Fentanyl and Nitazeni: five questions to understand why they are dangerous

The National Prevention Plan against the misuse of fentanyl and other synthetic opioids has been active in Italy for a few months. Although there are no alarming levels as in the United States, where the spread of these substances has already caused hundreds of thousands of deaths, it is still essential to maintain a high level of attention and work on prevention. Essential as an analgesic and anaesthetic drug, outside of medical supervision Fentanyl is one of the most dangerous substances: addiction can develop rapidly and the risks are serious, in some cases irreversible. Concern is also growing over new synthetic substances that are difficult to detect and combat, such as nitazenes.

Fentanyl is one of the opioids, substances that act on the nervous system to reduce the perception of pain. It is a synthetic, not a natural product, created for therapeutic purposes: it is used during surgery and in the treatment of chronic or cancer pain. In addition to its use as a drug, however, it has been spreading for some years now as a drug of abuse, i.e. as a substance taken to achieve psychoactive effects, either sedative or exciting. The consequences of this use are very serious: Fentanyl is up to a hundred times more toxic than heroin and morphine; it is also rapidly and powerfully addictive. The adverse effects are serious and can even lead to death.

Any use outside of medical supervision is dangerous. As the news has reported, in specific areas, such as certain cities in the United States, this drug has spread so rapidly that there is talk of a fentanyl epidemic. It is cheap and can be bought, illegally, even online. This is because it is easy to synthesise, i.e. to produce, and is sold in doses that contain other psychoactive or toxic substances. Moreover, there is currently an antidote (naloxone) to reverse symptoms in the event of an overdose only in the case of intoxication with pure Fentanyl or other opioids; if, however, excessive doses of Fentanyl are taken in combination with non-opioid substances, such as xylazine (also known as 'tranq'), the efficacy of naloxone may be reduced and advanced support may be required. In the worst cases, the consequence may be death.

In the short term, Fentanyl causes nausea, vomiting, constipation; prolonged use results in severe respiratory problems, up to death by suffocation. When mixed with other substances, such as xylazine, it can cause skin ulcers in the areas where it is injected, usually arms and legs. Hence the journalistic name used to describe this type of mixture: 'zombie drug'. Equally dangerous is addiction. With abuse comes tolerance, i.e. the need to increase doses and frequency of use to achieve the desired effects. When the substance is not available, withdrawal symptoms, physical and psychological disorders ensue. These manifestations appear quickly and, unlike other substances, are difficult to treat.

Not at the moment: the spread of this substance is very limited. Chemical analyses that are periodically carried out on waste water, aimed at detecting the quantity and location of drugs, have found samples of fentanyl in 33 Italian cities. The spread, however, has not reached worrying levels. For some months now, however, the Presidency of the Council of Ministers has activated a national alert plan in order to prevent and prepare for a possible health emergency. This is not a disproportionate precaution: hundreds of thousands of deaths have occurred in the United States due to the misuse of this substance. The health crisis, caused by Fentanyl and other toxic substances in that country, has consequences and costs that have already been described as 'immeasurable'. In our country, however, the spread of ketamine is increasing, and there is a growing alarm about new classes of synthetic substances, such as nitazenes.