Nitazenes are a group of synthetic opioids first developed in the 1950s, known for their extremely high potency. Some nitazene analogues are estimated to be 10 to over 40 times stronger than fentanyl, and up to 50 times more likely to cause respiratory depression than morphine. These substances started appearing in illegal drug markets around late 2019 and have been increasingly detected in overdose toxicology reports across the United States.
Impact in Milwaukee
During the first seven months of 2020, isotonitazene, a potent nitazene analogue, was linked to more than 40 overdose deaths in Milwaukee County and neighboring Cook County in the Chicago area. Milwaukee continues to experience a surge in opioid-related fatalities, largely driven by fentanyl and its analogues. Nitazenes are sometimes mixed into street drugs without users’ knowledge, increasing the risk of fatal overdoses. Although recent data on nitazene-related overdoses specifically in Milwaukee after 2020 is limited, national trends indicate a rising presence of these substances in synthetic opioid overdoses.
Pharmacological Characteristics and Detection
Nitazenes, including isotonitazene and its metabolite N-desethyl isotonitazene, act as ultra-potent μ-opioid receptor agonists, producing very strong and prolonged respiratory depression. This effect often requires more than the usual amount of naloxone to reverse. While naloxone (Narcan®) remains effective against nitazene overdoses, multiple doses and extended medical monitoring may be necessary due to the drugs’ long-lasting effects. Since 2024, specialized nitazene test strips have been introduced to detect major analogues such as isotonitazene, though these strips do not identify all variants and are not widely available yet.
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Why Milwaukee Needs to Stay Alert
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User Risk: Individuals using street opioids—heroin, fentanyl, counterfeit pills, or powdered mixtures—may unknowingly consume nitazene analogues, leading to unexpectedly severe overdoses.
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Treatment Challenges: Emergency personnel and harm reduction workers may not initially suspect nitazenes, which can complicate overdose response and naloxone dosing.
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Data Limitations: Testing for nitazenes is not standard in all fatal overdose investigations in Milwaukee, potentially causing underreporting of their actual impact.
Harm Reduction Recommendations
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Testing: Use fentanyl and nitazene test strips, where available, to screen drugs before use.
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Naloxone Preparedness: Keep naloxone accessible and be prepared to administer multiple doses if necessary.
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Avoid Using Alone: Use drugs in the presence of others who can assist in case of an overdose.
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Seek Immediate Medical Attention: Even after naloxone administration, individuals may need hospitalization due to prolonged respiratory depression.
Key Takeaways on Nitazenes in Milwaukee
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Extreme Potency: Nitazenes can be significantly more powerful than fentanyl, raising the overdose risk even with tiny amounts.
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Confirmed Local Cases: Over 40 isotonitazene-involved overdose deaths were documented in Milwaukee early in 2020.
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Naloxone Effectiveness: While naloxone works against nitazene overdoses, repeated or higher doses are often needed.
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Detection Gaps: Existing test strips can detect some nitazenes but are not comprehensive, and many routine toxicology tests miss these substances.
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Growing Concern: National surveillance points to an increasing presence of nitazenes mixed with fentanyl or counterfeit pills in the illicit drug supply.
Conclusion
Nitazenes represent a significant and growing threat in Milwaukee’s opioid crisis. Confirmed fatalities and national data emphasize the danger posed by these highly potent synthetic opioids. Enhanced awareness, widespread availability of testing tools, and robust harm reduction strategies are crucial to reducing deaths and protecting public health.
