Highly potent synthetic opioid detected in fake diazepam tablet

How to recognise the drug

As seen in the image, the tablet is blue, circular and does not have any markings. It was sold as a diazepam tablet. Please be aware that this substance could also be available as a blue powder made of crushed tablets. 

A sample of this substance was submitted to a New Zealand Needle Exchange Programme (DISC) drug checking clinic in Wellington. Further analysis of the sample was conducted by the Institute of Environmental Science and Research (ESR), which determined the sample contained N-Desethyletonitazene. No diazepam was detected in the tablet.

Nitazenes are increasingly being detected in fake benzodiazepine tablets internationally, and can vary in appearance (e.g. colour, shape, and markings) to the tablet pictured. Fentanyl test strips cannot be used to detect N‑Desethyletonitazene or other nitazenes.

The effects of N-Desethyletonitazene are likely similar to other synthetic opioids.These effects include:

• Feeling euphoric or in a ‘dreamlike’ state
• Sedation (‘the nod’ – being drowsy and then jerking awake)
• Temporary relief of pain, stress, or low mood
• Slowed and/or difficulty breathing
• Blue lips and/or fingertips
• Cold and clammy skin
• Pinpoint (tiny) pupils
• Seizures
• Becoming unresponsive and/or losing consciousness

How to reduce harm from the drug

Diazepam and N-Desethyletonitazene come from different classes of drugs and produce different effects. While both are central nervous system depressants, nitazenes are highly potent and act quickly to produce strong sedative/depressant effects.

A typical dose of N-Desethyletonitazene is measured in micrograms - much smaller than a typical dose of diazepam, which is measured in milligrams. This means that a person taking this substance thinking it is diazepam may inadvertently take multiple doses of N-Desethyletonitazene, significantly increasing the risk of serious harm, including death. 

N-Desethyletonitazene is a very strong opioid and consumption can easily lead to an overdose, even among people with experience using opioids. High Alert urges extreme caution should you choose to take these tablets and testing is recommended to help minimise the risk. KnowYourStuffNZ, the New Zealand Drug Foundation and the New Zealand Needle Exchange Programme run regular drug checking clinics. Information on upcoming clinics, including those coming up in the Wellington region, can be found on The Level.

If you choose to use this substance:

• Avoid using alone. Have a friend who can help, and call an ambulance, if things go wrong. Use a buddy system if needed - where someone is on the phone or calls you to check you are ok.
• Lower doses are less risky. Start off with an extremely small amount (a typical dose is in micrograms) to check how it affects you. In general, swallowing a substance has a slower onset than other methods and means there might be more time to get medical help if needed. The nitazene is unlikely to be evenly distributed across the pill, meaning some parts will be stronger than others. Crushing the pill, mixing it, and measuring out an extremely small amount helps to distribute the nitazene more evenly, and avoid overdose.
• Avoid using it at the same time as other substances, especially other depressant drugs such as alcohol, opioids, GHB/GBL, ketamine, and benzodiazepines, as these can increase the dangerous effects of opioids (for example, slowing or stopping breathing). 
• Have naloxone with you – a drug that can temporarily reverse the effects of an overdose and give you more time to get medical help. Talk to your GP about this. Some pharmacies and all needle exchanges stock naloxone. The Nyxoid nasal spray can also be purchased direct from the ‘Pharmaco Emergency Care’ website. High potency opioids like N-Desethyletonitazene may require more than one dose of naloxone.
  • Remember, nitazenes can be fast acting and you may not initially realise you require naloxone. Have someone with you who can administer naloxone if needed because you will not be able to administer it by yourself. 

Call 111 and ask for an ambulance immediately if you or someone else has any of the below signs after taking this substance. Tell them what has been taken and that it could be an opioid, it could save a life. Don’t leave the person alone and treat it as an overdose if unsure.

The signs of an opioid overdose include:

• The person's face is extremely pale and/or feels clammy to the touch.
• Their body goes limp.
• Their fingernails and/or lips have a purple or blue colour.
• They start vomiting or making gurgling noises.
• They cannot be awakened or are unable to speak.
• Their pupils become very small.
• Their breathing and/or heartbeat slows or stops.

If you have heard of any reports of this drug, please let us know through the Report unusual effects page, the alert ID is N24/0041. All submissions are anonymous.