A crushed partial white pill (reported by the client to have been a ‘Xanax’ bar) was expected to contain alprazolam (the active ingredient in Xanax). However, testing identified a combination of alprazolam, bromazolam, diazepam and the potent synthetic opioid protonitazene. The pill was sourced locally (ACT region).

What does this mean?

Protonitazene is a highly potent synthetic opioid, estimated to be more than 200 times stronger than morphine. Even tiny amounts can cause overdose. Nitazenes are turning up more often in pills, powders, and counterfeit medications across Australia.

Bromazolam, Alprazolam and Diazepam are all benzodiazepines – sedatives that vary widely in strength, onset and duration. When mixed with opioids they significantly increase the risk of depressant overdose.

Bromazolam is a new benzodiazepine that has strong sedative effects. There’s limited information available about it, and it hasn’t been used in human trials.

Alprazolam is not readily available from Australian pharmacies. While other brands containing alprazolam can be obtained on prescription, most if not all ‘Xanax’ bars can be expected to be counterfeit.

Effects

Nitazenes can cause opioid-like effects such as drowsiness, slowed or stopped breathing, loss of consciousness, cold or clammy skin, tiny pupils, or unusual breathing sounds like snoring or gurgling. These may be signs of an overdose.

Some nitazenes may require more than one dose of naloxone and ongoing monitoring, as effects can return after an initial revival.

Benzodiazepines (like bromazolam, alprazolam, and diazepam) can cause sedation, memory loss and loss of coordination. When combined with opioids, they increase the risk of overdose.

All nitazenes carry a high risk of overdose – even in very small amounts. It’s difficult for health services to provide safer use advice due to limited evidence that they can or should be safely used – being informed, carrying naloxone, and staying with others can reduce potential harm.

Reduing the harm

Test your stuff!

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

Some counterfeit pharmaceuticals can look very convincing and even be in ‘branded’ blister packs or packaging that appears authentic. Genuine pharmaceuticals are only disensed from pharmacies. Come and see us at CanTEST – we are a free, confidential harm reduction service.

Naloxone can reverse a protonitazene overdose, 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 (link in bio). You can get Nyxoid nasal spray naloxone for free from CanTEST.

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.