Research Alert
EMBARGO LIFTS AUGUST 29, 11AM EST
Author: Alex Manini, MD, MS, Professor of Emergency Medicine at the Icahn School of Medicine at Mount Sinai, Director of the Center for Research on Emerging Substances, Poisoning, Overdose, and New Discoveries
Journal: JAMA Open – Embargo lifts August 29, 2023, 11 am EST
Bottom Line: A subclass of opioid drugs called nitazenes are now emerging in the illicit opioid supply in the United States and are more potent than even fentanyl. These nitazenes add a layer of complexity to the dangers of illicit drug use, leading to a significantly increased rate of cardiac arrest in overdose cases and significantly higher doses of naloxone for in-hospital treatment when compared to fentanyl overdoses.
Why This Study Is Unique: This is the first human study to show the clinical effects of new potent opioids such as brorphine and nitazene class drugs.
Why This Study Is Important: This study is the first to identify the impact of new illicit opioids, including adverse consequences from nitazenes, such as frequent cardiac arrest, and higher dosage of naloxone for treatment.
How the Study Was Conducted: Researchers analyzed 2,298 patients admitted with opioid overdoses to emergency departments across the country between 2020 and 2022.
Study Results: Overdoses from the more potent opioids needed on average 1.33 doses of naloxone in-hospital, compared to 0.36 average doses for fentanyl overdose. In addition, 100 percent of overdoses on one nitazene drug (metonitazene) had a cardiac arrest.
What This Means for Clinicians/Hospitals: Clinicians in the United States should be aware of new potent opioids in the illicit drug supply and be prepared for higher naloxone dosing requirements.
Quotes:
“Given the alarmingly high cardiac arrest rate for nitazene overdose, this study should energize harm-reduction policies. And given the emergence of dangerous toxic drugs in the illicit opioid supply in the United States, future research should examine clinical outcomes from new potent opioids as the supply continues to evolve,” says Alex Manini, MD, MS, Professor of Emergency Medicine at the Icahn School of Medicine at Mount Sinai.
About the Mount Sinai Health System
Mount Sinai Health System is one of the largest academic medical systems in the New York metro area, with more than 43,000 employees working across eight hospitals, more than 400 outpatient practices, more than 300 labs, a school of nursing, and a leading school of medicine and graduate education. Mount Sinai advances health for all people, everywhere, by taking on the most complex health care challenges of our time—discovering and applying new scientific learning and knowledge; developing safer, more effective treatments; educating the next generation of medical leaders and innovators; and supporting local communities by delivering high-quality care to all who need it.
Through the integration of its hospitals, labs, and schools, Mount Sinai offers comprehensive health care solutions from birth through geriatrics, leveraging innovative approaches such as artificial intelligence and informatics while keeping patients’ medical and emotional needs at the center of all treatment. The Health System includes approximately 7,400 primary and specialty care physicians; 13 joint-venture outpatient surgery centers throughout the five boroughs of New York City, Westchester, Long Island, and Florida; and more than 30 affiliated community health centers. Hospitals within the System are consistently ranked by Newsweek’s® “The World’s Best Smart Hospitals” and by U.S. News & World Report's® “Best Hospitals” and “Best Children’s Hospitals.” The Mount Sinai Hospital is on the U.S. News & World Report's® “Best Hospitals” Honor Roll for 2023-2024.
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