In the United States and beyond, prescription painkillers and opioid-based drugs are being used illegally at crisis levels: there has been much reporting on the opioid crisis that is deepening in communities around the globe.[1] Synthetic opioids such as OxyContin and Fentanyl have made their way into otherwise non-opioid medications sold illegally and have been responsible for overdoses and even deaths among unsuspecting individuals seeking pain relief or sedative effects. In recent months, however, new types of illegal synthetic drugs have become a cause for concern.
These synthetic drugs are called xylazines and nitazenes; neither of these are approved for use in humans, yet they are being found in the blood of individuals who have overdosed and been taken to the hospital. There are indications that these drugs are being cut into other popular recreational drugs such as cocaine and heroin, which means that people may not know they are using them.
When working with individuals who are struggling with substance use and substance use disorder, understanding the changing landscape of drug use – as well as the particulars of the drugs which are being used, knowingly or otherwise – is crucial to being able to provide informed support and treatment. Below, we will take a brief look into xylazines and nitazenes, their side effects, and the potential dangers they present to communities.
Xylazines
According to the CDC, xylazine is a tranquilizer and non-opioid sedative. It is not approved for human use, but is a veterinary drug used to relax the muscles and create analgesic effects in animals who need treatment.[2]
Even though it is not an opioid, xylazine works in a similar way and has a similar effect: essentially, it removes pain and induces a feeling of calm.[3] For this reason, it is used in combination with cocaine, heroin, or fentanyl. Some users may mix xylazine into these drugs deliberately, but others have no idea that it has been added to the drug they are taking because dealers can add xylazine to increase the drug’s weight and thus save money.
Symptoms
When human beings use xylazine, they can experience any or all of the following symptoms:
- Sedation
- Difficulty breathing
- Slowed heart rate
- Significantly lowered blood pressure
- Skin wounds
- Severe withdrawal
Nitazenes
Unlike xylazines, nitazenes have never been approved for use, even in animals. They are extremely dangerous, and their effects are very strong. Like xylazines, they induce a feeling of calm and relieve pain. According to experts, the strongest nitazenes are between 10 and 16 times stronger than fentanyl, and nitazenes are the cause of the majority of overdose deaths resulting from the introduction of these two synthetic drugs into the illegal market.
Because nitazene is not, and has never been, available to buy legally, experts have suggested that nitazenes are being synthesized illegally in non-authorized laboratories by drug manufacturers around the world. Because nothing about their creation is monitored, they are extremely dangerous to users. Experts say that an amount of nitazene the size of a grain of sand is enough to cause a fatal overdose.
Symptoms
When human beings use nitazene, they can experience any or all of the following symptoms:
- Euphoria
- Drowsiness
- Low blood pressure
- Difficulty breathing
- Loss of consciousness
- Death
A Rapidly Changing Landscape
The statistics on xylazine and nitazene deaths are startling: in the United States, deaths due to xylazine in 2018 were approximately 250. By 2021, that number had jumped to over 3500. At that time, very few hospitals screened for these types of drugs; even now many hospitals don’t screen for these synthetic painkillers when overdoses come in, which means the statistics we have on the number of overdoses as a result of these drugs are likely incorrect.
Fortunately, overdose by both of these drugs can be effectively treated. Nitazene overdose can be treated using the same set of antagonist drugs used to treat opioid overdose. Xylazine can be treated by a combination of alkaloids and atipamezoles, although this treatment has been developed for animals and not humans, so its effectiveness and risks are not fully understood.
As treatment professionals, we have a responsibility to stay informed about the changing landscape of drug use in the United States and beyond. Knowing what information to provide to our clients, colleagues, family, and friends about the dangers of existing and new drugs is one crucial aspect of helping prevent overdoses involving nitazenes and xylazines in our country and elsewhere. In addition, knowing the history of these drugs, as well as their symptoms and risks, can help us mitigate the risk that they present to individuals who may already be struggling with substance use disorder.
It is increasingly important to be firm in our approach to these illegal synthetic drugs; they are having a devastating effect on our communities as overdoses and deaths become increasingly common. Being informed is the key to being a good community member and treatment professional during these exceptionally challenging times.
Sources:
[1] Feldscher, K. (2022). What led to the opioid crisis—and how to fix it. Harvard School of Public Health. https://www.hsph.harvard.edu/news/features/what-led-to-the-opioid-crisis-and-how-to-fix-it/
[2] CDC. What You Should Know About Xylazine. https://www.cdc.gov/overdose-prevention/about/what-you-should-know-about-xylazine.html
[3] Robinson, J. (2024) Explainer: Why is the use of highly potent synthetic painkillers nitazenes and xylazine spiking? Royal Society of Chemistry. https://www.chemistryworld.com/news/explainer-nitazenes-and-xylazine-a-cause-for-concern/4019353.article
