There is growing concern about the emergence of potent synthetic opioids in Australia. Earlier this month, South Australia released a public health alert regarding counterfeit oxycodone tablets that contained a powerful synthetic opioid, known as protonitazene. In June, the same drug was found in a white powder sold as cocaine in Melbourne.
Later that month, synthetic opioids were detected in four individuals dying from drug overdose in Broadmeadows, Victoria.
So what are nitazenes, what makes them so dangerous and how should we be responding to the emergence of these drugs in Australia?
WHAT ARE THEY?
Nitazenes are synthetic opioids that are up to 1000 times more potent than morphine and 20 times more potent than fentanyl. They were first synthesised in the late 1950s as a potential pain reliever, but never developed due to concerns regarding toxicity. Over the past few years, clandestine laboratories have been synthesising these drugs as alternatives to common opioids such as fentanyl and heroin because they are cheaper and easier to produce than plant-based opioids. They are also used as adulterants in fake pharmaceuticals, and recreational drugs like cocaine, ecstasy, ketamine, and cannabis vapes. This means that some people use nitazenes without knowing, exposing them to a higher risk of harm; users may not realise they have consumed a nitazene until it is too late.
WHAT MAKES THEM SO DANGEROUS?
Synthetic opioids interrupt the part of the brain that controls breathing. Signs of a synthetic opioid overdose typically include slowed breathing, pinpoint pupils, drowsiness and loss of consciousness, and it can occur very quickly, especially in people who are not used to taking opioids. These drugs are so strong that as little as a grain of salt can cause a fatal overdose, without rapid medical intervention. Taking these drugs (intentionally or unintentionally) with alcohol or other drugs can increase the risk of overdose even further.
Exposure to nitazenes is not limited to people who use illicit opioids – we have seen them in products sold as a wide range of party drugs. This means that a broad range of strategies are required to reduce harm, in addition to increased education and awareness.
WHAT IS THE SCALE OF THE POTENTIAL CRISIS AHEAD AS THESE DRUGS BECOME MORE AVAILABLE?
There is growing concern from authorities and public health experts about the rise of these drugs here in Australia.
It is estimated that 2000 people have died in the USA from nitazenes since 2019, worsening the opioid epidemic they have been battling for years, that already kills 80,000 Americans annually.
In the UK, the National Crime Agency reported at least 176 nitazene-related deaths between mid 2023 and May 2024, raising concerns of a second wave of drug-related deaths in the region. They have also been reported throughout other parts of the world including Europe and Canada and are now one of the fastest growing groups of new psychoactive substances in the world.
The first report of nitazenes in Australia was in two patients presenting to a Melbourne Emergency Department in 2022. In May 2024, a Victorian Coroner cited 16 deaths caused by these drugs since early 2021, indicating that they were circulating in the Victorian drug supply even earlier. The Australian Federal Police and Australian Border Force reported the seizure of over 800 tablets containing nitazene analogues in late 2023, and more recently, 4 kilograms of nitazenes were seized from a house in Melbourne – enough to kill thousands of people.
HOW SHOULD WE BE RESPONDING?
There are a number of government-led initiatives aiming to prevent a potential synthetic opioid crisis like we have seen in other countries, but more needs to be done. Recently, the Victorian government announced that drug checking will be introduced over the Summer. Drug checking services are already available in the Australian Capital Territory and Queensland. These are free, confidential, and anonymous services that analyse the contents of drugs and provide information, counselling and advice to service users based on their specific test result, encouraging safer choices and reducing harm.
Increasing access to supervised injection facilities, like the ones in Melbourne and Sydney, is essential in the face of a potential opioid crisis. There has never been a death at over 130 supervised drug consumption facilities across the world. Since the Uniting Medically Supervised Injecting Centre in Sydney opened in 2001, there has been over 11,000 overdoses without a single death. Similarly in Victoria, over 7500 overdoses have been treated at the North Richmond Community health Medically Supervised Injecting Room without anyone dying.
People using recreational drugs other than opioids are still at risk of a nitazene overdose because of the contamination of the illicit drug supply. So, everyone needs to be aware of the signs of opioid overdose, call triple zero in an emergency, and keep naloxone on hand. Naloxone is a drug that reverses opioid overdose. It is free at Australian pharmacies to anyone who may experience or witness an opioid overdose. We need to get naloxone into the hands of every first responder and all individuals – think of it as an addition to everyone’s first aid kit.
Australia spends more on drug law enforcement than treatment, prevention and harm reduction combined. Only 1.6% of all government funding on illicit drug countermeasures goes towards harm reduction, despite being relatively inexpensive to implement and highly cost-effective – not to mention the lives saved. We need to invest in and expand harm reduction strategies, like drug checking and supervised drug consumption facilities, so that all Australians have access to these life-saving services.
Synthetic opioids, including nitazenes, present a serious public health concern for Australia. Being prepared is essential to reducing the potential harm caused by these drugs (and others) in Australia.
