Nitazenes

Opioid

Nitazenes are a group of synthetic opioids which have emerged in the UK drug supply. They can be taken on their own (sometimes unknowingly), and they have been found in heroin and other illicit drugs like oxycodone and benzodiazepines. If a drug contains nitazenes, there is an increased risk of harm, overdose and death.

Also known as:

  • metonitazene
  • etonitazine
  • N-pyrrolidino-etonitazene (NPE)

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What do nitazenes look like?

When it’s not cut with other drugs, nitazenes are an off-white or brown powder.

However, nitazenes will look different depending on what they’re mixed with. If mixed with another drug, it’s often impossible to see them.

How are nitazenes taken?

Most of the time, people aren't aware that nitazenes have been mixed into the drug that they think they’re taking. This makes the drug even more dangerous and significantly increases the risk of overdose.

When not cut with other drugs, nitazenes can be:  

  • Snorted up the nose 

  • Smoked by heating on foil first - sometimes known as ‘chasing the dragon’

  • Injected* by dissolving in water first

If mixed into other substances, they may be vaped or swallowed as tablets.

*Injecting is particularly dangerous and increases risks including infection with Blood Borne Viruses (BBVs) like Hepatitis C or HIV.

How will nitazenes make me feel?

Nitazenes mimic the effects of opioids like heroin and can make you feel:

  • Happy

  • Relaxed

  • Euphoric

  • Sleepy

  • Nauseous 

  • Confused or disorientated

  • Dizzy 

  • Like you’re zoned out

Nitazenes can also slow down your heart rate and breathing, which can lead to coma.

When nitazenes are mixed with other drugs, the effects can be different and not what’s expected, which can increase the risk of harm. They can also magnify the effect of other substances, increasing the risk of overdose and death.

How long do the effects last?

It depends on several factors, including your age, weight and metabolism, other drugs you have already taken, the purity of the drug, and the dose.

Generally speaking, when mixed with another drug, the effects start within a few minutes and can last for several hours. If injected, the effects are almost immediate.

What happens to my body if I use nitazenes frequently?


Nitazenes can:

  • Cause your body to develop a tolerance, which can lead to increased use and dependence 

  • Cause problems when you stop using or cut back. This is known as withdrawal and can make stopping challenging

Using nitazenes frequently can cause:

  • Damage to veins at injection sites, which can lead to blood clots

  • Infections around injection sites, which can lead to sepsis

  • Increased risk of developing Blood Borne Viruses (BBVs), especially if using shared or dirty needles

How to reduce harm while using

We recognise that some ways of using drugs are safer than others, and by providing information which supports people to make informed decisions, we can help people to minimise harm.  

  • Start low, go slow: Strength can vary between batches, even if you take the drug regularly, starting with a small amount and waiting at least two hours before your next dose can help to reduce the risk of overdose
  • Go at your own pace: Everyone responds differently to drugs - trying to keep up with others puts you at greater risk of overdosing
  • Try not to use on your own: It's best not to use if you’re on your own or if you’re in a position where there is nobody you could call for help. A buddy system - where one person takes their dose first and waits until the peak effects have worn off before the other person uses - makes it more likely that someone can help if anyone overdoses
  • Try not to mix: Try to take one drug at a time, as mixing with other drugs or alcohol can increase your risk of overdose
  • Opt for methods that carry less risk: It’s less risky to smoke nitazenes than it is to inject, as it greatly decreases the risk of overdose (although not completely), and reduces risk of BBVs
  • Use your own equipment: Using your own equipment, including measures and needles, can help to prevent the spread of blood-borne viruses (BBVS) like Hep B, Hep C and HIV.  You can get clean equipment from any drug service and many pharmacies
  • The recovery position: The recovery position helps to prevent someone unconscious from choking on vomit. If someone is unconscious, putting them in the recovery position, getting help if needed, and staying with them will help to reduce the risk of harm

What do I do if I think someone has overdosed?

If you think someone has overdosed, put them in the recovery position and get help fast by calling 999, telling emergency services what you know. 

Symptoms of nitazene overdose include:

  • Not being able to wake someone up
  • Difficulty breathing
  • Lips or fingertips with a blue (on lighter skin) or grey (if darker skin) tinge
  • Finding it difficult to walk or talk 
  • Confusion

If you have naloxone - give it. Naloxone reverses the effects of opioid drugs like heroin, morphine and methadone, and it works on synthetic opioids too. It may take more naloxone doses to reverse the overdose if someone has taken nitazenes.

If someone hasn’t overdosed on opioids, naloxone won’t harm them. But if they have, it could save their life - so if you suspect someone has overdosed, it’s always best to administer naloxone. 

You can get a naloxone kit and training on how to use it from your local WithYou service. 

More information about naloxone, including how to use it.

Withdrawal signs, symptoms, and what to do

If your body develops a tolerance to nitazenes, you may feel you need to take more to get the same effects.

You can become dependent on nitazenes, and regular use can lead to physical withdrawal symptoms when you try to stop or cut back.

We recommend getting professional support to cut down.

Withdrawal symptoms include:

  • Shaking
  • Sweating
  • Aches and pains
  • Stomach problems, nausea or vomiting
  • Sleep disturbance
  • Increased heart rate or blood pressure

If you’re dependent on nitazenes, we can help you cut down safely, as stopping suddenly can lead to withdrawal complications. 

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The law 

Nitazenes are a Class A drug, which means it's illegal to be found carrying or using them. The legal term for this is possession. The maximum sentence for possession of a Class A drug is up to seven years in prison, a fine or both. 

It’s also illegal to give away or sell nitazenes. This is known as supply, and is a more serious offence than possession.  It can be considered supply if you give your friend some or share some with them, and this could get you time in prison, an unlimited fine or both.

Medicine

Want to know more?

Head back to our substance glossary to find out all about common drugs and their effects.

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