Boulder County officials are warning residents of a rare but emerging class of drug on the streets that could be more potent than fentanyl and require several doses of naloxone to reverse overdose effects.
In the past six months, two men in their 20s, including a college student, died after overdosing on a mixture of drugs, including nitazenes, a strong synthetic opioid, according to the Boulder County coroner’s office, which sent out an email about the deaths last week.
Though nitazenes were developed decades ago, they were never approved by the FDA and pose a high risk due to the limited knowledge about the drug among health care providers and law enforcement officials, said Jeff Martin, the county’s chief deputy coroner.
“When you’re dealing with substances that have that same potency of fentanyl or even greater than fentanyl, there’s just a public concern there,” Martin said.
The two cases, one which is part of a criminal investigation, were the first detection of nitazenes in the county, Martin said. Statewide, there have been 13 overdose deaths tied to nitazenes between August 2021 and October 2023, all of which were along the Front Range, according to the Colorado Department of Public Health and Environment.
Though still rare, the drug raises concerns for health officials. Here’s what you need to know:
Nitazenes were developed decades ago but never approved by the FDA
Nitazenes were developed in the 1950s to manage pain but were never brought to the market, said Andres Guerrero, who oversees CDPHE’s overdose prevention unit. The drug has not been approved for medical use anywhere and is synthesized in illegal labs.
“Constantly there’s new drugs coming out, so this is not completely unexpected,” Guerrero said. “People were using heroin for a long time and then it kind of switched over to fentanyl and now we’re seeing some other synthetic opioids like nitazene and nitazene analogs come about. It really is just a product of the market.”
Some compounds of nitazenes can be up to 43 times more potent than fentanyl, according to the Center for Forensic Science Research and Education.
Chemists mix the drugs, changing its molecular structure to evade detection
Similar to fentanyl and its multiple chemical structures, chemists try to stay “one step ahead” of the Drug Enforcement Administration by tweaking nitazene’s structure to avoid detection, Guerrero said.
“It’s almost like a recipe book, so the analogs are just different types of base structures of a nitazene with some different things added on to these different analogs,” Guerrero said.
“It’s definitely a challenge.”
A unique compound of the drug was detected in a 20-year-old’s body after the Boulder County coroner’s office requested additional testing from a national forensic research laboratory.
“That’s when they found a very obscure nitazene compound — it’s the first time that they’ve seen that forensically in the United States,” Martin said.
Over the past year, Boulder County has seen a decrease in fentanyl deaths, the coroner’s office said, but the emergence of nitazenes raises new concerns.
In one of the two Boulder County cases, a 22-year-old man died of a mixture of drugs after purchasing what he likely believed to be Xanax from the “dark web,” Martin said.
The drug can be injected, smoked or swallowed, he said.
“Those chemical structures change weekly, monthly, or even daily sometimes,” Martin said. “We’re always kind of a step behind chasing what the new emerging drug is because these chemists are smart.”
Naloxone can help reverse overdose effects tied to nitazene
Since nitazene is a type of synthetic opioid, naloxone can help reverse overdose effects.
“This is one of the best tools that we have for fentanyl, for nitazene, for the analogs,” Guerrero said.
Narcan, one form of the overdose antidote, is now available without a prescription.
“You can literally just go to the pharmacy and buy it,” Guerrero said.
Because the illicit drug market is not regulated for any sort of potency or purity, it’s impossible for people to know what is in the substance they take if it doesn’t come from a doctor, he said.
“My overall fear is people need to be very, very careful when they’re accessing drugs through illicit means because you don’t know what is in it. “
Though powerful, deaths tied to nitazenes are still very rare
For now, nitazenes are not common in Colorado.
“This is not something we are seeing all over the place,” Guerrero said. “It’s still relatively new.”
In Denver, there were five deaths tied to a nitazene compound in 2022, but none last year, according to the city’s Office of the Medical Examiner.
In El Paso County, there have been four deaths related to the synthetic opioid since late 2022, Coroner Dr. Leon Kelly said.
Other states have reported a rise in nitazene-related cases. In Ohio, the state attorney general issued a warning after state investigators reported a 19% increase of nitazene cases in the first quarter of 2022 compared with the previous year. In Tennessee, officials reported 42 fatal overdoses in 2021, up from 10 in 2020. Zero were reported in 2019.
The DEA has received 2,400 reports of nitazenes since 2019, the agency reported.
The Boulder County coroner’s office is working with law enforcement and health care providers to “be on the lookout” with the hopes the warning helps with investigations and diversion efforts.