serious risks to humans.
However, the unpredictable nature and a lack of research on their effects cause more concern.
Nitazenes are a lot more dangerous than fentanyl, requiring two to three times the amount of naloxone to reverse the effects of the opioid.
Naloxone works by blocking opioids from attacking the opioid receptors of the brain and is available as either a nasal spray or injection.
What can Australia learn from elsewhere?
Crawford said experts were calling out the issue to prevent a crisis, like in Canada where there have been 40,000 opioid deaths since 2016.
In response, Canada has decriminalised hard drugs such as fentanyl, heroin, methamphetamine, and cocaine.
Along with removing criminal charges for possession, the country has taken a holistic approach to reducing harm including substance use services, education, and public health campaigns.
Crawford said decriminalisation is necessary to prepare Australia adequately and put the right programs in place, including national drug checking.
"Drug decriminalization will do will allow us to do things like drug checking and have safer drug supply programs," he said.
"We can't do that without changing the way that we deal with drugs."
