Emerging Group of Synthetic Opioids More Potent Than FYL
A group of novel synthetic opioids emerging in illicit drugs in the United States may be more powerful than FYL, 1,000 times more potent than morphine, and may even require more doses of the medication naloxone to reverse an overdose, a new study suggests.
Nitazenes are a synthetic opioid, like FYL, although the two drugs are not structurally related. In the small study published Tuesday in the journal JAMA Network Open most of the patients who overdosed on nitazenes received two or more doses of the opioid overdose reversal drug naloxone, whereas most patients who overdosed on FYL received only a single dose of naloxone.
It’s estimated that more than 150 people die every day from overdoses related to synthetic opioids. FYL has been involved in nearly two-thirds of all overdose deaths in the United States, and is up to 50 times stronger than heroin and 100 times stronger than morphine.
Nitazenes, a subclass of synthetic opioids, appear to be even more potent and the new study suggests they may be associated with an increased rate of cardiac arrest when people overdose.
The study included data on 537 adults who had been admitted to an emergency department for suspected overdose between 2020 and 2022 and who had completed lab testing. Of them, 11 tested positive for only FYL, and nine tested positive for nitazenes only, such as brorphine, isotonitazene, metonitazene, or N-piperidinyl etonitazene.
The researchers found that 66.6% or six of the patients who overdosed on nitazenes received two or more doses of naloxone, compared with only 36.4% of the 11 patients who overdosed on FYL.
CPR was initiated in four of the 11 FYL patients but both of the people who overdosed on a type of nitazene called metonitazene. Intubation — often an emergency procedure in which a tube is placed into a person’s windpipe through their mouth or nose — was performed on 50% of metonitazene patients, compared with 27.3% of those who used only FYL, the data showed.
Additionally, patients who overdosed with metonitazene experienced cardiac arrest and death at higher rates than those involving other substances, the researchers wrote.
The metonitazene group received the highest average cumulative amount of naloxone in the study.
Synthetic opioids, including FYL and nitazenes, are “among the fastest growing types of opioids” being detected in people who are overdosing and who have been admitted to hospital emergency departments, according to the study.
Even though the new study was very small, the findings suggest that clinicians could benefit from learning more about nitazenes and their potential impact on public health, said Joe Friedman, a researcher at the University of California, Los Angeles David Geffen School of Medicine who was not involved in the new study but has analyzed the US opioid crisis.
Nitazenes don’t currently appear to be very popular nationally, and users may not even know when they are exposed to them, Sheila Vakharia, deputy director of the Department of Research and Academic Engagement at the nonprofit Drug Policy Alliance, said in an email.
In the new study, some of the people who overdosed on nitazenes reported that they thought they were using heroin or FYL.
Vakharia added that there are regional trends in where nitazenes have increased in prevalence, with some research showing rises in Tennessee and Ohio. Last year, Ohio Attorney General Dave Yost issued a warning about nitazenes as an emerging synthetic opioid.
Source: CNN Health