A CAPSULE FILLED WITH WHITE POWDER expected to contain an unknown opioid was found to contain the highly potent synthetic opioids metonitazene and protonitazene. While both metonitazene and protonitazene have each been detected separately at CanTEST, this is the first detection of a combination of these nitazenes in a single sample by drug checking service in Australia.

Both metonitazene and protonitazene are known to be 50-200 times stronger than morphine. Even tiny amounts can cause overdose. Nitazenes continue to be detected with increasing frequency in several parts of Australia, and in various forms.

Effects

All nitazenes carry a risk of fatal overdose – even in very small amounts. Nitazenes are known to cause opioid-like overdose (lowered/loss of consciousness, breathing slowly or not at all, tiny/pinpoint pupils, discoloured lips/nails, cold or clammy skin, choking/coughing/gurgling or snoring sounds are all potential signs). Nitazenes can cause multiple overdoses over time. It’s difficult for health services to provide safer use advice due to the limited evidence that either of these substances can or should be used safely. Being informed, carrying naloxone, and staying with others can reduce potential harm.

Reducing the harm

Test your stuff!

Always assume that your drugs may not be what you expect.

Naloxone

Naloxone can reverse an opioid overdose, and nitazenes are responsive to naloxone but several doses may be required. Never use alone and keep naloxone on hand. Search ‘Take Home Naloxone’ to get locations for free naloxone anywhere in Australia. Locals can get Nyxoid nasal spray naloxone for free from CanTEST, or visit cahma.org.au/services/naloxone to access their free postal naloxone service.

Responding to an overdose

Always call 000 immediately (even if you have and use naloxone). Learn first aid and CPR. Because opioid overdoses first affect a person’s breathing, rescue breaths are important when responding to a suspected opioid overdose.