18 Sep Dangerous Synthetic Opioids Driving Current Overdose Crisis
PainRelief.com Interview with:
Dr. Durbhakula
Shravani Durbhakula, MD, MPH, MBA
Associate Professor of Anesthesiology,
Division of Pain Medicine
Vanderbilt University School of Medicine
Medical Director, Comprehensive Pain Service
Vanderbilt University Medical Center
PainRelief.com: What is the background for this study?
Response: Our study highlights the rapid rise of nitazenes—extremely potent and dangerous synthetic opioids—silently driving the current overdose crisis. Developed in the 1950s by a pharmaceutical company and never approved for clinical use, nitazenes are up to 20 times more potent than fentanyl and are undetectable with standard drug tests available in emergency rooms.
These opioids are often mixed into counterfeit pills or other street drugs, posing an unseen threat. Furthermore, nitazenes interact with opioid receptors in a unique way, increasing overdose risk, heightening respiratory depression, and accelerating tolerance development, which makes them even more dangerous for users.
PainRelief.com: What should readers take away from your report?
Response: Readers should recognize that nitazenes represent a growing threat in the opioid epidemic. They are more dangerous and harder to detect than substances like fentanyl. Although animal studies have provided some data, human clinical information is sparse. For instance, we still don’t fully understand how naloxone works against nitazenes, such as how many doses may be required for reversal. Our report stresses the urgent need for enhanced diagnostic tools, such as test strips capable of detecting nitazene analogues in a pill or powder, and emphasizes the importance of public education about the dangers of counterfeit pills.
PainRelief.com: What recommendations do you have for future research as a result of this study?
Response: Future research must prioritize gathering human clinical data to better understand the long-term effects of nitazenes, their metabolism, and how they interact with overdose treatments like naloxone. It’s also crucial to explore the scope of nitazene exposure across various communities. Additionally, improving and validating diagnostic tools to reliably detect nitazene analogues in emergency rooms and at the point of care is essential to prevent misdiagnoses and delays in treatment.
PainRelief.com: Is there anything else you would like to add? Any disclosures?
Response: Yes, it’s critical to note that many individuals using nitazenes may not even realize they’re consuming them, as these substances are frequently mixed into counterfeit pills disguised as other opioids. This underscores the need for robust public education campaigns. Ultimately, this is not just a drug problem—it’s a public health crisis. Addressing it requires a multi-faceted approach involving clinicians, public health officials, law enforcement, and community organizations to work together on harm reduction strategies, addiction treatment, and raising awareness.
Citation:
Ryan Mortman, Shravani Durbhakula, Trent Emerick, Nitazenes: Are Pain Physicians Aware of the Risks?, Pain Medicine, 2025;, pnaf127, https://doi.org/10.1093/pm/pnaf127
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Last Updated on September 18, 2025 by Marie Benz MD FAAD