NASHVILLE, Tenn. (WZTV) — A Vanderbilt doctor is raising the alarm about a powerful class of synthetic opioids known as nitazenes, drugs that were shelved decades ago but are now reappearing in the street drug supply.

Dr. Shravani Durbhakula, an anesthesiologist and associate professor at Vanderbilt University Medical Center, co-authored a recent study with the University of Pittsburgh on nitazenes. She says the drugs are “honestly, really scary,” describing them as anywhere from “tens, to hundreds, to even thousands of times more powerful than morphine, and up to 20 times more powerful than fentanyl.”

Nitazenes were first developed in the 1950s by a pharmaceutical company exploring new pain treatments. But they were never approved for medical use because they proved too toxic.

“Just a very little bit of these compounds can make someone stop breathing,” Durbhakula said.

Researchers warn that drug dealers are reviving nitazenes because they are cheap and relatively easy to make. Recipes for the compounds were published in old academic journals, and many of the precursor ingredients can be sourced overseas. Dealers can stretch supply by mixing small amounts of nitazenes into other drugs, from counterfeit oxycodone pills to heroin and cocaine.

What makes the drugs even more dangerous is that most standard toxicology screens do not detect them.

“Our emergency room doctors don't know what these folks have taken when they come in with poisoning from this drug,” Durbhakula explained.

Specialized tests called liquid chromatography are needed, but they are not widely available in ER settings.

So far, about 90 deaths in Tennessee have been linked to nitazenes, many of them white men around age 40, but researchers believe the true number is far higher because not every county submits overdose samples for secondary testing. Knox County has reported a disproportionate number of cases, largely because its medical examiner’s office sends samples to the DEA for confirmation.

Durbhakula calls nitazenes a “silent threat.”

“Most people don’t know that they’re taking this,” she said. “But imagine fentanyl is already so deadly, and now you mix it with something that’s up to 20 times more potent. Your body isn’t prepared for that.”

She says naloxone, often used to reverse overdoses, may require multiple doses to counteract nitazenes. Families and individuals at risk should be aware of the danger, and communities should discuss harm reduction tools like test strips.

“Nitazene test strips are available, and they can help someone check a pill or powder before using it,” Durbhakula explained. “They’re not perfect, they don’t detect every single analog, but they can save lives.”

Recovery experts: 'No chance to hit bottom'

In Middle Tennessee, recovery leaders say they are already seeing the impact. Adam Landry, program director at Discovery Place in Burns, Tennessee said nitazenes are showing up in their treatment community.

"They can kill you the first time you use them," Landry said, "you're dealing with a drug that doesn't even give you the chance to hit bottom."

Landry said families are terrified, and they need to act quickly if they suspect a loved one is using. "Get help as fast as possible. If you're worried, reach out, call people in the community, seek help," he said.

For Landry, who was once a guest of Discovery Place himself, the issue is deeply personal.

"I see families on a regular basis that are terrified, not just of this drug, but of alcohol, cocaine, anything, even cocaine can be laced with nitazenes," he said. "But there is hope. I've seen hundreds of families restored through recovery."

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