Arnaud Pontin (Image : Adobe Stock)
An alert issued by the French National Order of Pharmacists and the Order of Pharmacists of Quebec warns about the circulation of counterfeit pills that imitate analgesics or benzodiazepines on the illicit counterfeit drug market.
The danger is particularly serious: behind the familiar appearance of a prescription medication may be nitazenes, extremely potent synthetic opioids. Some can be up to 500 times more potent than morphine and even more potent than fentanyl.
In other words, a pill that appears to be a known medication may actually contain a completely different substance, at a potency that the person taking it cannot determine.
The appearance of the pill therefore provides absolutely no guarantee of its contents. On the illicit market, the consequences of a mistake can be dramatic, and a single dose can expose someone to severe or even fatal opioid poisoning.
Nitazenes: these opioids are raising concern among authorities
Nitazenes are a family of extremely potent synthetic opioids, originally developed in the 1950s as part of research into pain medications, but they were not marketed as commonly used treatments.
Today, some compounds in this family are being found in the illicit drug market and in counterfeit pills imitating prescription medications. Their potency varies depending on the compound, but some nitazenes can be much more potent than morphine and exceed the potency of fentanyl.
The main danger is unpredictability: the user may be unaware that nitazenes are present and may not know how much has been taken. Like other powerful opioids, they can cause respiratory depression, loss of consciousness and fatal overdose.
Nitazene overdose: signs that can save a life
When a counterfeit pill contains a nitazene, an overdose can occur quickly and become fatal. The danger is even greater because the person taking the pill may be completely unaware of the presence of this opioid or its concentration.
The first sign to watch for is breathing. A person experiencing an overdose may breathe very slowly, irregularly, or stop breathing altogether. They may also become extremely drowsy, lose consciousness or be impossible to wake. Their lips or fingernails may turn blue, gray or purple. Very small pupils, cold and clammy skin, as well as gurgling, unusual snoring or choking sounds may also be observed.
Do not wait for all of these symptoms to appear. If an opioid overdose is possible, call 911 immediately, administer naloxone if available and stay with the person. Naloxone can temporarily reverse the effects of opioids, but its effect may wear off before the substance itself has stopped acting.
A person who simply appears to be sleeping deeply after taking an unknown pill may actually be experiencing a potentially fatal overdose.
Nitazenes: naloxone may require multiple doses
Naloxone can save a life during an opioid overdose, but its effect is temporary. It temporarily blocks the effects of opioids on the brain and can restore breathing. In the case of nitazenes, particularly potent opioids, an overdose may nevertheless be more difficult to reverse and multiple doses of naloxone may be required.
Naloxone generally acts quickly, but its effect may wear off before the opioid has completely stopped acting. The person may then begin breathing very slowly again or stop breathing. A first dose should therefore not be considered sufficient if the person does not recover.
If an overdose is suspected, call 911 immediately and administer naloxone if available. If breathing does not return to normal or the person remains unconscious, an additional dose may be administered after 2 to 3 minutes, in accordance with Health Canada guidelines and the instructions for the kit being used.
Do not hesitate to administer multiple doses when the situation requires it. An overdose is a medical emergency. The person must be monitored continuously until emergency responders arrive, even if they regain consciousness after receiving naloxone.
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