Nitazenes

What are Nitazenes?
Nitazenes are a group of illicit synthetic opioids originally developed as potential painkillers but never approved for medical use because even very small amounts can cause respiratory arrest and death. Some nitazenes may be dozens of times more potent than fentanyl and hundreds of times more potent than morphine, making them extremely dangerous. Specialized nitazene drug-testing strips can help detect nitazenes in illicit drugs; however, common fentanyl testing strips do not detect nitazenes. Naloxone is a lifesaving medication that may reverse a nitazene overdose if administered quickly enough, although repeated doses may be required.

Forms of Nitazenes:
In the United States, nitazenes have been found in the illicit drug market as powders, crystalline solids, vape cartridges, or nasal sprays. Nitazenes may be injected, inhaled, or swallowed. They may be mixed into other illicit substances such as heroin, ketamine, or synthetic cannabinoids, often without the knowledge of the person using the drug.

Effects:
Effects include heavy sedation, dangerous slowing or stopping of breathing (respiratory depression and arrest), and death from overdose.
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Kratom

What is Kratom?
Kratom is a plant-derived psychoactive substance made from the leaves of the Southeast Asian tree Mitragyna speciosa. At lower doses, it can have stimulant-like effects, such as increased energy or alertness. At higher doses, it can produce opioid-like effects, including pain relief, sedation, and euphoria. Kratom products sold in the U.S. lack consistent safety standards and may contain variable amounts of psychoactive compounds or contaminants. Use can lead to physical dependence and withdrawal. Some products labeled as kratom may contain concentrated or semi-synthetic compounds, such as 7-hydroxymitragynine (7-OH), which act on opioid receptors and increase the risk of addiction and overdose. At high doses, these products may cause loss of consciousness, respiratory depression, and death.

Forms of Kratom:
In parts of Southeast Asia, kratom leaves have traditionally been chewed or brewed into tea. In the United States, kratom is commonly sold as capsules, powders, extracts, or teas purchased online or from smoke shops and vape stores.

Effects:
Kratom can produce stimulant-like effects at lower doses and opioid-like effects at higher doses, such as pain relief, euphoria, and sedation. Effects can include nausea, vomiting, constipation, dizziness, high blood pressure, confusion, seizures, slowed breathing, and death.
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7-Hydroxymitragynine (7-OH)

What is 7-OH?
7-Hydroxymitragynine (7-OH) is a powerful psychoactive drug derived from the kratom plant. 7-OH occurs naturally in kratom leaves in very small amounts, but some products contain highly concentrated or synthetic forms. These products may be marketed under names such as 7-OH-mitragynine, 7-HMG, 7-OHMG, 7-Hydroxy, or mitragynine pseudoindoxyl. Kratom or 7-OH products are often marketed for opioid withdrawal, depression, anxiety, or pain; however, they are not approved by the U.S. Food and Drug Administration (FDA) and have been linked to overdose deaths in Los Angeles County.

Forms of 7-OH:
7-OH is sold in concentrated forms such as powders, pills, extracts, liquid shots, drinks, gummies, and teas.

Effects:
7-OH is a potent opioid-like compound that can produce pain relief and euphoria but also carries significant risks, including sedation, respiratory depression, dependence, overdose, and death.
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Xylazine

What is Xylazine?
Xylazine (pronounced ZY-luh-zeen) is a veterinary anesthetic that is classified as an alpha-2 agonist with sedative and pain-relieving properties used to calm animals during procedures. In the United States, xylazine is not approved by the U.S. Food and Drug Administration (FDA) for any medical use.

While there is no antidote or medication to reverse a xylazine overdose, people should administer naloxone during an overdose since naloxone is effective against any opioids with which the xylazine may be mixed. Multiple doses of naloxone may be required. After naloxone administration, the person who overdosed may start breathing but may remain unconscious for a prolonged period of time. People should also call 911 to ensure the person who overdosed receives prompt medical care.

Forms of Xylazine:
Xylazine is an adulterant that may be “cut” (mixed) into other illicit (illegal) substances, such as opioids like fentanyl, heroin, and other counterfeit (fake) pills that mimic in appearance other medications such as Norco, Percocet, Vicodin, Xanax, and others. Similar to illicit opioids, xylazine may be introduced into the body by snorting, smoking, injecting, or other modes of using illicit substances. bbbbb

Effects:
Sedation, dangerously low blood pressure, slowed heart rate, slowed breathing rate, magnifies the effect of slower breathing (respiratory depression) or stopped breathing (respiratory arrest) leading to overdose death. Side effects may also include complex wounds, at times distant from the drug-injection site. Xylazine-associated wounds may be large, involve bone, muscle, or other tissues below the skin, and may become infected and/or have necrotic (dead) tissue, requiring specialized medications, treatments, and/or surgery.
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Medetomidine

What is Medetomidine?
Medetomidine is a veterinary anesthetic with sedative and pain-relieving properties used to calm animals during procedures. It is classified as an alpha-2 agonist, like xylazine but more potent.

Medetomidine may be mixed into illicit substances without the knowledge of the person using the drug. In Los Angeles, medetomidine has been identified in illicit drugs. Although it has not been commonly detected in the local drug supply, public health officials are concerned that its presence may increase.

There is no FDA-approved antidote for medetomidine overdose. However, naloxone should still be administered because medetomidine is usually mixed with opioids such as fentanyl.

Forms of Medetomidine:
Medetomidine is not typically sold as the main illicit substance; rather, when medetomidine appears in the illicit drug supply, it is usually as an adulterant mixed with (“cut into”) opioids such as illicit fentanyl, fentanyl analogs, and heroin. It is often mixed into powdered forms of these other illicit drugs or pressed into counterfeit (fake) pills that mimic other medications, such as fake oxycodone (“M30”-type tablets).

Effects:
It can magnify effects, including heavy sedation, low blood pressure, slowed breathing, and slowed heart rate, which may make overdoses harder to recognize and respond to. A person exposed to medetomidine may require hospitalization to manage overdose response, withdrawal, and after-care.
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Tianeptine

What is Tianeptine?
Tianeptine is an antidepressant used in some countries to treat depression. At high doses, it can produce opioid-like effects, giving it potential for misuse and dependence. In the United States, tianeptine is not approved by the U.S. Food and Drug Administration (FDA) for any medical use.

Forms of Tianeptine:
Sometimes referred to as “gas-station heroin,” tianeptine products may be sold online or in retail stores as dietary supplements.

Effects:
Reported effects include improved mood, increased energy, and appetite suppression. Adverse effects may include agitation, rapid heart rate, high blood pressure, confusion, breathing problems, nausea, seizures, loss of consciousness, and death.
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Nitrous Oxide

What is Nitrous Oxide?
Nitrous oxide, commonly called “laughing gas,” is a dissociative anesthetic used medically by dentists and physicians as a sedative during minor procedures. Industrially, nitrous oxide is used as a propellant, for example, in whipped-cream chargers.

Forms of Nitrous Oxide:
Nitrous oxide is a colorless, non-flammable gas with a sweet odor. People may misuse nitrous oxide by inhaling it from small metal canisters (“whippets”) or from balloons filled from larger dispensers in order to get a brief high. In recreational settings, it may be used alone or alongside other drugs at parties and clubs.

Short-Term Effects:
Short-term effects include euphoria, mouth or throat frostbite, slurred speech, lightheadedness, dizziness, fainting, limb weakness, and loss of consciousness, which can lead to falls or other injuries. High-dose use can cause oxygen deprivation (asphyxiation) and sudden death.

Long-Term Effects:
Long-term use can lead to serious health problems, including vitamin B12 deficiency, impaired bone marrow function, abnormal blood counts, and lasting neurological damage to the brain and spinal cord.
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