Nitazenes

Effects of nitazenes

There is no safe level of drug use. Use of any drug always carries some risk. It’s important to be careful when taking any type of drug. 

Nitazenes affect everyone differently, based on:

• size, weight and health
• whether the person is used to taking it
• whether other drugs are taken around the same time
• the amount taken
• the strength of the drug (varies from batch to batch).

Onset and duration of effects

How fast a drug takes effect and how long it lasts can vary depending on how it's taken - for example, whether it's snorted, swallowed, or injected.⁷

There are many types of nitazenes, and research on them is limited. How quickly their effects are felt, and how long they last, can vary between types.⁸

Effects

Effects can include:

• euphoria 
• relaxation, drowsiness and clumsiness
• pain relief
• reduced stress 
• itchiness 
• nausea and vomiting 
• fever and sweating 
• slow breathing and heart rate.⁹

Impact of mood and environment

Drugs that affect a person’s mental state (psychoactive drugs) can also have varied effects depending on a person’s mood (often called the ‘set’) or the environment they are in (the ‘setting’): 

• Set: a person’s state of mind, previous encounters with the drug, and expectations of what’s going to happen. For example, feelings of stress or anxiety before using nitazenes may result in an unpleasant experience and make those feelings worse.
• Setting: the physical and social environment where you take nitazenes – whether it’s known and familiar, who you're with, if you're indoors or outdoors, the type of music or sounds, and lighting. The ideal setting to take nitazenes will vary based on the individual and drug they’re using.¹⁰

Being in a good state of mind, with trusted friends and a safe environment before taking nitazenes reduces the risk of having a bad experience.¹⁰

Overdose

If you take a large amount of nitazenes or use a strong batch, you could overdose.⁵

The potency (strength) of nitazenes varies between drugs in the class. They can range from levels similar to morphine, to a lot stronger than fentanyl.^{11, 12}

Your risk of overdose can also increase if you mix nitazenes with alcohol or other drugs, including medications.

Nitazene overdose can cause death.⁵

Call triple zero (000) and request an ambulance if you or someone else has any of the following symptoms (emergency services are there to help and can provide more instructions).

Signs of opioid overdose can include:

• unconscious or non-responsive
• slow breathing, abnormal breathing, or not breathing at all
• slow or no heartbeat and pulse
• choking or gurgling sounds
• skin colour changes, especially lips and fingernails
• bluish-purple skin for people with lighter complexions
• greyish or ashen skin for people with darker complexions
• vomiting
• cool or clammy (wet and sweaty) skin
• small ‘pinpoint’ pupils.^{13, 14}

Learn more on overdose and drug-related emergencies.

Naloxone

Naloxone (also known as Nyxoid®/Narcan®) temporarily reverses the effects of opioid overdose (including nitazenes). It’s available for free over the counter from most local pharmacies and can be administered by anyone, including family or friends and bystanders.¹⁵

If a person does not respond to the first dose after 3 minutes, give them a second dose. This can be repeated until the ambulance arrives.^{16, 17}

Find naloxone near you

Mixing with other drugs

Mixing nitazenes with other drugs can have unpredictable effects and increase the risk of harm.

Mixing includes using more than one drug (including alcohol or medications) at the same time, or one after another. You should also consider what drugs you’ve taken in the last 24 hours.

Due to the lack of formal research around mixing nitazenes with other substances, this information covers mixing other drugs with opioids: 

Low risk

• Opioids and cannabis: can work together to increase the effects of both drugs, there is a risk of being more impaired than wanted or planned.

Caution required 

• Opioids and MDMA/LSD: Unlikely to cause interaction. Don’t use Tramadol and MDMA together due to risk of seizures.

Dangerous

• Opioids and nitrous oxide: Can cause impaired coordination, memory loss and passing out.
• Opioids and GHB/GBL/benzodiazepines/alcohol: Can cause difficulty breathing, passing out, vomiting and possible death. 
• Opioids and ketamine: Can cause nausea, vomiting, passing out, and possible death.
• Opioids and cocaine/crystal methamphetamine (ice)/amphetamines: Increases the risk of heart strain. The stimulant effect of these drugs increases heart rate, and the opioid decreases heart rate. Depending on the amount taken there is a risk of respiratory arrest or heart problems if one wears off before the other.^18-20

Using more than one drug or type of drug at the same time is called polydrug use.¹⁴

Reducing harm

There are ways you can reduce the risk of harm when using nitazenes.

• Start low, go slow – try a little bit first to see how you feel. Wait at least 5 hours before deciding whether to take more.
• Keep naloxone nearby – in case of an overdose.
• Test your drugs if there is an available drug checking (pill testing) service near you, to find out what the drugs contain and how strong they are.
• Never use alone – use around people you trust and somewhere you feel safe. If you are using with someone else, use at separate times.
• Don’t operate machinery, drive, or swim.^{15, 21-23}

If injecting

• Always use new needles – never share needles or other injecting equipment. Use your own spoon/cup and tourniquet. Use new barrels, filters, sterile water, and swabs. Safely dispose of used equipment.
• Visit a needle and syringe program for sterile equipment, disposal of used equipment, and expert medical advice.^{15, 21-23}

Coming down

Nitazenes are not known to cause comedown effects.

Long-term effects

Long-term effects can vary depending on how much, how often and how nitazenes are consumed.

The long-term effects of nitazenes haven’t been studied enough to understand what the risks might be, but it’s thought they may be like other opioids, such as fentanyl.²⁴

Some common long-term effects of opioids include:

• constipation
• increased risk of getting sick from viruses and infections
• sleep problems
• reduced bone density and higher risk of breaking bones
• heightened sensitivity to pain (opioid-induced hyperalgesia)
• impacts on hormone levels leading to reduced sex drive, infertility, erectile dysfunction, or menstrual cycle changes.^{25, 26}

Nitazenes and mental health

Research has found a link between some mental health conditions and the risk of opioid overdose.^{27, 28}

There is evidence that as many as 1 in 3 people with an opioid use disorder also have post-traumatic stress disorder (PTSD).²⁹

People experiencing mental health concerns such as depression, anxiety, PTSD, psychosis, or bipolar disorder are also more likely to experience an opioid overdose compared to those without these conditions.²⁷

This association has been seen across different groups, including people in emergency departments, veterans, and those in prison settings.²⁷

Tolerance

Regularly taking nitazenes can lead to developing a tolerance, which means you need to take larger amounts to get the same effects.³⁰

Tolerance to nitazenes also affects other opioids (known as cross-tolerance). For example, tolerance to nitazenes will also result in a higher tolerance to oxycodone or fentanyl.^{20, 31}

Tolerance should return to normal within 1 – 2 weeks of not using opioids.²⁰

Dependence

People who regularly use nitazenes may become dependent. They may feel they need to use nitazenes to go about usual activities like working, studying and socialising, or just to get through the day.30, 32

Withdrawal

Withdrawal refers to the symptoms that can occur when someone who is dependent on a drug, or who has been using it regularly over time, stops or reduces their use.³³

Withdrawal can include physical symptoms (such as headaches, or nausea) and psychological symptoms (such as anxiety, or depressed mood).³³

Symptoms - including how strong they are and how long they last - will vary depending on the type of drug and a person’s history of use.³³

Withdrawal from nitazenes can be potentially life-threatening.³⁴

If you, or someone you care about, is planning to stop taking nitazenes after using them for a long time, it’s important to speak with a medical professional for guidance and supervision.

Withdrawal symptoms

Reducing, or stopping using nitazenes after a period of regular use can lead to withdrawal symptoms, including:

• excessive sweating 
• restless legs 
• fever 
• dizziness
• flu-like symptoms
• blackouts
• anxiety 
• panic attacks.^{35, 36}

Reduced tolerance and overdose risk

After withdrawing from opioids such as nitazenes, your body is no longer used to it and your tolerance drops.²⁰

This means if you use the same amount as before, it can be too much for your body and cause an overdose.²⁰

Always start with a lower dose after a break from nitazenes or other opioid drugs.²⁰

Pregnancy and breastfeeding

Before pregnancy

There is research that shows opioid drugs, including nitazenes, can impact fertility.

They can:

• affect menstrual cycles
• lower sex drive.
• lower testosterone levels
• reduce sperm quality and movement
• cause erectile dysfunction.^37-39

During pregnancy

Opioid use during pregnancy can harm the baby’s development.^{40, 41}

Opioids can pass to your baby via the placenta. This can affect the baby’s growth and result in a premature (early) birth, which has other health impacts on the baby.⁴⁰

Other chemicals may be present in illegal or counterfeit (fake) opioid medication, and there is no way to know exactly how these will impact the baby or the pregnancy.⁴²

If you’re injecting opioids, it’s important to not share injecting equipment with other people. This protects you and the baby from bloodborne viruses such as HIV and hepatitis C.⁴³

After pregnancy

Opioid use during pregnancy can sometimes cause withdrawal symptoms in babies after birth. This is known as neonatal opioid withdrawal syndrome (NOWS).^{41, 44}

NOWS is easily diagnosed and treated, and not all babies will experience symptoms.⁴⁴

Breastfeeding your baby while using opioids in high doses is not recommended, as the drugs can be present in breastmilk and affect the baby.^{40, 43, 45, 46}

If you’re planning to breastfeed, make sure you talk with your midwife or doctor about your use of opioids.⁴¹

Getting help

If your use of nitazenes is affecting your health, family, relationships, work, school, financial or other life situations, or you’re concerned about someone, there is help and support. 

• Call the National Alcohol and Other Drug Hotline on 1800 250 015 for free and confidential advice, information and counselling about alcohol and other drugs.
• Search our Help and Support directory to find your preferred support, by adding your location or postcode and filtering by service type.