Over the last decade, we’ve watched fentanyl reshape the landscape of substance use in America. Overdoses changed. Risk patterns changed. Treatment changed. And now, something even more potent is entering the supply, quietly and quickly.

Nitazenes are ultra-potent synthetic opioids originally created in the 1950s and are rapidly emerging in U.S. drug markets, often showing up where people least expect them. They are not prescribed, not FDA-approved, and not predictable. And like fentanyl, they are entering the supply through contamination, counterfeiting, and cost-cutting and not through consumer demand.

Clients aren’t asking for nitazenes. They’re falling into them.

What Are Nitazenes?

Nitazenes (also called benzimidazole-opioids) are a class of synthetic opioids first developed by a Swiss pharmaceutical company in the late 1950s, but they were never approved for medical use in the United States. They disappeared from public awareness for decades, showing up only in a few rare toxicology cases until suddenly reappearing in the illicit market around 2019.

Source: chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://deadiversion.usdoj.gov/drug_chem_info/benzimidazole-opioids.pdf

Since then, nitazenes have been identified in drug supplies across Europe, North America, and South America. The U.S. Drug Enforcement Administration (DEA) now considers them an emerging and serious public health threat.

Illicit manufacturers continue to modify the chemical structure, creating new analogs faster than labs can catalog them.

How Potent Are Nitazenes? Far Stronger Than Fentanyl

This is the part that should make everyone pause.

According to international and U.S. data, nitazenes range from slightly less potent than fentanyl to more than 40 times stronger — with some analogs reaching up to 4,300 times the potency of morphine.

For context:

• Fentanyl is 25–50 times stronger than heroin.

• Some nitazenes are 5–9 times stronger than fentanyl.

• Other nitazenes (like N-pyrrolidino variants) are up to 25–43 times stronger.

And as the DEA notes, their pharmacology produces the same dose-dependent respiratory depression seen with other opioids, but at much lower thresholds.

A person can overdose on a dose they cannot see, taste, or detect.

That’s the danger.

Source: chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.oas.org/ext/DesktopModules/MVC/OASDnnModules/Views/Item/Download.aspx?type=1&id=1045&lang=1

Why Are Nitazenes Showing Up in the Drug Supply?

People typically do not seek out nitazenes. They appear:

• Mixed with fentanyl

• Sold as heroin

• Hidden in pressed “pain pills” or counterfeit oxycodone

• Laced into benzodiazepine-like pills

• Blended into powders to increase potency cheaply

Because they’re chemically distinct, standard fentanyl test strips often cannot detect them, leaving people with a false sense of safety.

In other words:
People don’t know what they’re taking. That is the crisis.

Source: chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.ccsa.ca/sites/default/files/2022-03/CCSA-CCENDU-Drug-Alert-Nitazenes-2022-en_0.pdf

What Overdoses Look Like, and Why They’re So Dangerous

Nitazene overdoses look similar to fentanyl overdoses but progress faster due to potency:

• Sudden loss of consciousness

• Deep sedation

• Respiratory depression

• Cyanosis

• Potential seizures

• Rapid progression to cardiac arrest

Naloxone does work but here’s the catch:
Multiple doses are frequently required.

This is crucial for treatment providers, sober living staff, first responders, and families to understand.

Where Are Nitazenes Being Detected?

While data are still emerging, early trends include:

• Over 4,300 law enforcement seizures in the U.S. since 2019

• Wastewater detection in Washington and Illinois

• Sharp increases in Tennessee nitazene-related fatalities

• Widespread contamination in Québec and Toronto

• Massive co-presences in São Paulo, Brazil (95% of opioid seizures contained nitazenes)

The explosion of varieties also makes tracking harder and means the spread is likely underreported.

What This Means for People in Recovery

This is the part that hits home in treatment programs across the country.

Return-to-use episodes already carry elevated risk due to following tolerance loss. With nitazenes, the risk becomes catastrophic. One unexpected exposure, even in a small amount, can be fatal.

Clients who believe:

• “I’m only using a little; I’ll be fine,”

• “I know my dealer,”

• “It’s the same stuff I always get,”

• “I only use socially on weekends,”

…are now at far greater risk than they understand.

This is not about moral judgment.
This is pharmacology.

And the pharmacology is unforgiving.

What Providers Must Do Now

We can’t control the drug supply, but we can control our response.

1. Educate clients immediately.

Not as scare tactics, but as life-saving harm-reduction. Clients deserve to know the truth about what’s happening in the supply.

2. Encourage multiple naloxone kits.

One dose may not be enough.

3. Talk openly about supply unpredictability.

People need to understand that contamination is more common than intentional misuse.

4. Incorporate nitazene education into groups and individual sessions.

Pretending "fentanyl is the worst of it" is no longer accurate.

5. Destigmatize harm-reduction conversations.

Clients are more likely to share information when they do not fear judgment.

6. Train staff on rapid recognition of nitazene overdose.

The progression can be quick. Seconds matter.

The Bottom Line

Nitazenes represent the next evolution of America’s opioid crisis — not because people are seeking stronger highs, but because illicit markets are cutting corners with increasingly dangerous substances.

Treatment professionals need to be ahead of this wave, not behind it.

Awareness is prevention.
Education is prevention.
Compassion is prevention.

Lives depend on it.

About the Author

Carmichael McKinley Finn, MA, LMFT, LADC, ADCR-MN, is an Executive Director, clinician, educator, and national presenter specializing in substance use disorder (SUD) treatment, trauma, and behavioral health leadership. He leads Recovering Hope Treatment Center in Mora, Minnesota—a women- and family-centered program providing residential and outpatient services—and teaches in multiple collegiate behavioral health programs across Minnesota.

With dual licensure in mental health and addiction counseling, Carmichael is known for his direct, honest approach to clinical care and his commitment to workforce development, ethical leadership, and trauma-informed systems. His work includes developing treatment policies, supervising clinical teams, consulting for organizations across the state, and advocating for improved resources and better outcomes for families impacted by SUD.

Carmichael writes about emerging drug trends, harm-reduction practices, leadership, and the evolving landscape of behavioral health. His perspective blends frontline experience, systems insight, and a deep belief in compassionate, evidence-based care.