Synthetic Drugs More Powerful Than Fentanyl Coming to Denver, Expert Predicts

This is the third in a series of stories on fentanyl and overdoses in Colorado. Click to read part one, "Fentanyl and Other Drugs Killing the Most Coloradans," and part two, "Why Denver Heroin Users Are Switching to Fentanyl."

A bipartisan group of legislators is currently crafting bills intended to tackle the fentanyl crisis in Denver and Colorado even as the tragedies continue to pile up; the latest involves three suspected fentanyl-related deaths inside a Cortez motel room. However, most reports suggest that the lawmakers are focusing more on tougher penalties than on public health.

Lisa Raville, executive director of the Harm Reduction Action Center, whose mission is to "educate, empower and advocate for the health and dignity of Denver's people who inject drugs," hopes that's not the case, for a variety of reasons. She sees crackdowns of the sort epitomized by a Denver Police Department sweep of Union Station last month as emblematic of policies that have repeatedly failed. And such legislation could also be rendered ineffective or obsolete by the continuing influx of new and more powerful synthetic opioids, including protonitazene, shorthanded as nitazene, which started showing up on the East Coast a year or two ago and appears to be heading west in the same way that fentanyl invaded Colorado.

"We've been telling folks, 'Listen, these new synthetic drugs are going to come here, they're definitely coming here,'" Raville notes. "So far, there's been a lot of 'I don't know. I doubt it.' But of course, they're coming here."

"New Synthetic Opioid Protonitazene Increasing in Prevalence as 'Nitazenes' Gain Traction Across the United States and Canada," published in December by the Pennsylvania-based Center for Forensic Science Research & Education, offers a primer on the substance. Its summary describes protonitazene as "a new, potent synthetic opioid" that's "dissimilar in structure to synthetic opioids typically encountered in forensic casework (e.g., fentanyl, heroin)" but is "approximately three times more potent than fentanyl." The first case was reported to NPS Discovery, an open-access drug early-warning system, last May, with somewhere between nine and fifteen additional examples popping up before the end of 2021.

Also raising an alert about protonitazene is the Washington/Baltimore High Intensity Drug Trafficking Area, whose November warning mentions a WTOP News story that month about a chemist in Washington, D.C., identifying a sample during a used syringe test program.

One concern about various members of the nitazene family, including substances such as butonitazene, etodesnitazene, flunitazene, metonitazene and metodesnitazene, is that they may be resistant to Narcan, which is widely used to reverse the effects of overdoses.

Also on the Washington/Baltimore HIDTA's radar is isotonitazene, which "activates the mu-opioid receptors in a similar fashion as fentanyl and hydromorphone." Narcan appears to work on isotonitazene, HIDTA acknowledges, but three deaths involving it were reported in Europe last year, and there's been at least one seizure of the drug in California.

Raville thinks that Colorado legislators will get nowhere trying to play Whac-a-Mole with fentanyl and other synthetic opioids, since new ones are emerging on a regular basis.

"We've had drugs forever and ever, but in the U.S., we've never had a really good conversation about them," she maintains. "The last fifty years of the War on Drugs has been racist and classist — and then we had D.A.R.E. and 'Just Say No.' When I give people tours of the center, it takes a while to bring them to a place of neutral because there's so much misinformation out there."

She adds: "We want to be innovative in the time of this overdose crisis, because we know law enforcement is never going to cut off fentanyl. That's been some of the rhetoric I've been hearing, but it's here, babe, and it's been here for years."

And more synthetic drugs are undoubtedly on the way.