(The Center Square) – Illicit drug dealers have started mixing a group of opioid alternatives developed more than 60 years ago with fentanyl and heroin to create dangerous and potent drug cocktails that pose risks for unsuspecting users and challenges for public health officials.
The drugs, called nitazenes or benzimidazole-subclass opioids, were first created in the late 1950s. Swiss chemical company CIBA Aktiengesellschaft developed protonitazene, metonitazene and other synthetic substances of the benzimidazole structural class as alternatives to morphine. Although they had potent analgesic effects, clinical development was abandoned because of an increased risk of negative side effects. They have since emerged as drugs of abuse, according to the U.S. Drug Enforcement Agency. A 2022 World Health Organization report on protonitazene found the drug was slightly more potent than fentanyl. Fentanyl is about 100 times more potent than morphine, according to the DEA.
Between 2019 and 2021, protonitazene was found in forensic analysis in cases in the U.S., Canada, Europe, and Australia, according to a 2023 study published in “Pain and Therapy.”
A recent Department of Justice crackdown that resulted in indictments against eight China-based companies and their employees for drug crimes sheds new light on how nitazenes are making their way into the illicit drug supply in the U.S.
One case focuses on Jiangsu Bangdeya New Material Technology Co., Ltd., a company based in Jiangsu, China. The company openly advertised protonitazene and metonitazene for sale in online advertisements. It has since been the target of U.S. sanctions from the Department of the Treasury’s Office of Foreign Assets Control.
The company came to the attention of federal law enforcement agencies after doing business with a southern Florida drug trafficker referred to in the indictment only as co-conspirator 2. The drug trafficking co-conspirator 2 was based in Deerfield Beach, Florida. The dealer sold fentanyl in “distribution quantity amounts” to other drug traffickers in South Florida, according to the indictment.
The dealer started working with Jiangsu Bangdeya New Material Technology in late 2021. In the past 18 months, the company shipped six kilograms of metonitazene and nine kilograms of protonitazene to the dealer and undercover agents in Florida, according to the indictment. The dealer paid in bitcoin, a cryptocurrency.
The dealer was looking for chemicals to mix with fentanyl and heroin “to increase his supply of opioids and to enhance their effects on consumers,” according to the indictment. He was ordering 300 to 500 grams of protonitazene or metonitazene from Bangdeya each month. The unnamed dealer was busted on June 15 after law enforcement intercepted one of the Bangdeya packages. At the time of the arrest, agents found 8.7 kilograms of mixed opioids.
“Co-Conspirator 2 mixed several different opioids and pressed them together,” according to the indictment. “The resulting mixture was a powerful and dangerous combination of protonitazene, metonitazene, fentanyl, fluorofentanyl, and heroin.”
Such opioid cocktails can lead to overdoses for unsuspecting illicit drug users, who oftentimes think they are buying prescription opioids such as oxycodone. The cocktails create further challenges for doctors and public health officials.
“Synthetic opioids, such as the fentanyl analog and nitazene drug class, are among the fastest growing types of opioids being detected in patients in the emergency department with illicit opioid overdose,” researchers warned in a paper published in August in JAMA Network Open. “Clinicians should be aware of these opioids in the drug supply so they are adequately prepared to care for these patients and anticipate needing to use multiple doses of naloxone.”
Naloxone is a medication used to reverse opioid overdoses.
In the JAMA Network Open study of 537 overdose patients in the U.S. from 2020 to 2022, researchers found nine people tested positive for nitazenes such as brorphine, isotonitazene, metonitazene, or N-piperidinyl etonitazene. That’s about 1.7% of the total. Of the 537 patients, 11 were found to only test positive for fentanyl – about 2%.
U.S. officials reported 107,735 overdose deaths between August 2021 and August 2022 from drug poisonings, according to the U.S. Centers for Disease Control and Prevention. About 66% of those deaths involved synthetic opioids such as fentanyl.
