A novel synthetic opioid that is ~20x more potent than fentanyl has been linked to 8 overdose deaths across 5 states in the last month, according to the Center for Forensic Science Research and Education (CFSRE).
The drug—N-pyrrolidino etonitazene (also referred to as etonitazepyne)—is the latest synthetic drug to emerge in the midst of the opioid epidemic and COVID-19 pandemic.
The non-profit CFSRE first detected N-pyrrolidino etonitazene in May 2021 after toxicology work in an overdose case in West Virginia. Since then, it has appeared during death investigations in four other states: Pennsylvania, New York, Florida and Colorado. Additionally, identification of the synthetic opioid has been recently reported by agencies in Europe, as well.
According to CFSRE, N-pyrrolidino etonitazene is dissimilar in structure to the synthetic opioids typically encountered in forensic casework, such as fentanyl.
“Unlike the 2-benzylbenzimidazole analogues that were first synthesized and reported in the literature in the 1950s (e.g., metonitazene, isotonitazene), N-pyrrolidino etonitazene does not appear in prior literature or patents,” said the CFSRE in a public alert published Thursday about the new NPS. “Recent in vitro pharmacological data suggest that this new opioid exhibits potency similar to etonitazene (~20x more potent than fentanyl).
Even though it is dissimilar to others, the signs and symptoms of an N-pyrrolidino etonitazene overdose appear consistent with other synthetic opioids, including sedation and respiratory depression. CFSRE says naloxone is effective in reversing the symptoms of an overdose, although repeated administration may be necessary.
In 2018, CFSRE launched a program called "NPS Discovery" as a response to the increased emergence and proliferation of deadly new synthetic drugs, especially those associated with increasing overdose and mortality rates within the opioid epidemic. Since then, NPS Discovery has grown to become the go-to organization for timely information-sharing regarding the appearance of new illicit synthetic drugs in the United States.
“Our program is designed to be an early warning for these types of situations, and we take this responsibility very seriously as we interact with government, public, and private partners," said Alex Krotulski, an associate director at the CFSRE and program manager for NPS Discovery.
The CFSRE said it is currently working with partners to test postmortem blood specimens by GC-MS for the presence of N-pyrrolidino etonitazene, but additional confirmations are still pending.
Photo: Alex Krotulski reviews data for forensic toxicology samples. Credit: CFSRE