Responding to reports of nitazene toxicity in Australia

The Medical Journal of Australia, Journal Year: 2025, Volume and Issue: unknown

Published: Feb. 12, 2025

Nitazenes are a class of synthetic 2-benyzl-benzimidazole opioid receptor agonists that can be several hundred times the potency morphine.1 Clonitazene and etonitazene were initially developed in 1950s as potential analgesics, but never approved for therapeutic purposes due to their high potency.1 Isotonitazene was first notified drug concern United Nations Office on Drugs Crime (UNODC) 2019. By beginning 2024, 13 different nitazene analogues across six global regions had been reported, highlighting continued proliferation chemically modified structures into market.2 Nitazene-associated harms deaths have reported North America Europe, with toxicity symptoms being similar those from other opioids, including respiratory depression decreased level consciousness.1 now an established feature Australian illicit market,3 11 nitazenes classified Schedule 9 (prohibited substance) by Therapeutic Goods Administration.4 The confirmed detections Australia 2021, reports New South Wales5 Victoria.6 Sentinel toxico-surveillance Victorian emergency department presentations analytically protonitazene, metonitazene, isotonitazene, butonitazene, etodesnitazene etonitazepyne 32 cases between July 2020 February 2024.7 Wastewater analysis has not detected Australia, routine monitoring this method new psychoactive substances is limited.8 A recent retrospective study national coronial data identified 17 (etodesnitazene, metonitazene protonitazene) toxicity, 2021.9 also police customs seizures multiple jurisdictions, Northern Territory NSW.3 Analysis cryptomarkets indicated increase availability sale online 2023 January 2024.10 Government-issued public alerts intended raise awareness risks market issued health departments some, all, jurisdictions. list related provided Box, relevant alert, where available. Criteria issuing vary so box indicative types may caused nitazenes, rather than comprehensive list. Public Capital Territory,11 NSW,12 Queensland,13 SA11 Victoria.14 found represented or opioids such heroin, non-opioid substances: gamma-hydroxybutyrate (GHB), ketamine, cocaine, 3,4-methylenedioxymethamphetamine (MDMA) mescaline analogue, 3,5-dimethoxy-4-propoxyamphetamine (3C-P).3 presented counterfeit forms pharmaceutical oxycodone alprazolam. Routes administration similarly varied, oral, insufflation, vaporised, rectal injection routes reported.3 Protonitazepyne Protonitazene There production political changes Afghanistan, key producer which resulted marked decrease opium supply.15 While full effects disruption immediately apparent, it important consider preparedness use, increases unintentional exposure nitazenes. Responding promptly emerging drugs dependent early recognition presence community. Given nature relies sources understand presence, use drugs. In addition traditional indicators, surveys hospital presentation data, methods provide toxicological verification (eg, surveillance, checking, syringe residue, wastewater monitoring, seizure testing), well more informal anecdotal people who frontline service providers, data) necessary signals community broader shifts over time. Prompt responses, alerts, depend systems knowledge exchange, decision-making processes, information dissemination stakeholder groups (including peer-led user organisations [DUOs] non-health sectors police) both within Drug notifications organisations, play role ensuring informed response. engagement half survey participants (567 used drugs) changed mentioned either stopping type entirely (18%), avoiding using specific matching alert (20%) changing behaviours (18%).16 number considerations optimise benefits how concise, range levels.17 Meaningful appropriately resourced collaboration lived living experience essential ensure just effective responses concern. DUOs facilitating these partnerships cannot understated. Incorporation risk communication design enhances uptake messaging acceptability relevance language methods. antagonist naloxone at reversing toxicity,7 although higher repeated doses needed given longer duration compared commonly opioids.18 All pharmacies supply free through Commonwealth-funded Take Home Naloxone Program, there room participating, support pharmacists provision education.19 People aware familiar possible need doses. Due variety unpredictability medical services should called when overdose suspected. Importantly, underscores broaden distribution populations (such methamphetamine stimulants) settings music events) traditionally associated use. clinical harm reduction services, carriage evaluation Western feasible, save lives enabling prompt response overdose20 demonstrating commitment protect wellbeing all distribution, needle programs supervised consumption rooms, empower reduce harm. Such trusted source information21 central community-led education efforts relatively low even reduction. Harm alone mixing Staggering group recommended rapid onset loss consciousness. Immunoassay test strips cost tool allow certain fentanyl), effectiveness recently established.22 ACT, Queensland, Wales Victoria checking operation planning stage. afford opportunity appear influencing drugs.23 Sufficient access dependence treatment (ODT) programs, expanding ODT medications, reduces overdose, bloodborne virus transmission all-cause mortality.24 Although medications included Pharmaceutical Benefits Scheme, thereby increasing affordability, considerable around current capacity meet reducing available prescribers dispensaries. Preparedness potent necessitates urgent updating guidelines medication-assisted ODT25 account developments long-acting formulations injectable buprenorphine) expanded roles nurse practitioner prescribing, pharmacy dispensing administration. extent will become landscape unknown, sufficient opioid-related harms. must responses. Effective patterns sector only provides some readiness they emerge. National Centre Clinical Research Emerging (NCCRED) Alcohol (NDARC) funded Government Department Health Aged Care. Amy Peacock supported Medical Council (NHMRC) Fellowship (#1174630). Network project 5-year NHMRC Ideas Grant (GNT2001107). Funders no planning, writing publication work. Open publishing facilitated University Wales, part Wiley - agreement via Librarians. received untied educational grant funding Seqirus Mundipharma post-marketing surveillance Australia. Not commissioned; externally peer reviewed.

Language: Английский

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The UHPLC-MS/MS method for the determination of 26 synthetic benzimidazole opioids (nitazene analogs) with isomers separation

Journal of Pharmaceutical and Biomedical Analysis, Journal Year: 2025, Volume and Issue: 260, P. 116796 - 116796

Published: March 5, 2025

Language: Английский

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Sensors for the detection of new psychoactive substances (NPS)

Comprehensive analytical chemistry, Journal Year: 2025, Volume and Issue: unknown

Published: Jan. 1, 2025

Language: Английский

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Trends in novel opioid use and detections in exposures and police drug seizures in New South Wales

Drug and Alcohol Review, Journal Year: 2025, Volume and Issue: unknown

Published: April 16, 2025

Abstract Introduction Novel opioids, including non‐medical and non‐opium‐based opioids such as fentanyl analogues nitazenes, pose a significant risk of harm due to their high potency. There is little published data on novel opioid detections harms in Australia, yet they are implicated multiple deaths. This study describes the New South Wales. Methods A retrospective analysis was conducted using four statewide datasets: Coronial Toxicology, Illicit Drug Analysis Unit, Prescription, Recreational Substance Evaluation Program (PRISE), NSW Poisons Information Centre. These datasets were interrogated for available (cases or substances seized by police) between 1 January 2019 31 May 2024. Results Overall, there 106 103 cases. PRISE identified 91% clinical cases, reflecting program's reach. Fentanyl predominated until 2021, whereas nitazenes from 2022. Most acetylfentanyl ( n = 54), followed isotonitazene 13). Positive more frequent urine compared blood, supporting testing both samples. Overall numbers low, but often associated with harm, Discussion Conclusions We anticipate that these underestimate opioids; example, drugs not being tested routinely laboratory biological samples, all police seizures analysed. change predominant observed during period. Enhancing systems readiness detect respond vital, resourcing laboratories.

Language: Английский

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Navigating nitazenes: A pharmacological and toxicological overview of new synthetic opioids with a 2-benzylbenzimidazole core

Neuropharmacology, Journal Year: 2025, Volume and Issue: unknown, P. 110470 - 110470

Published: April 1, 2025

Language: Английский

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Opioïdes de synthèse, la course à la puissance

Actualités Pharmaceutiques, Journal Year: 2025, Volume and Issue: 64(646), P. 37 - 39

Published: April 25, 2025

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