Life-threatening nitazenes on the market – new overdose crisis feared

29. November 2023

John Melhus.

In recent months, the Norwegian Customs Service has made record seizures of drugs containing nitazenes. Nitazenes can be up to a thousand times stronger than heroin.

Rus og samfunn 29 November 2023: Deadly nitazenes on the market – fear new overdose crisis, by Berit Simenstad.

In recent months, the Norwegian Customs Service has made record seizures of substances containing nitazenes. Nitazenes can be up to a thousand times stronger than heroin. Researchers warn of a new overdose crisis and FHR calls for proactive measures from the authorities.

Nitazenes are synthetic morphine substances (opioids) and can be up to a thousand times stronger than heroin. Until recently, fentanyl was the most potent drug on the illegal market. Nitazene (including metonitazene, etonitazene and protonitazene) is many times stronger than that again.

– These drugs are deadly. We have never made as many seizures as we have done in recent months. We see this as worrying,” said Sondre Hammerstad, Head of Section at Norwegian Customs, in a press release earlier in November(read here).

A global trend

The seizures are not isolated incidents, but part of a global trend.

In September, a 25-year-old man died in Halden after ingesting metonitazene. You can read more about it in this article on nrk.no. After an overdose death in Sunnmøre, it turned out that the tablets the person in question had taken contained etonitazepine, a type of nitazene.

– “It takes so little to have a strong effect. Nitazenes are low-dose drugs, and serious effects can occur even at low doses,” Anita von Krogh, senior adviser at the Poisons Information Centre , told NRK.

Krogh went on to say:

– “Nitazenes have an analgesic and calming effect. Overdoses can cause breathing problems, coma and circulatory problems. Taking the drug can also lead to cardiac arrest. Simply handling it, for example by breaking it up and bagging it, can in the worst case lead to serious reactions.

Risk of a sharp increase in overdoses

Nitazene impurities have been detected in several different illicit drugs, such as benzodiazepines, opiates and various cannabis products. Both nationally and internationally, especially in Ireland and the UK.

Earlier in November, more than 40 overdose cases were recorded in Dublin within 36 hours(read more about it here). In connection with this, a batch of heroin contaminated with nitazene was uncovered.
After a period of decline in overdose deaths in Estonia, the number of overdoses has skyrocketed again with the arrival of nitazene on the market. Read more about it here.

– The scale is alarming

The Norwegian Association for Humane Drug and Alcohol Policy (FHR) believes that what we have seen so far is just the tip of the iceberg:

– Norway and Europe may be on the verge of a new serious overdose crisis. The scale is alarming and is beginning to surround our country. The recent seizures by customs authorities represent just the tip of an iceberg. Norway, like many other nations, is struggling to intercept only a fraction of the illicit drugs coming across our borders,” says John Melhus, international advisor at FHR. He believes we need to see the wave of nitazene in the context of major changes in the international heroin market:

In Afghanistan, the Taliban’s crackdown on opium production has disrupted the global heroin supply. Afghanistan accounts for more than 80 per cent of the world’s heroin production.

– “Even though there are large stocks of opium that can sustain heroin production for perhaps one to two years, there are various scenarios that can either mitigate or exacerbate the crisis,” says Melhus.

Warning from the UN

So far, there is little to suggest that the Taliban’s efforts against opium production are a charade. Opium production is now down 95 per cent, from 6,200 tonnes in 2022 to just 333 tonnes in 2023. At the same time, the Afghan currency has strengthened and they have succeeded in cracking down on corruption at border crossings.

UNODC, the UN Office on Drugs and Crime, has recently warned that the large reduction in opium production in Afghanistan could lead to a wave of new and far stronger drugs on the market. Read more here.

– Several measures in Norway can counteract

FHN points out that it may be crucially important for Norway to take proactive measures to counter the possible heroin drought.

– The heroin drought is likely to be replaced by substances such as fentanyl or nitazenes. To prepare for this scenario, we need to utilise all available resources. This includes expanding access to naloxone, more user rooms, implementing permanent and expanded heroin-assisted treatment. There must also be increased access to medicines with reduced side effects and potentially less side effects, such as long-acting morphine,” says FHR chairman Arild Knutsen, pointing to other measures that can curb an overdose crisis in the wake of nitazene-containing drugs:

“Low-threshold OMT, drug analysis and good warning systems are important steps to counter the potential threat. The authorities should also consider setting up a committee to monitor the situation and consider special measures.
By looking to other countries, we can learn from alternative models, such as Canada’s “safe supply”. By providing access to regulated and safe drugs to those who need it, the demand for illegal and potentially lethal substances can be greatly reduced and the market weakened considerably.
It’s also critically important that law enforcement and healthcare professionals work together seamlessly. Joint efforts between the justice and health sectors can promote a more humane and holistic approach to drug-related challenges.
Organisations such as the Open Society Foundations advocate for police involvement in harm reduction and emphasise focusing on the wellbeing of the individual rather than punitive measures. This approach encourages a shift from arrests and confiscation of drug paraphernalia to supporting people with substance use challenges.
By prioritising harm reduction, collaboration between law enforcement and healthcare professionals, and exploring innovative approaches, we can be equipped to meet the challenging situation and ensure the safety and health of our fellow human beings.