The Colombo Plan has issued a health alert regarding the growing global threat posed by Benzimidazole (Nitazene) opioids. These highly potent synthetic compounds, which far exceed the strength of fentanyl, are driving significant increases in overdose deaths and public health crises across multiple regions.

Nitazene tablets containing 29 mg of metonitazene (equivalent to containing 145 times the lethal dose of fentanyl) heading to Florida, Connecticut, and Brazil were seized from international express mail. Public health and safety officials are urged to remain vigilant against this emerging danger.

Hear from Thom Browne, CEO of the Colombo Plan, as he addresses this emerging threat during his session at the upcoming National Prevention Summit. This discussion is especially pertinent for Florida. Click here to register for the conference now to stay informed and be part of the solution.

Key Insights:

  • Potency and Risk: Nitazenes, also known as Benzimidazoles, are synthetic opioids estimated to be 1.5–20 times more potent than fentanyl. A single tablet seized in 2023 contained metonitazene levels equivalent to 290 mg of fentanyl — 145 times the estimated fatal dose.
  • Global Spread: Reports from North America, Brazil, Europe, Australia, New Zealand, and West Africa reveal a sharp rise in nitazene-related deaths.
  • Distribution and Adulteration: Nitazenes are typically found in tablet or powder form, often mixed with fentanyl, other synthetic drugs, or designer benzodiazepines like Bromazolam, further compounding the risks.
  • Sample Testing: U.S. Crime Lab data shows 2.6% of analyzed cases (55 exhibits) contained 19 or more substances in addition to the principal nitazene compound.
  • Adverse Effects: Like other synthetic opioids, nitazenes cause profound sedation and respiratory depression, often leading to fatal overdoses.

Naloxone and Treatment:

Naloxone remains effective in reversing nitazene overdoses but may require multiple doses due to the drug’s extreme potency.

Emerging Analogs:

Since 2019, a range of nitazene analogs has surfaced in the U.S., including metonitazene, isotonitazene, protonitazene, and N-pyrrolidino protonitazene. The NPS Discovery program at CFSRE tracks these trends quarterly, with protonitazene, metonitazene, and N-pyrrolidino protonitazene among the most common in late 2024.

Call to Action:

Stakeholders must collaborate to monitor, educate, and implement strategies to mitigate the escalating threat of nitazenes. Effective policy, public awareness, and access to life-saving tools like naloxone are critical in addressing this public health emergency, as the spread of these synthetic opioids could significantly worsen the opioid epidemic or spark new outbreaks in unsuspecting countries and regions.

Click on the image below to download the full alert, which includes regional insights and actionable information, and share it within your communities.