Fentanyl is a synthetic opioid drug that has the same effects as morphine or heroin but it’s a lot more powerful than these drugs. That means a tiny dose can have a dangerous effect. It’s the leading cause of opioid overdose deaths in the United States.
And now, a new and even deadlier drug is appearing. Nitazenes, another type of synthetic opioid, are stronger than fentanyl. They are showing up in counterfeit pills and other illicit drugs.
Bryan Kuhn, PharmD, a pharmacist and poison education specialist with Banner Health, shared information about these risks so you can protect yourself and your loved ones.
What is fentanyl?
Fentanyl is a man-made opioid that is 50 to 100 times stronger than morphine. Health care providers may prescribe it to manage severe pain, such as after surgery or for advanced cancer. But most of the fentanyl that’s causing overdoses today is made illegally.
It’s relatively easy to get fentanyl or the things you need to make it and it’s cost-effective for illegal drug manufacturers to use and distribute it.
Here’s why it’s so dangerous:
- Fentanyl may be found in counterfeit pills that look like anxiety medications or prescription painkillers, including street versions of oxycodone. These pills are typically blue and are labeled M30, which is what the prescription version of the drug looks like.
- It may be mixed with drugs like heroin, cocaine or methamphetamine.
- Fentanyl has no taste, smell or color, so it’s almost impossible to detect without testing.
The problem is that fentanyl is so strong that the amount can vary from tablet to tablet when drug cartels are making it.
“With five micrograms, you could be fine, but with 500, you could be dead. Micrograms are a tenth of a milligram. It’s not that hard to have that sort of inconsistency,” Dr. Kuhn said. And there’s no good way to measure how much fentanyl is in a tablet.
If you're buying an illicit or street drug, chances are it's contaminated with fentanyl. “Many of the overdose patients we see at the hospital test positive for fentanyl,” Dr. Kuhn said.
Introducing nitazenes: The new danger
Nitazenes are a newer class of synthetic opioids that may be up to 20 times stronger than fentanyl, with similar effects.
“We're finding nitazines mixed into the illicit fentanyl supply at varying rates, but overall rates are increasing around the country,” Dr. Kuhn said. “So far, it’s not clear if nitazenes are changing the trajectory of overdose deaths from opioids but finding them in the illicit drug supply is certainly concerning.”
What makes nitazenes different?
Nitazenes differ from fentanyl in a couple of ways:
- Harder to detect: Routine drug tests often miss them.
- Stronger effects: Even tiny amounts can stop breathing within minutes.
Plus, they are often mixed with fentanyl or other drugs. This combination greatly raises the risk of overdose.
Public health officials are concerned because nitazenes are spreading quickly in the illicit drug market. Cases of nitazene-related overdoses have already been reported across the US.
How to protect yourself from fentanyl and nitazenes
The best way to stay safe is to avoid using any pills or drugs that don’t come directly from a licensed pharmacy. Counterfeit pills bought online, through social media or from unregulated sources are especially dangerous. Assume any “prescription” pill you buy outside of normal channels is fake and very possibly deadly.
Many people who use drugs cannot simply choose to stop. Dr. Kuhn said the best thing to do is to have the nasal spray naloxone (Narcan) on hand to counteract an overdose. Naloxone is available at pharmacies, health departments and harm-reduction programs without a prescription.
“Most insurances cover Narcan and AHCCCS [Arizona’s Medicaid agency] covers it 100%,” Dr. Kuhn said. “The earlier you administer it, the safer you are and the less likely you’ll have permanent neurological damage or death.”
“There are other programs if you want to detox from drugs but the intervention that is known to save lives is naloxone. That is the number one thing you can do to protect yourself in the event of an overdose. You want to have it with you for an emergency and you want those around you to have it as well,” Dr. Kuhn said.
You may also want to use drug testing kits for fentanyl or nitazenes if they are available in your community.
“Be vigilant. The illicit drug supply always has contaminants and adulterants,” Dr. Kuhn said.
Signs of an overdose
Knowing the symptoms of an opioid overdose can save a life. “The signs and symptoms of an opioid overdose are the same for fentanyl and nitazenes,” Dr. Kuhn said.
Common signs include:
- Slow, shallow or stopped breathing
- Being unconscious, unresponsive or unable to wake up
- Pinpoint pupils
- Cold, clammy skin
- Blue or dusky skin
- Limp body
- Weak heart rate
- Low blood pressure
What to do if you suspect an overdose
- Assess the person for signs of an overdose. Ask if they are OK, call their name, shake their shoulders and check for the signs listed above.
- If they show signs of overdose, roll them onto their back and administer naloxone nasal spray. You can call 888-688-4222 for help, though the package instructions for how to use it are clear.
- Call 911.
- If the person doesn’t respond, give another naloxone dose after two to three minutes. One does isn’t always enough.
- Begin CPR if you are trained, until emergency responders arrive.
The bottom line
Fentanyl and nitazenes are both deadly and even one counterfeit pill can be fatal. The best protection is to avoid illicit drugs altogether, carry naloxone and stay informed about these threats.
But if you or someone you love uses drugs, you know stopping isn’t easy. If you need help getting off drugs, call the Opioid Assistance and Referral Line at 888-688-4222.
Get help if you’re struggling. At Banner Health, we offer compassionate, confidential addiction treatment and recovery programs.
By educating yourself and sharing this information with others, you can help prevent overdoses and save lives.
