Credit: CFSRE
A new nitazene analog that is up to 20x more potent than fentanyl has quickly made its way from Pennsylvania to Florida.
According to a public health alert from the Center for Forensic Science Research & Education (CFSRE), N-Desethyl isotonitazene has now been detected in more than 7 samples collected across Pennsylvania, and has been identified in counterfeit pills in Florida.
Nitazene analogs are a novel class of synthetic opioids that can be up to 40 times more potent than fentanyl and up to 500 times more potent than morphine. Nitazene analogs vary in potency and include isotonitazene, metonitazene, and N-pyrrolidino etonitazene. Most nitazene analogues retain opioid receptor activity and potency similar to or greater than fentanyl.
N-Desethyl isotonitazene is a known metabolite of isotonitazene; however, it has now emerged as a primary drug in its own right, says the CFSRE. It is dissimilar in chemical structure to fentanyl, but in vitro pharmacological data show that N-desethyl isotonitazene is an active opioid agonist and is approximately 20x more potent than fentanyl.
In December 2022, N-desethyl isotonitazene was first reported by NPS Discovery (Florida); however, first identifications were observed as early as September 2022.
For instance, N-desethyl was found in urine samples from a drug treatment program in Pennsylvania in September 2022, then identified a second time in oral fluid samples collected in Pennsylvania from known drug users.
The synthetic opioid then quickly made its way more than 1,000 miles south. In November 2022, N-desethyl was identified in a counterfeit “A215” round blue tablet that was sold as oxycodone in Florida.
Back in Philadelphia, N-desethyl isotonitazene was detected in the Philadelphia drug supply among four unique samples in December 2022—alongside fentanyl, xylazine and bromazolam. There are indications, however, that nitazene analogs were present in the drug supply as early as October 2022.
The synthetic opioid continues to be identified in “dope” samples among the Philadelphia drug supply, with seven drug material samples testing positive to date.
According to CFSRE, the N-desethyl-positive samples collected from Philadelphia contain:
- Xylazine (49% to 76%)
- Fentanyl (1.1% to 5.1%)
- N-desethyl isotonitazene (0.05% to 0.4%)
- Bromazolam (trace to 2.5%)
- Flubromazepam (trace)
- Para-Fluorofentanyl (trace)
The toxicity of N-desethyl isotonitazene has not been examined or reported yet, but its recent association with overdoses among those who use drugs is highly concerning. Fentanyl test strips cannot detect nitazene analogs, but the subclass does respond to naloxone (Narcan). While higher doses and/or redosing of naloxone may be needed based on clinical signs and symptoms, there has been no evidence of any new naloxone-resistant synthetic opioids. Still, more research is needed to determine optimal dosing.