STRONGER THAN FENTANYL AND HEROIN: NITAZENES ARE CAUSING FEAR AMONGST AUSTRALIAN LAW ENFORCEMENT AND MEDICAL AUTHORITIES

"They were intending to take heroin," Bec tells 7.30.

"That's my understanding."

On the Tuesday after the Easter long weekend, Aboriginal peer worker Bec arrived at the Penrith needle and syringe exchange to see an unusual sight.

A line-up around the corner of people waiting for the service to open.

They were there to get take-home naloxone, a medication that rapidly reverses the effects of opioid overdose.

"At first I was kind of, you know ... mucking around with them. I said, 'You have a big weekend, guys?'" she said.

"They were quick to tell me what had actually gone on … there'd been 20-odd overdoses in that one weekend."

That was strange to Bec, because many of the clients were seasoned heroin users. 

They all said the substance was a yellow powder. Some speculated the heroin had been cut with fentanyl, but no one was sure.

"They were telling me it happened very quickly, that people were going down very quick, and that it was taking multiple doses of naloxone to bring them back ... anywhere up to five."

The dozens of overdoses were later revealed to be caused by nitazenes, a deadly synthetic opioid which can be stronger than fentanyl and hundreds of times more potent than heroin.

Within days, peer support workers from the NSW Users and AIDS Association (NUAA) were on the streets of Penrith delivering extra doses of take-home naloxone to drug users and training them on how to administer it.

"I was just concerned that we weren't going to be able to dispense the naloxone as fast as we were needing it," Bec, an Aboriginal peer worker, said.

Researchers, harm reduction experts and the Australian Federal Police (AFP) worry that this is the start of what's to come as nitazenes increasingly infiltrate Australia's underground drug supply.

They are now warning anyone taking any kind of illicit substance to be on high alert, carry naloxone and be ready to use it.

'This might be coming at you in the future'

Nitazenes have been found in every state and territory in Australia and in drugs from heroin to MDMA, ketamine, cocaine and counterfeit pharmaceutical products.

The class of synthetic opioids were first developed by pharmaceutical companies looking for alternatives to morphine in the 1950s, but were abandoned because they were too potent.

Nitazenes are still not being used pharmaceutically but they are starting to appear in the illicit market in Australia, reflecting trends around the world.

In the UK there's been over 170 overdose deaths from nitazenes. It's estimated there's been thousands more in the USA over the past few years.

Statistics around the exact number of Australians who have died from nitazene overdose are hard to confirm, because many people don't know what they've taken and testing isn't always done to confirm which opioid a person has overdosed on.

But the Victorian Coroners Court has confirmed there's been at least 16 deaths in that state alone.

The NSW cluster earlier this year was picked up because there were so many overdoses in a short time period.

Health workers were able to get a sample of the substance and send it for testing, resulting in a state-wide alert through the NSW Health early-warning alert system. But not every state has a drug alert system like NSW. 

NSW Ambulance Senior Assistant Commissioner Clare Beech says the service has seen an anecdotal increase in call outs for overdoses in some areas.

"We're noticing that drug users are having experiences that they weren't expecting," she said. 

"They might be finding that the drugs that they're using are much stronger than they expected, or they were expected to have a certain reaction and in fact they might be having the opposite effect.

"So I guess the message is, you just never know exactly what you're taking. And if someone around you becomes unwell, make sure you call triple-0 as quickly as you can."

This week Victoria's chief health officer warned people have been seriously harmed after ingesting a white powder sold as cocaine that contained a type of nitazene.

Professor Nadine Ezard from the National Centre for Clinical Research on Emerging Drugs says that is particularly concerning.

"If someone's purchasing cocaine for its stimulant effect, and they inadvertently take nitazenes, which are sedatives, they may actually become unconscious or even stop breathing altogether," she said.

"Even if you're thinking you're just only ever going to do a pill or a couple of lines of cocaine, you really need to be aware that this might be coming at you in the future.

"We don't know why they're ending up in other drug classes. It doesn't make a lot of sense to give someone a sedative when they're asking for a stimulant drug."

Nitazenes coming from China and India

The AFP is warning that the synthetic opioid is likely to become more prevalent as drug dealers look for cheap alternatives to heroin after the Taliban cracked down on opium production in Afghanistan in 2022.

"Certainly that has been reported, that particularly in Afghanistan, the crackdown on opium production has caused organised crime across the globe to look to alternative opioid substances," AFP Commander Paula Hudson told 7.30.

The AFP says their intelligence suggests nitazenes are being manufactured cheaply in factories in China and India and imported into Australia through the mail.

"We are concerned with the increase in border detections of nitazenes. Since January 2023 to now we've detected 37 packages," Commander Hudson said.

"Criminal organisations stop at nothing to reap benefits and make money out of the misery of people and communities. They are seeing nitazenes purely as a cheap alternative.

"It does present a real danger to people that are thinking they're taking one substance, particularly people that are not tolerant to opioids, they might be thinking they're taking ketamine, ecstasy.

"Opioids have an effect of respiratory decompression, that means your breathing shallows, it reduces, and quickly you go into unconsciousness.

"And that's then, you know, on the pathway to to death."

Bracing for more overdoses

User organisations say that as well as seeing nitazenes cut with other drugs, some clients are intentionally using them.

Because there's such a variation in strength, that's a dangerous prospect, according to NUAA CEO Dr Mary Harrod.

"I would say to be very, very careful," she said.

"[A] recent incident where two people overdosed, intentionally taking nitazenes, they thought they were getting one type of nitazene and they got another which was much stronger."

The NUAA runs a free statewide naloxone postal service, which has seen an increase in orders since alerts for nitazenes began.

Dr Harrod says even occasional recreational drug users who would never consider using drugs like heroin need to be aware they are at risk of an opioid overdose and carry naloxone and be aware they may need multiple doses.

"You should always call an ambulance because the naloxone might wear off and the person will go back into overdosing," Dr Harrod said.

Watch 7.30, Mondays to Thursdays 7:30pm on ABC iview and ABC TV