Public Health Scotland. Public health alert for action: Nitazene-type drugs in Scotland. (12 Aug 2025)
External website: https://publichealthscotland.scot/publications/rap...
Nitazenes are a group of synthetic (lab-made) opioids that are now widely detected in all parts of Scotland. Due to their high potency and increasing presence in the drug supply, nitazenes pose a substantial risk of overdose, hospitalisation and death. Nitazenes have been seized in both Scottish communities and custodial settings.
They are most commonly detected in drugs sold as: heroin, benzodiazepines, oxycodone. They are often found alongside other drugs, and the risk of harm associated with nitazenes should be addressed in the context of polysubstance use (mixing drugs). Services supporting people who take drugs should promote and discuss realistic harm reduction measures based on effective approaches for opioid and polydrug use, with greater caution needed due to the risk of contamination.
Overdose signs and response actions for nitazenes are the same as for other opioids, but the overdose may be more sudden and severe due to their increased strength. Naloxone effectively reverses opioid-type drug overdoses, but repeat doses may be required. Doses should be administered one at a time, two to three minutes apart. Services should improve access to naloxone and ensure all staff are trained to recognise overdose signs, know how to use naloxone, and have access to it.
Further information on nitazenes can be found in the resources section.
What are nitazenes?
Nitazenes are a category of new synthetic opioids (NSOs), also known as 2-benzyl benzimidazole opioids. They are extremely potent opioid receptor agonists, meaning they strongly activate opioid receptors and depress the central nervous system. Nitazenes are the most commonly detected NSOs in Scotland, however 'fentanyl' is often used as a generic street name for all synthetic opioids. The first detection of this drug family in European drug markets was in 2019 and the first detection in Scotland was in mid-2021. As of 2024, 22 different nitazenes have been identified in Europe (European Drug Report 2025).
Many of these have been found in Scotland, most commonly:
- etonitazene
- metonitazene
Other nitazenes detected include:
- isotonitazene
- clonitazene
- hydronitazene
- etonitazepyne (N-pyrrolidino etonitazene)
- protonitazepyne (N-pyrrolidino protonitazene)
- isotonitazepyne (N-pyrrolidino isotonitazene)
- N-desethyl etonitazene
- N-desethyl isotonitazene
- N,N-dimethyl etonitazene
- protodesnitazene
- isotocyanazene
Recognising and responding to a possible nitazene overdose
The signs and the response actions for nitazenes are the same as for any other overdose involving opioids, but due to increased strength the overdose may be more sudden and severe. Opioid overdose signs:
- unconsciousness (won’t wake with a shout or a shake)
- unable to speak or respond
- slowed breathing and heart rate
- snoring or noisy breathing
- blue or pale lips and skin
- pinpoint pupils
Please be aware: people may be taking a combination of drugs with different effects and the signs may not be as clear cut as the above. Some people may display all overdose signs, others will have one or two.
Learn more about overdose:
In an emergency - Checklist:
Check if the person is conscious by shaking them and loudly calling their name or asking if they’re okay.
If there’s no response, check they are breathing.
- Stay calm and shout for help.
- Call 999 and ask for an ambulance. Tell them your location and give as much information as you can about what’s happened. Be open about the substances taken – you won’t get in trouble for getting help.
- Follow the call handler’s instructions. If you are by yourself, put them on speakerphone to leave your hands free.
If they’re unresponsive and breathing:
- put them in the recovery position (on their side with head tilted back)
- give naloxone (see naloxone section)
- monitor breathing
- if no response after 2 to 3 minutes, give naloxone again.
If they’re not breathing:
- put them on their back
- give 30 chest compressions followed by two rescue breaths
- give naloxone
- repeat cycles of chest compressions, rescue breaths and naloxone
Learn more about emergency first aid:
What is naloxone?
Naloxone is a life-saving medicine that can temporarily reverse the effects of an opioid overdose, including synthetic opioids such as nitazenes. Naloxone is available at all pharmacies for use in an emergency. You can get naloxone from some pharmacies and drug services.
How to administer naloxone
Naloxone is very easy to administer. You can learn how to administer naloxone in a free e-learning module by the Scottish Drugs Forum (SDF). Due to the high potency of nitazenes repeat doses may be required before the overdose is reversed. Doses should be administered one at a time, waiting 2 to 3 minutes between each dose while watching for a response. The aim is to get the person breathing normally – they don’t need to be fully alert and awake.
Administration of naloxone should continue until:
- the person is breathing normally
- emergency services arrive and take over
- you have no naloxone left.
After administering naloxone
If multiple kits have been administered but they are having no effect, it may be that this is a different type of medical emergency. An ambulance should be called immediately so that professional assistance can be offered as soon as possible. Naloxone will start to wear off after 20 to 30 minutes. The duration of action of naloxone is shorter than that of opioid drugs, which means there is a risk of repeat overdose. Administer further doses of naloxone as required. Stay with the person and monitor. When they wake up provide reassurance and explain who you are and what has happened.
For more information and tutorial videos, visit naloxone.org.uk:
After an overdose
In the hours and days that follow an overdose, the person may feel tired, confused or unwell. They might have injuries, memory loss or difficulty thinking clearly. There is a risk of re-overdose – either when naloxone wears off or if more drugs are taken. Stay with the person and let them rest in a safe place, but check in regularly, especially in the first few hours. Keep an eye on their breathing and alertness. If they’re open to it, gently talk about what happened and explore ways to stay safe or get support.....
[For more information on nitazine and overdose, see the RADAR website]
B Substances > New (novel) psychoactive substances > Synthetic opioids > Benzimidazole, Nitazenes, Brorphine
G Health and disease > Substance use disorder (addiction) > Drug use disorder > Drug intoxication > Poisoning (overdose)
J Health care, prevention, harm reduction and treatment > Harm reduction > Substance use harm reduction
J Health care, prevention, harm reduction and treatment > Health related issues > Health information and education
J Health care, prevention, harm reduction and treatment > Type of care > Emergency care
T Demographic characteristics > Substance or health care worker / provider
VA Geographic area > Europe > United Kingdom > Scotland
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