Nitazens, stronger than fentanylfeed overdoses. Researchers urge better detection and reduction in misdeeds.
The Nitaznes, a group of extremely powerful synthetic opioids, quickly become an important factor in the overdose epidemic, according to a Analgesic Review published by researchers from the Vanderbilt University Medical Center and the University of Pittsburgh Medical Center.
These drugs were first synthesized in the 1950s but were never approved for clinical use. They are estimated at more than 20 times stronger than fentanyl and hundreds to thousands of times stronger than morphine.
Nitaznes can appear in several forms, including liquid, pills and powder, and since 2019, they have been increasingly identified in the products sold on the illegal drug market as well as on social networks.
Difficult to detect and very dangerous
Although initially conceived as potential pain relievers, Nitaznes have never been tested in clinical or authorized trials for medical use in humans. Classified as illegal substances in Annex I, they are often mixed with counterfeit pills or other street drugs. Composing the danger, they are not reliably detected by standard drug detection methods.
“For patients, in particular those who suffer from an opioid disorder or those exposed to illicit substances, the Nitaznes constitute a serious and often hidden threat,” said co-author Shravani Durbhakula, MD, an associate professor of anestheology, division of pain medicine at the Vanderbilt University Medical Center.
“Because these drugs may not appear on routine toxicology screens, clinicians may miss a critical element of the diagnosis during overdose treatment. Patients may also need higher or repeated doses of naloxone to reverse their effects,” she said.
Dead and relationships on overdose
Between 2019 and 2023, the Declaration system for the overdose of involuntary drugs from Tennessee (TN sudors) documented 92 fatal overdoses in the state involving Nitaznes.
Data has shown that naloxone has only been given in approximately a third of these cases. In any case where Nitaznes were present, they were combined with other drugs, most often fentanyl and methamphetamine.
“Many people who consume Nitazens don’t even know they take them,” said Durbhakula. “These substances are often adulteners in pills sold like other opioids, which makes public education more important than ever.
“We also want to emphasize that this is not just a drug problem; It is a public health emergency. The resolve will require collaboration between clinicians, public health officials, police and community organizations to implement harm reduction strategies, support the treatment of drug addiction and raise awareness of these evolutionary threats, “she added.
Enlargement of awareness and next steps
The authors recommend extending access to new test strips that can detect Nitazens and so that patients at risk of having access to take -out Naloxone, treatment of drug addiction and education on counterfeit pills.
“Nitaznes are an emerging class of synthetic opioids which are even more powerful than fentanyl and often not detected by routine drug tests,” said corresponding author Ryan Mortman, MD, a resident of the Department of Physical Medicine and Rehabilitation at the Medical Center of the University of Pittsburgh.
“Their rapid distribution on the illicit drug market, combined with the difficulty of overthrowing overdoses, underlines the urgent need for public awareness, early recognition and expanded access to harm reduction tools such as Naloxone,” he said.
The co-author Trent Emerick, MD, an associate professor of anesthesiology and perioperative medicine and bio-engineering at the Pittsburgh University School of Medicine, said that the next steps consist in generating human clinical data to better understand the effects of naloxons, in particular long-term health impacts, metabolism and response to treatments Naloxone.
“The opioid crisis continues to evolve, and an in -depth understanding of the mechanisms and risks of Nitaznes is crucial for pain physicians, anesthesiologists and other providers,” said Emerick.
Reference: “Nitazenes: are pain doctors aware of the risks?” By Ryan Mortman, Shravani Durbhakula and Trent Emerick, September 14, 2025, Analgesic.
Doi: 10.1093 / PM / PNAF127
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