Nitazenes – Opiate Nation

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Wastewater monitoring is an effective tool in detecting emerging opioid threats, predicting overdoses, and tailoring treatments, according to new research from Biobot Analytics, Mathematica, and the Washington/Baltimore High Intensity Drug Trafficking Area (W/B HIDTA) program. (1)

My husband and I live in Melbourne, Australia part of the year so we can be close to our daughter and family. We love Australians and their friendly and balanced way of approaching life and politics. It is a federal parliamentary democracy similar to England.

One area where they are ahead of the USA is in their approach to illicit drugs. As a nation with comprehensive health care for all from cradle to grave, they have a more communal attitude than our American individualistic posture. They view caring for each other as part of being a healthy and functioning society.

This necessarily affects how they treat people who use illicit drugs. They aggressively pursue educational and preventative measures while also working to keep those who use drugs as safe as possible until they are ready to seek recovery. While they don’t have a fluid border with a drug-producing country like we do with Mexico, they still have a problem with illicit drugs arriving from China and Asia.

One area that they use as a public health strategy is wastewater surveillance such as was used during the Covid-19 pandemic. Samples are collected from wastewater treatment plants, sewer systems, or targeted populations such as college dorms or prisons. When pooled together, they provide a community view of drugs circulating in the population. The samples are analyzed and the data is calculated through very sophisticated methods. The data then give objective, community-wide information on drug use trends. This is of great benefit in tracking changes and identifying new drug use and outbreaks and as an early warning tool. In the US, Biobot Analytics and Mathematica are leading the way with the “Drug-Surge” algorithm. (1) In a study involving five counties across four states, the algorithm correctly flagged between 71% and 100% of drug overdoses.

The US Drug Enforcement Agency (DEA) uses this wastewater testing to detect trends in illicit substances well in advance of reported overdoses. Xylazine was detectable a month before suspected overdoses from it were reported. Geographic and socioeconomic trends can be tracked also. If put to use, a national alert system would give early warning of at least a week in order to alert the public to a new or more potent drug threat.

In the US, the National Wastewater Surveillance System (NWSS) that is run by the CDC began in response to the Covid-19 pandemic. The CDC coordinates a national system primarily for infectious disease monitoring. While drug consumption can also be targeted, a national program does not yet exist. (3,4) Meanwhile, the National Institute on Drug Abuse (NIDA) is working with Biobot and Mathematica and has regional programs focusing on illicit drug use as a response to the opioid crisis.

With the CDC in the midst of worrisome changes, let’s be vocal proponents for increased national coordinated surveillance of illicit drugs in our wastewater and the use of that information to help prevent overdoses and deaths.

Wastewater Data Offers Powerful Tool in Confronting Opioid Epidemic

https://www.mathematica.org/news/wastewater-data-offers-powerful-tool-in-confronting-opioid-epidemic#:~:text=Wastewater%20monitoring%20is%20an%20effective,early%20warning%20for%20new%20threats.

2. DEA Releases 2025 National Drug Threat Assessment

https://www.dea.gov/press-releases/2025/05/15/dea-releases-2025-national-drug-threat-assessment

3. Correlation between wastewater-based substance use prevalence and syringe distribution in a harm reduction program in the United States

https://www.sciencedirect.com/science/article/abs/pii/S0048969725018261#:~:text=In%20the%20U.S.%2C%20although%20the,2019;%20NFLIS%2C%202024).

4. Wastewater-based monitoring could help guide responses to the USA opioid epidemic

https://www.nature.com/articles/s44221-023-00082-9

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Just when we thought everyone was aware of the fatal danger of fentanyl and it being mixed into every drug of abuse available on the street, a new threat arises. Nitazene or Isotonitazene (ISO) or Protonitazene, new lab-made opioids, are showing up at hospitals and morgues around the world in the bodies of people thinking they were taking their drug-of-choice only to find it was laced with one more deadly drug. It is being mixed in with cocaine, or formulated into fake Oxy’s and other pills. In the US, it first showed up in 2019 in the Midwest and spread rapidly.

Nitazenes were developed in the 1950’s by pharmaceutical companies as an alternative to morphine but shelved due to the risks of overdose. There is still no approved medical use for nitazenes today. Another ‘Designer Drug’ being made in illicit labs around the world, Nitazenes are up to 40 times stronger than fentanyl. Fentanyl is already 50 times more powerful than heroin and up to 800 times more powerful than morphine.

No wonder these drugs are referred to as ‘Frankenstein Opioids’ – only an insane, evil intentioned scientist would work to create such a drug. But in reality, the motivation is greed more than insanity because synthetic drugs are cheap to make and easy to ship and deliver – and highly profitable. But evil is the correct description for the immoral heads of the drug syndicates and cartels around the world whose entire life and business is dealing death.

What can be done?

For parents with children still at home, community connection and education are the best preventative measures. As I have said before, my husband and I were totally unaware of what substances were readily available to our middle school son in the early 2000’s. Our concern was smoking and marijuana. Little did we know. General discussions about drug abuse were the extent of our educational conversations. But we would have been much better prepared and had much more information if we had been involved with our kids’ school community. Instead, we were insulated from vital resources because we spent so much time with our church community. But make no mistake. Many of the families at church with kids in youth group were just like us – unaware and ill prepared and sadly many of them suffered the same loss as we did.

There are other important aspects in raising self-reliant kids who are not subject to the lures of the “cool” kids or “in” crowd. Below is a link to a previous blog dedicated to the perils modern teens and their parents face with important resources. I hope it will be helpful to you and those you love.