Nitazenes represent a growing threat to public health in Europe
Authors: Isabelle Giraudon, Katri Abel-Ollo, Diāna Vanaga-Arāja, Peter Heudtlass, Paul Griffiths
Journal: The Lancet Public Health (2024)

Adam Holland and colleagues reported in their Comment1Holland A Copeland CS Shorter GW et al.Nitazenes—heralding a second wave for the UK drug-related death crisis?.Lancet Public Health. 2024; 9: e71-e72Summary Full Text Full Text PDF Scopus (0) Google Scholar that nitazenes could be exacerbating the crisis in drug-related deaths in the UK. Their Comment reinforces concerns we, at the European Monitoring Centre for Drugs and Drug Addiction, have raised—that nitazenes pose a credible threat and that predicted changes in heroin availability in Europe could herald an increase in the use of synthetic opioids with possibly profound implications for public health.2Griffiths PN Seyler T De Morais JM Mounteney JE Sedefov RS Opioid problems are changing in Europe with worrying signals that synthetic opioids may play a more significant role in the future.Addiction. 2023; (published online Dec 21.)https://doi.org/10.1111/add.16420Crossref Scopus (0) Google Scholar New data from Estonia and Latvia in particular show how the introduction of nitazenes can rapidly affect trends in drug-related mortality. Baltic countries have a long history of synthetic opioid problems dating back to an earlier Taliban ban on opioid production,3European Monitoring Centre for Drugs and Drug AddictionEuropean Drug Report 2023: trends and developments.https://www.emcdda.europa.eu/publications/european-drug-report/2023_enDate: 2023Date accessed: February 11, 2024Google Scholar and can serve as an early indicator of a more generalised future problem. Isotonitazene has been detected in Estonia since 2019, and other nitazenes such as protonitazene and metonitazene have been increasingly identified in post-mortem analyses of drug-related deaths cases since 2022. In 2022, 32 of 82 drug-related deaths (39%) in Estonia were associated with nitazenes and 2 of 63 (3%) in Latvia. In 2023, nitazenes were identified in 56 of 117 drug-related deaths (48%) in Estonia and in 38 of 130 (29%) in Latvia. This development is worrying. In drug-related death cases involving nitazenes, the most prominent nitazenes detected in Estonia in 2023 were protonitazene (38 of 56; 68%) and metonitazene (27 of 56; 48%); isotonitazene (32 of 38; 84%) was most common in Latvia. Figures for 2023 are preliminary and might be underestimates. There are other signals that problems associated with nitazenes might be growing in the EU. In 2023, deaths related to nitazenes have been reported in the French department of La Réunion,4Agence Régionale de santé La RéunionVigilance: circulation of an unidentified substance with a fatal risk.https://www.lareunion.ars.sante.fr/vigilance-circulation-dune-substance-non-identifiee-risque-mortelDate: Sept 8, 2023Date accessed: February 11, 2024Google Scholar and outbreaks of non-fatal overdoses noted in Ireland.5Health Service Executive IrelandHSE issues warning to heroin users following cluster of overdoses in Dublin.https://www.hse.ie/eng/services/news/media/pressrel/hse-issues-warning-to-heroin-users-following-cluster-of-overdoses-in-dublin.htmlDate: Nov 9, 2023Date accessed: February 11, 2024Google Scholar We therefore support the call to action made by Holland and colleagues. We would add that we cannot assume that existing approaches to responding to opioid problems will be sufficient without adapting to the challenges posed by the appearance of a range of highly potent but pharmacologically diverse substances. We declare no competing interests.