Novel 2-Benzylbenzimidazole Opioids: Emerging Drugs of Abuse and Pharmacological Considerations with Nitazene Analogs

PURPOSE OF REVIEW: To summarize the developing evidence on novel 2-benzlbenzimidazole opioids (nitazene analogs), including pharmacology, potency, toxicology, management of overdose, and public health issues that are caused by this set of compounds as there is an increasing presence in illicit drug markets. RECENT FINDINGS: Nitazene analogs include those such as isotonitazene, metonitazene, protonitazene, and etonitazene are highly potent mu opioid receptor agonists and are increasingly detected in counterfeit and illicit pharmaceutical products with exposure in other substances including other drugs. Reports from multiple clinical, forensic, and public health investigations have all demonstrated that severe opioid toxicity can be characterized by profound respiratory depression, which is seen in nitazene compounds. Detection remains a central issue with this compound because these derivatives frequently are missed in routine toxicology screening. Nitazene analogs represent a new class of synthetic opioids that are associated with a high overdose risk related to high potency and increased prevalence worldwide. New techniques for overdose reversal include improvements in the pharmacology of opioid antagonists, prolonged and improved monitoring, and advances in life support inside and outside the hospital setting.