TRENTON, NJ – A new wave of synthetic opioids is alarming doctors and public health officials across the country as emergency rooms report patients collapsing within seconds of use and requiring multiple doses of naloxone to survive.
The drugs, known as nitazenes, are a class of lab-made opioids that federal health officials say can be up to 40 times stronger than fentanyl.
According to Green Branch Recovery, Nitazenes are already on the streets in New Jersey.
“In recent years, the opioid epidemic has taken new and more dangerous turns. One of the latest developments is the emergence of a synthetic opioid group known as nitazenes. While still unfamiliar to many, these substances are already contributing to overdose deaths across the United States, including here in South Jersey,” the group says.
According to the Centers for Disease Control and Prevention, nitazenes are now appearing in street drug samples across several states, often mixed with fentanyl and veterinary tranquilizers to create what the Drug Enforcement Administration describes as a “catastrophic” street cocktail.
ER doctors told NPR they’ve seen patients “collapse almost instantly,” noting that standard naloxone responses are proving less effective against the new compound’s speed and potency.
Medical officials brace for faster overdoses and longer recoveries
Clinical reports from the National Institutes of Health show that some nitazene overdoses require stacked doses of naloxone or prolonged ventilation, leaving first responders and bystanders with only seconds to react.
The DEA says the mixtures are unpredictable, often causing sudden respiratory failure, rapid loss of consciousness, and severe muscle rigidity. Some users have also suffered skin ulcers that form far from injection sites, suggesting toxic contamination within the supply chain.
Wisconsin health officials raise alarm over emerging drug threat
Xylazine—a veterinary sedative already linked to fentanyl mixtures—has been increasingly detected in toxicology screenings statewide. Officials said nitazenes are now being monitored as “likely already present” in local drug supplies.
Hospitals from Milwaukee to Madison are preparing for an influx of overdose cases as winter months drive more users indoors, heightening the risks of isolated drug use and delayed medical response.
Experts warn of a ‘perfect storm’ forming in the Midwest
Public health experts describe the situation as a convergence of factors — potent synthetic opioids, contaminated supply chains, faster collapse times, low user awareness, and seasonal isolation — creating what they warn could become a more devastating wave than fentanyl’s first surge.
Doctors and health officials are urging communities to remain vigilant, carry naloxone, and seek immediate help at the first sign of overdose symptoms as nitazenes emerge as one of the deadliest synthetic drugs to hit U.S. streets.
Congress has already proposed a bill to outlaw the drug:
H. R. 5032
To amend the Controlled Substances Act to permanently schedule the class of benzimidazole-opioids known as nitazenes, and for other purposes.
IN THE HOUSE OF REPRESENTATIVES
August 22, 2025
Mr. Vindman (for himself and Mr. Baumgartner) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee on the Judiciary, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned
A BILL
To amend the Controlled Substances Act to permanently schedule the class of benzimidazole-opioids known as nitazenes, and for other purposes.
Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,
This Act may be cited as the “Nitazene Control Act”.
(1) Nitazenes are a class of synthetic opioids first synthesized in the 1950s that exhibit extreme potency at the mu-opioid receptor, with some analogs exceeding the potency of fentanyl.
(2) The Drug Enforcement Administration (DEA) has temporarily or permanently scheduled multiple nitazene compounds under Schedule I of the Controlled Substances Act due to their high abuse potential and lack of accepted medical use.
(3) Nitazenes and nitazene analogues have emerged in the illicit drug supply as designer drugs and contribute to overdose and fatal poisonings in the United States.
(4) A class-wide permanent scheduling of nitazenes is necessary to preemptively address the proliferation of new analogs, streamline enforcement, and protect public health.
SEC. 3. Schedule I classification of nitazenes.
(a) Amendment.—Section 202(c) of the Controlled Substances Act (21 U.S.C. 812(c)) is amended by adding at the end of Schedule I the following:
“(f) Benzimidazole-opioids, commonly referred to as nitazenes, including any substance (including its salts, isomers, and salts of isomers) that has a chemical structure that is substantially similar to that of etonitazene or isotonitazene, including:
“(1) A benzimidazole core substituted at the 2-position with a benzyl or substituted benzyl group; and
“(2) A basic nitrogen-containing side chain at the 1-position; and
“(3) Exhibits agonist activity at the mu-opioid receptor.Such substances include, but are not limited to: etonitazene, clonitazene, metonitazene, isotonitazene, protonitazene, butonitazene, etodesnitazene, flunitazene, N-pyrrolidino etonitazene, N-desethyl isotonitazene, and N-piperidinyl etonitazene.”.
(b) Removal of temporary status.—Any substance included in the amendment to section 202(c) of the Controlled Substances Act made by this section that was temporarily scheduled under section 201(h) of the Controlled Substances Act shall be deemed permanently scheduled and subject to the requirements of Schedule I as of the date of enactment of this Act.
(c) Rulemaking authority.—The Attorney General, in consultation with the Secretary of Health and Human Services, may issue rules to clarify the scope of the nitazene class as necessary to enforce this section, provided such rules are consistent with the chemical definition in subsection (a)(1).
(1) Notwithstanding the amendments made by subsection (a), a researcher who, as of the date of enactment of this Act, is conducting research involving a substance described in subsection (a) that was not previously listed in Schedule I of section 202(c) of the Controlled Substances Act (21 U.S.C. 812(c)), shall not be required to obtain a registration under section 303(f) of such Act (21 U.S.C. 823(f)) solely due to the inclusion of that substance in Schedule I, provided that:
(A) the research is being conducted pursuant to an active investigational new drug (IND) application or other applicable regulatory exemption recognized by the Food and Drug Administration or Drug Enforcement Administration;
(B) the research was approved by an institutional review board (IRB) prior to the enactment of this Act; and
(C) the researcher notifies the Attorney General, in a manner determined by the Attorney General, within 90 days of enactment of this Act.
(2) The exemption under paragraph (1) shall remain in effect for a period not to exceed 18 months from the date of enactment, during which time the researcher may apply for a registration under section 303(f), and the Attorney General shall expedite such applications to ensure continuity of research.
(3) Nothing in this subsection shall be construed to authorize the initiation of new research using substances described in subsection (a) without proper registration and scheduling compliance.