This new synthetic opioid’s proving a problem.

There’s been a new synthetic opioid being sold as oxycodone. N-pyrrolidino etonitazene (also known as etonitazepyne), is sold in a little blue pill with M on one side and 30 on the other. According to Forensic®, N-pyrrolidino etonitazene is a novel synthetic opioid which is very potent and could easily cause a deadly overdose.

We released an alert about it with High Alert and the DIANZ network on Friday night, and we’ve had some responses from y’all in the last 24 hours:

Stick with your mates

This new synthetic opioid has been linked to deaths in the UK and the US. It’s only just hit Aotearoa’s shores, and so far it’s not doing us any kind of good. So if you choose to have some oxycodone without testing it, make sure you have a sober person with you, just in case.

Even if you’re a seasoned traveller on the opioid/synthetic opioid path, reports say that N-pyrrolidino etonitazene is not something to treat lightly.

If you’ve taken an ‘oxycodone’ and start feeling a bit odd, even just a wee tiny bit, have someone bring you to A&E immediately. Don’t roll the dice on this one.

So far, these are the things people report feeling:

  • Feeling euphoric or in a ‘dreamlike’ state.
  • Drowsiness and starting awake
  • Temporary relief of pain, stress, or low mood.
  • Itchiness
  • Severe nausea and/or vomiting.
  • Severe sweating or fevers.
  • Slowed and/or difficulty breathing.
  • Blue lips or fingertips.
  • Cold and clammy skin.
  • Pinpoint (tiny) pupils.
  • Becoming unresponsive and/or losing consciousness.

Naloxone and Nyxoid are great…if you can get them

There are two emergency treatments for opioid overdose in Aotearoa which will also work with N-pyrrolidino etonitazene – Nyxoid nasal spray and Naloxone injection. These work by temporarily and immediately reversing the opioid-like effects long enough for an ambulance to arrive.

Nyxoid spray

You can get an emergency pack of 2 doses of Nyxoid spray without a prescription. It costs $92.

If the person that is having the overdose isn’t revived by the first dose after 2-3 minutes, you can give them a second dose. You can keep giving them doses of Nyxoid every 3 minutes until they revive.

However, if the ambulance hasn’t arrived 3 minutes after the second dose and your mate is still unresponsive and you’re not rich enough to have more than one pack, they’re in real trouble and potentially going to die.

Naloxone injection

Is only available by prescription, or at some (not all) of the Needle Exchange clinics around Aotearoa. We couldn’t find any information about what kind of criteria you needed to meet to be granted a prescription for Naloxone HCl as an injection. But we did find criteria for Naloxone in tablet form as a combination to treat opioid dependence. We couldn’t find anything for Naloxone alone.

According to PHARMAC’s April 2022 schedule, some of the easier to meet conditions for the Naloxone combination tablets to be prescribed are:

  • The patient has to be opioid dependent
  • The patient has to be in Ministry of Health-approved opioid treatment service
  • The patient can’t be taking methadone or any other opioid replacement substance.

The prescription is only for 1 month and, with the PHARMAC subsidy, costs between $18.37 and $53.12, depending on how strong the dose is.

We imagine that the Naloxone HCl injection isn’t going to be cheap. Also there’s the cost of going to the doctor, having to talk to the doctor about the fact you take opioids and watching them make that face of instant judgement.

This stuff saves lives, so why is it so hard for the people that need it to get it?

We don’t know. But it does smell an awful lot like prohibition-style legislation. It also smells like the kind of moral policing that thinks that people dying is an allowable consequence of someone being lied to about what they’ve been sold.

What’s the difference between a synthetic opioid and a regular opioid?

Synthetic opioids are made by people in labs. They’re made specifically to bind to opioid receptors in your brain to help manage pain. They include substances like fentanyl, carfentanyl, meperidine, hydromorphone, and many others.

The main important difference for us is that synthetic opioids are *a lot* more potent than ‘natural’ opioids like codeine, morphine, or heroin. So the dangerous dose level for fentanyl will be far smaller than the dangerous dose for heroin.

This new synthetic opioid is reported to be 20x more potent than fentanyl, so you can imagine how miniscule the dangerous dose for N-pyrrolidino etonitazene is.

Read more about synthetic opioids on the Science Direct website

Read more about non-fentanyl synthetic opioids in Pharmacotoxicology of Non-fentanyl Derived New Synthetic Opioids on the Frontiers in Pharmacology website

Read more about post-mortem toxicology of fentanyl and fentanyl analogues on the Frontiers in Pharmacology website

You helped us find this dangerous substance, so thank you <3

The sample that sparked this alert was brought to us because it resembled pills being sold overseas that contained dodgy stuff. We sent the sample away to ESR for further testing. Our specs can’t conclusively identify substances that are active at such low doses but ESR have more precise lab equipment than us. They came back to us with information that we could act on and warn everyone with.

The fact that you trust us enough to let us take substances and investigate them and warn people about them is one thing. The more important thing, we think, is that you trust us with your safety and your anonymity enough to come to us with your substances in the first place.

Your trust in us allows us to find potentially life-threatening substances and warn people about them before they get hurt. This trust is infinitely precious to us, and we’ll work hard to continue to be worthy of it.

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