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Addiction ProfessionalNitazene Overdoses Driving Higher Rates of Cardiac Arrest, Requiring Larger Doses of Naloxone

The synthetic opioids show elevated cardiac arrest rates in overdose compared to fentanyl.

A recent study published in JAMA Network Open unveils alarming clinical effects of nitazenes—an emerging subclass of synthetic opioids. Compared to fentanyl overdoses, nitazenes contribute to a significantly higher rate of cardiac arrest and require larger naloxone doses during in-hospital treatments.

HCN Medical Memo
This study underscores the urgent need to be vigilant when treating opioid overdoses, especially those involving new subclasses like nitazenes. Given their significantly higher rate of causing cardiac arrest and requiring more naloxone doses for treatment, the medical community must be prepared for evolving challenges in the opioid crisis.

Key Points:
  • First study involving human subjects to examine novel potent opioids (NPOs) like brophine, isotonitazene, metonitazene, and N-piperidinyl etonitazene.
  • National sample included 2,298 patients admitted to emergency departments between September 21, 2020, and September 27, 2022, with 537 having complete laboratory testing data.
  • Only 11% of these 537 patients tested positive for fentanyl alone, while nine were positive for NPOs.
  • Nitazene overdoses required an average of 1.33 doses of naloxone for treatment, versus 0.36 average doses needed for fentanyl overdoses.
  • A staggering 100% of overdoses involving the drug metonitazene resulted in cardiac arrest.

“Given the alarmingly high cardiac arrest rate for nitazene overdose, this study should energize harm-reduction policies. And given the emergence of dangerous toxic drugs in the illicit opioid supply in the United States, future research should examine clinical outcomes from new potent opioids as the supply continues to evolve.”
– Alex Manini, MD, MS, Study Author, Professor of Emergency Medicine at the Icahn School of Medicine at Mount Sinai, New York

Additional Point:
  • Researchers indicate the necessity for further studies to confirm these alarming preliminary findings.

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