Nitazenes

We are seeing a rise in some street drugs being contaminated with potent synthetic opioids mainly nitazenes. These street drugs include heroin, illicit oxycodone pills, street benzos, and synthetic cannabis (spice).

Nitazenes are much more potent than heroin, especially in relation to a person’s ability to breathe. This has led to an increase in deaths caused by overdose.

If you are a heroin user or use other opiate-type drugs or street tablets, the advice on this page will help you to reduce your chances of overdosing.

What do Nitazenes look like?

Nitazenes in general are a powder but this can be pressed into a tablet and dyed to make it a different colour. It’s soluble in liquids. This means they can look like anything.

How to keep yourself safer?

We know that there are risks with all illicit drugs due to the way they are produced. However, there are some things you can do that can keep yourself safer.

Look out for each other

Don’t use drugs alone. It’s always better to be with someone you trust so you can keep an eye on each other. If you can’t do this in person, then ring someone tell them where you are and if they can stay with you on the line until you have used and feel OK. If not, ask them to call you back in five minutes and if there is no response to call an ambulance and give them your location.

Consider using the BuddyUp phone app if you have a smartphone. It’s a confidential service that allows you to prepare an overdose rescue plan. BuddyUp is available via Android and iPhone.

Naloxone

•Where is your naloxone kit?
•Is it intact?
•Is it in date?

Carrying naloxone always means you are ready. If you are using with other people, make sure there are multiple kits available, and people know how to use them.

You can grab a kit from any treatment service and in some places they are available at the pharmacy. Naloxone buys you time to get an ambulance and it could be the difference between surviving or not surviving.

Start low and go slow

With a lot of the heroin and other street drugs being contaminated you need to be cautious with every pill, powder, or liquid. Start with a small amount and wait before taking more.

If you’re using pills that haven’t been prescribed, try cutting them into smaller pieces or crush the pill, dab a bit, and wait.

Don’t mix your drugs

Mixing drugs is more likely to cause an overdose. Try to use one drug at a time. If you are going to mix drugs, use less of each.

Check your drugs

There is no way to see what your drugs contain. Consider sending an anonymous substance sample to the WEDINOS Project for analysis. You don’t need to provide personal details other than your age, sex and the first part of your postcode.

Getting the results takes a few days, so take it easy. Use the low and slow method if you are going to take drugs in the meantime.

Nitazene test strips, which are used to check for the presence of nitazenes in drugs are available from most treatment services. There is a separate leaflet for these that explains how they work.
Make sure you are on the right dose of Methadone or Buprenorphine

If you are in treatment, it might be a great time to talk about dosage and making sure you are on the right amount. If you’re not in treatment then come and see us. Having a low dose and still using drugs and your prescription can be riskier than having a higher dose of methadone or buprenorphine and not using or reducing your drug use.

Smoke don’t inject

It is always safer to smoke rather than inject but be aware recently a significant number of people who have overdosed were smoking contaminated heroin. Smoking does NOT remove the risk of overdose.
The usual effects of heroin use, like drowsiness and slower breathing, can look similar to overdose, so it’s important to know the difference.

Some signs of an opiate overdose:

Pinpoint pupils which indicates opioid use
Shallow and or infrequent breathing- Breaths that are shorter and not as deep as normal. They also may be not as frequent as usual or have a snoring/rasping sound to their breathing. They may not be breathing at all.
Unresponsive- Not responding to someone’s voice or physical attempts to wake them up, such as shaking, and speaking in a loud voice (don’t shout at a person or inflict pain by, for example, pinching or hitting the person)
Change in skin colour- Bluish tinge to lips, tip of nose, eye bags, fingertips, or nails. Darker skin then appears grey or whitish around the mouth in light skinned people. In darker-skinned people, skin can appear greyish or duller than usual. In this instance, a colour change might be easier to detect on the inside of the lips, on the gums and under fingernails.
Limp body A person may find it hard to hold their own body weight so they slump over or are unable to stay upright.
Severe nausea (feeling sick) and vomiting (throwing-up)- Opioids can trigger the vomiting reflex, causing nausea and throwing up.

What to do if someone has overdosed

Call 999

Get the ambulance moving. Give them as much information as you can and they will provide you with instructions on what to do. They are there to help. Its really important when the ambulance arrives that the person goes in it. With the extreme sedation causes by nitazenes extended monitoring by healthcare professionals in hospital is needed to avoid further overdoses.

Administer naloxone

If you’re unsure if the cause of the overdose is heroin or another drug, give them naloxone anyway. It won’t cause any harm.

A single dose of naloxone will begin to work in 2-3 minutes, and its effects will last between 20-40 minutes. If nitazenes are involved, you may need to give them more than one dose but space the doses out as you have been trained.

It’s more likely that overdose symptoms will return with nitazenes, so keep an eye on the person longer than you would if they had overdosed on heroin alone. You only need to recover their breathing. They don’t necessarily need to regain consciousness.

Put them in the recovery position.

When they are breathing normally again, put them in the recovery position. This will help with their breathing and guard against inhaling their sick if they vomit.

Remember that naloxone is not a substitute for emergency medical care. It’s a temporary measure that buys time until proper medical treatment can be given.

Stay with them

Keep an eye on them. The effects of naloxone will wear off. You may need to give them more doses. Make sure they get in the ambulance if possible.