Searching for a Needle in a Haystack: Chemical Analysis Reveals Nitazenes Found in Drug Paraphernalia Residues

Introduction A group of synthetic opioids, the nitazenes, is appearing in the illicit drug market. Monitoring these novel psychoactive substances is challenging due to constantly evolving analogues and the small amounts of these potent drugs that are consumed. This study aimed to investigate the presence of nitazenes in drug paraphernalia in South Australia using sensitive and selective analytical methods. Methods Injecting drug paraphernalia samples were collected from needle and syringe programme sites in South Australia that offer disposal services. Chemical analysis using liquid chromatography tandem mass spectrometry was used to identify nitazenes in these samples. Results Nitazenes were detected in 16 samples from a total of 300 (5%). Two of these samples contained more than one nitazene in combination with the non‐opioid sedative xylazine. The main drug detected in the nitazene‐positive samples was heroin. Seven different nitazenes were detected across all samples. Discussion and Conclusions Due to their relatively high potency and harm potential, the detection of nitazenes in drug paraphernalia is a public health concern. All nitazene‐positive samples contained other drugs, indicating potential poly‐drug use, needle and syringe re‐use, or contamination of the drug of choice with nitazenes. This study shows that chemical analysis of drug paraphernalia is feasible, non‐invasive, and effective, providing early signal identification to monitor the appearance of dangerous novel psychoactive substances being consumed.