Experts are sounding the alarm about a little-known drug that’s up to 20 times more deadly than fentanyl.
Nitazenes are a group of synthetic opioids, similar to fentanyl, developed in the 1950s to help relieve pain, though they never made it to patients due to an extremely high risk of overdose.
In addition to rivaling fentanyl, they’re also hundreds of times stronger than already highly addictive morphine.
Despite never being approved for clinical use, nitazenes are increasingly being made illegally in labs and pressed into pills, liquids or powders and sold via social media.
Distributors often sell them as counterfeit substances that buyers believe are legitimate drugs like Xanax or oxycodone, leaving many users unaware they are even taking them.
Thought to be manufactured in China and India, the drugs are also mixed in with other counterfeit or illegal drugs like heroin, fentanyl and methamphetamine.
Writing in a medical journal this week, doctors from Vanderbilt University and the University of Pittsburgh warned that nitazenes are not only deadly but also evade testing since standard screening it not built to detect its many synthetic variants, making it more difficult to treat overdoses.
The team urged health authorities to expand access to newly formulated test strips that can detect nitazines to better treat overdoses.
A DEA agent in the Washington Division is shown holding a baggie of counterfeit pills that contain nitrazene
They also advised doctors to give patients vulnerable to nitazine overdose, such as those who are homeless or have substance use disorder, over-dose stopping naloxone (Narcan) to have on hand in case they ingest nitazines.
Dr Shravani Durbhakula, study co-author and associate professor of anesthesiology Vanderbilt University Medical Center, said: ‘For patients, especially those with opioid use disorder or those exposed to illicit substances, nitazenes pose a serious and often hidden threat.
‘Because these drugs may not show up on routine toxicology screens, clinicians could miss a critical piece of the diagnosis during overdose treatment.
‘Patients may also need higher or repeated doses of naloxone to reverse their effects.’
Since 2019, when nitazines began being widely used, the drugs have been found in at least 4,300 law enforcement-led drug seizures. But because they easily evade testing, health officials believe the actual number is likely much higher.
There are dozens of analogs, or modified versions of nitazenes, that have varying levels of potency.
Potency also varies among batches, depending on the type of nitazene analog lacing the drugs, and uneven mixing means one pill may have a lethal dose while another has barely any.
Compared to fentanyl, the analogs butonitazene and etodesnitazene are 25 to 50 percent as strong, while isotonitazene (ISO) is five to 10 times stronger.
The most extreme variants, N-pyrrolidino protonitazene and N-pyrrolidino etonitazene, are up to 25 times stronger and up to 43 times stronger than fentanyl, respectively.
Nitazene is so new that there is no firm nationwide data on its rise, though several states have reported notable increases.
Tennessee in particular has seen a notable jump in nitazene-related deaths, Vanderbilt and University of Pittsburgh researchers wrote in their newly published article.
They wrote that between 2019 and 2023, the Tennessee State Unintentional Drug Overdose Reporting System (TN SUDORS) identified a total of 92 nitazene-involved fatal drug overdoses among Tennessee residents.
However, naloxone was only given in one in three of those deaths, and all of the deaths involved the drug being mixed with other substances, most commonly fentanyl and methaphetamine.
Lucci Reyes-McCallister, 22, died in January after taking a fake Xanax pill laced with N-pyrrolidino protonitazene, a synthetic opioid 25 times deadlier than fentanyl
Hunter Clement, right, swallowed a counterfeit Percocet pill that was pressed with nitazenes. He died of an overdose at 21
And in Pennsylvania, nitazenes have been a contributing factor in 45 deaths since 2023.
From May 2024 to 2025, Houston, Texas, DEA agents reported 15 nitazene overdose deaths in people ranging in age from 17 to 59. The agency also reported 11 seizures of nitazene from November 2024 to February 2025.
And in May, Andrew Renna, Assistant Port Director for Cargo Operations at JFK Airport in New York City, revealed the agency ‘seized almost a pound of nitazene that was going to a private residence in South Carolina.’
The drug was shipped from the UK.
Renna said: ‘Unfortunately, here at JFK, we’re seeing xylazine and nitazenes at least a few times a week in quantities ranging from just a few grams to upwards of a pound or more.’
Dr Durbhakula said: ‘Many people consuming nitazenes don’t even know they’re taking them. These substances are often adulterants in pills sold as other opioids, making public education more important than ever.’
Earlier this year, Lucci Reyes-McCallister, 22, died after taking what he believed was a Xanax pill. However, it had been laced with N-pyrrolidino protonitazene, a form of nitazene 25 times deadlier than fentanyl.
Six months later, his friend Hunter Clement, 21, suffered the same fate after swallowing a counterfeit Percocet containing nitazenes.
Dr Ryan Mortman, corresponding study author and resident at the University of Pittsburgh Medical Center, said: ‘Nitazenes are an emerging class of synthetic opioids that are even more potent than fentanyl and often undetected by routine drug tests.
‘Their rapid spread in the illicit drug market, combined with the difficulty of reversing overdoses, underscores the urgent need for public awareness, early recognition, and expanded access to harm-reduction tools such as naloxone.’
The above graph shows the different forms of nitazenes that have been seized by the National Forensic Laboratory Information System (NFLIS) between 2021 and 2024
The raw chemicals to make nitazenes are believed to come from China and India. Chemical companies there are able to synthesize the compounds at scale in a relatively easy process of three or four steps before the substance is smuggled to the UK, Europe and the US.
Compared to countries in Asia, Europe, South America, as well as Australia, New Zealand, and the Pacific islands, the US has the widest range of nitazene analogs and the most fatalities.
Dr Durbhakula said: ‘We also want to stress that this is not just a drug issue; it is a public health emergency. Addressing it will require collaboration between clinicians, public health officials, law enforcement and community organizations to implement harm-reduction strategies, support addiction treatment, and raise awareness about these evolving threats.’
Nitazene overdose can lead to severe and life-threatening symptoms, including slow or shallow breathing, which indicates respiratory depression, a hallmark of opioid toxicity.
One to two doses of Narcan nasal spray can usually resolve an overdose when given early, but because nitazenes are so potent, doctors fear patients may need additional doses.
Dr Trent Emerick, study co-author and associate professor at the University of Pittsburgh’s School of Medicine, said the team is next planning to look at clinical data to assess the long-term risks of nitazenes and how the drugs respond to naloxone.
He said: ‘The opioid crisis continues to evolve, and a thorough understanding of the mechanisms and risks of nitazenes is crucial for pain physicians, anesthesiologists and other providers.’
This article was originally published by a www.dailymail.co.uk . Read the Original article here. .