Nitazenes (also spelled “nitazines”) are a class of synthetic opioids belonging to the benzimidazole structural family. Originally developed in the 1950s by a Swiss pharmaceutical company as potential painkillers, they were never approved for medical use because of their extreme danger—the margin between a therapeutic dose and a fatal overdose was simply too narrow.

These drugs remained largely forgotten for decades until 2019, when they began appearing in the illegal drug supply. As law enforcement cracked down on fentanyl, underground chemists turned to historical pharmacology research to create new synthetic opioids that weren’t yet scheduled or detectable.

Types of Nitazenes

Over 20 different nitazene compounds have been identified. The most common variants include:

• Isotonitazene (ISO) — The most prevalent form in the U.S., approximately 500x stronger than morphine
• Metonitazene — Commonly found in South America and increasingly in North America
• Etonitazene (“Pyro”) — Over 40x more potent than fentanyl, 1,000x stronger than morphine
• Protonitazene — Detected in U.S. wastewater samples in Washington and Illinois
• N-Desethyl etonitazene — A newer variant linked to deaths in Colorado

According to the DEA, nitazenes are now a Schedule I controlled substance, meaning they have no accepted medical use and a high potential for abuse.

The extreme potency of nitazenes is what makes them so deadly. A dose that would be safe for morphine would be instantly fatal with certain nitazene compounds.

Because nitazenes are relatively new to the illegal drug market, street names are still evolving. Parents, educators, and first responders in Charlotte, NC should be aware of these terms:

What Does Nitazene Look Like?

Nitazenes can appear in multiple forms, making identification extremely difficult:

• Powder: White, off-white, brown, or yellowish powder
• Counterfeit pills: Pressed to look like oxycodone “M30” tablets, Dilaudid “M-8” tablets, or Xanax bars
• Liquid: Solutions for nasal spray or injection
• Blotter paper: Soaked into paper strips similar to LSD
• Mixed into other drugs: Hidden in heroin, cocaine, MDMA, ketamine, and even cannabis vape cartridges

Because of their extreme potency, nitazene overdoses can occur within minutes of exposure. Recognizing the signs quickly is critical to saving a life.

What to Do If You Suspect an Overdose

1. Call 911 immediately. North Carolina has a Good Samaritan law protecting people who report overdoses from drug possession charges.
2. Administer naloxone (Narcan) if available. For nitazenes, multiple doses may be required.
3. Perform rescue breathing if the person is not breathing.
4. Place in recovery position (on their side) if breathing resumes.
5. Stay with them until help arrives—overdose symptoms can return.

Free naloxone is available in Mecklenburg County. Residents can request it directly from Mecklenburg County Public Health.

This detection gap creates several serious problems:

• Overdose deaths go unrecognized: Medical examiners may attribute deaths to “opioid overdose” without identifying nitazenes specifically
• Users can’t test their drugs: Unlike fentanyl, there are no consumer test strips for nitazenes
• Emergency responders don’t know what they’re dealing with: Treatment protocols may be insufficient for nitazene’s extreme potency
• Surveillance data is incomplete: The true scope of the nitazene crisis is likely undercounted

According to Vanderbilt University Medical Center researchers, in Tennessee alone, naloxone was administered in only 1 in 3 nitazene-involved deaths—largely because responders didn’t recognize the overdose in time.

Yes, naloxone (Narcan) can reverse nitazene overdoses—but with important caveats:

Why Nitazenes May Require More Naloxone

• Higher receptor binding: Nitazenes bind strongly to opioid receptors, requiring more naloxone to displace them
• Longer duration: Some nitazene variants last longer than naloxone, meaning overdose symptoms can return
• Unknown dosing: When nitazenes are mixed into other drugs, the amount consumed is unpredictable

Where to Get Free Naloxone in Charlotte, NC

• Mecklenburg County Public Health: Free naloxone upon request
• Most pharmacies: Available without prescription under NC’s statewide standing order
• Community organizations: Many harm reduction groups distribute naloxone kits
• MEDIC (Mecklenburg EMS Agency): Leaves naloxone kits after overdose responses

Always call 911 after administering naloxone, even if the person appears to recover. With nitazenes, symptoms can return when the naloxone wears off.

For Parents of Teens & Young Adults

• Have direct conversations about the dangers of ANY pill not from a pharmacy—counterfeit pills kill
• Educate about the risks: Even “trying something once” can be fatal with nitazene-laced drugs
• Keep naloxone at home: It’s legal, free, and could save your child’s life
• Know the warning signs of opioid use: drowsiness, small pupils, slurred speech, frequent flu-like symptoms
• Monitor for counterfeit pills: Any pill with “M30,” “Xanax,” or other imprints could be fake

For People Who Use Drugs

• Never use alone: Have someone present who can administer naloxone and call 911
• Start with a small amount: You cannot know the potency of street drugs
• Carry naloxone: Multiple doses may be needed for nitazene overdoses
• Avoid mixing substances: Combining opioids with alcohol, benzodiazepines, or other depressants multiplies the risk
• Consider treatment: Nova Transformations offers compassionate, evidence-based care in Charlotte, NC

If you or a loved one is struggling with opioid addiction—whether to prescription painkillers, heroin, fentanyl, or other synthetic opioids—professional treatment can help. Nova Transformations in Matthews, NC offers comprehensive programs for the greater Charlotte area.

Treatment Programs Available

• Partial Hospitalization Program (PHP): Intensive daytime treatment while living at home or in sober housing
• Intensive Outpatient Program (IOP): Flexible scheduling for those with work or family obligations
• Dual Diagnosis Treatment: Addressing addiction alongside co-occurring mental health conditions like depression, anxiety, or PTSD
• Medication-Assisted Treatment (MAT): Evidence-based medications like buprenorphine (Suboxone) combined with counseling

Why Choose Nova Transformations?

• Luxury, home-like environment that promotes healing and comfort
• Evidence-based therapies: CBT, DBT, trauma-informed care, EMDR
• Experienced staff: Many team members are in recovery themselves
• Individualized treatment plans tailored to your unique needs
• Insurance accepted from major providers
• Convenient Matthews, NC location serving all of Charlotte metro