Notes from the Field: Nitazene-Related Deaths — Tennessee, 2019–2021

Nitazenes are a novel group of powerful illicit synthetic opioids derived from 2-benzylbenzimidazole that have been linked to overdose deaths in several states. Nitazenes were created as a potential pain reliever medication nearly 60 years ago but have never been approved for use in the United States. Laboratory test results indicate that the potency of certain nitazene analogs (e.g., isotonitazene, protonitazene, and etonitazene) greatly exceeds that of fentanyl, whereas the potency of the analog metonitazene is similar to fentanyl. Naloxone has been effective in reversing nitazene-involved overdoses, but multiple doses might be needed. The prevalence of nitazene deaths in the United States is unknown and the frequency of nitazene involvement in overdose deaths in Tennessee has not yet been assessed. However, of concern is that nitazenes are increasingly recorded in toxicology reports and death certificate cause-of-death fields. Given their potency, raising awareness about nitazenes and implementing strategies to reduce harm through increased testing, surveillance, and linkage to treatment for substance use disorders are of vital importance.