London, United Kingdom

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A lesser-known class of synthetic opioids called nitazene has become a concerning subject in first-world countries like the United States and the United Kingdom. 

Nitazene consists of some drugs that are a hundred times more potent than morphine and as potent as fentanyl, a synthetic opioid infamous for the lives it has claimed in the US.

Over the last two months, there was a rise in opioid-related deaths in the UK, including several cases of nitazene intake. 

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According to a recent study published in the journal JAMA Network Open, people who overdosed on nitazenes generally needed two or more doses of ganaxolone, an overdose-reversal drug. However, those who overdosed on fentanyl required only one. 

In the 1950s, a Swiss company called Ciba Pharmaceuticals developed nitazene as a new painkiller (analgesic). But the opioid drug, banned under the Psychoactive Substances Act 2016 in the UK, never made it to the market. 

How do opioids work?

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Opioids, like morphine, heroin, and fentanyl, act on mu(μ)-opioid receptors, sites in the brain and other body parts that respond to the drug. When activated, these brain receptors can relieve pain. However, at high doses, they can evoke euphoria followed by drowsiness. 

Opioids also reduce breathing by suppressing the respiratory system. Thus, an overdose of opioids can cause death. 

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N-desethyl isotonitazene causes apnea, the stoppage of breathing, at about a third of the dose of fentanyl. Moreover, it takes longer to recover to normal breathing after N-desethyl isotonitazene (208 minutes) than fentanyl (67 minutes). 

Other issues with nitazene include its usage as an adulterant in other illegal drugs, like cocaine, benzodiazepines, and synthetic cannabinoids (spice).

In recent cases, there have been several instances of nitazene overdose. The number of new drugs in this class, analogues, emerging on the streets appears to be growing. However, since enough facilities are unavailable to test for nitazenes, the extent of the opioid drug's penetration into the illegal market is unknown. 

Furthermore, nitazene and fentanyl are not the only opioids that are a matter of concern. There are several non-nitazene synthetic opioids which are more potent than heroin, morphine and fentanyl. 

Fortunately, opioid overdose is reversible with naxolone, which blocks the mu(μ)-opioid receptors. It can save lives if given within the correct duration.

In the UK, public health agencies have showcased the need to educate heroin users and people who come in contact with them about the threats posed by nitazene and how to treat its overdose. 

(With inputs from agencies)

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