What are Nitazenes?

Nitazenes are a class of high-potency synthetic opioids originally developed in the 1950s but never approved for medical use. They are structurally unrelated to fentanyl yet can be far stronger—some analogs estimated to be 20–40x more potent than fentanyl. Nitazenes such as isotonitazene, protonitazene, metonitazene, and etonitazene have re-emerged in illicit drug markets in recent years, often found in counterfeit pills, powders, or mixed with heroin or fentanyl without the user’s knowledge. They typically appear as off-white, beige, or brown powders but can be pressed into tablets or blended into other substances.

Because they were never developed for clinical use, nitazenes have no legal medical applications and are considered illicit in all forms. Their extreme potency greatly increases the risk of overdose, respiratory depression, and death—even in very small quantities. Many users unknowingly consume nitazenes when contaminants are present in counterfeit opioid pills or “heroin” mixtures. Due to their rising prevalence and high mortality risk, nitazenes have become a growing concern for public health agencies, law enforcement, and toxicology programs.

For point-of-care testing environments, nitazenes present a challenge because standard opioid or fentanyl panels may not detect them, prompting the development of specialized assays. Their legal classification and rising presence in overdose cases have made nitazene screening increasingly relevant for workplaces handling safety-sensitive roles, medical environments, corrections, and treatment programs.

Effects:

• Extreme respiratory depression

• Sedation and impaired consciousness

• Pinpoint pupils

• Euphoria (in some cases, but much less predictable than other opioids)

• Profound drowsiness or “nodding off”

• Reduced blood pressure and slowed heart rate

• High risk of overdose even at very small doses

• Loss of coordination and slowed motor skills

• Severe physical dependence potential

• Withdrawal symptoms similar to—but often more intense than—other opioids

What is Tramadol?

Tramadol is a synthetic opioid analgesic used medically to treat moderate to moderately severe pain. It acts on the central nervous system by binding to opioid receptors while also inhibiting the reuptake of serotonin and norepinephrine—giving it both opioid and atypical antidepressant-like properties. Because of its dual mechanism, tramadol carries risks of dependence, withdrawal, seizures, and serotonin syndrome.

Prescription tramadol is supplied as tablets, capsules, or extended-release formulations. Colors, shapes, and markings vary by manufacturer, but most tablets appear white or off-white. Illicit or misused tramadol may appear as loose tablets, counterfeit pills, or crushed powder.

Medical use:

• Prescribed for pain management

• Often used after surgery, injury, or for chronic conditions

• Available in immediate-release and extended-release forms

Recreational misuse:

Some individuals misuse tramadol for its sedative, mood-altering, and opioid-like effects. High doses increase the risk of overdose, seizures, respiratory depression, and dangerous interactions with other CNS depressants or SSRIs/SNRIs.

Effects:

• Pain relief and reduced discomfort

• Mild euphoria or mood elevation

• Drowsiness or sedation

• Dizziness or impaired coordination

• Constipation or gastrointestinal slowing

• Nausea or vomiting

• Headache

• Risk of seizures at high doses

• Respiratory depression (especially with other depressants)

• Dependence, tolerance, and withdrawal over time

What is ETG?

EtG, or Ethyl Glucuronide, is a direct metabolite of ethanol (alcohol) that the body produces after alcohol consumption. Unlike measuring alcohol itself—which leaves the body relatively quickly—EtG remains detectable for a longer period, making it a reliable biomarker for recent alcohol use. In point-of-care rapid toxicology screening, EtG tests provide fast results at the collection site, allowing programs to identify alcohol exposure even after the effects of intoxication have subsided.

EtG testing is commonly used in workplace programs, treatment settings, court-ordered monitoring, and recovery programs where abstinence or recent use must be verified. Because EtG indicates alcohol consumption, not impairment, it helps organizations monitor compliance, assess risk, and make timely decisions. Rapid EtG screens are valued for their simplicity, quick turnaround time, and ability to detect drinking within approximately the past 24–72 hours, depending on the individual and amount consumed.

Effects:

• Impaired Judgment 
• Slower Reaction Time
• Reduced Coordination 
• Slurred Speech and Decreased Cognitive Clarity
• Mood Changes: Lowered Inhibitions or Aggression
• Nausea, Vomiting, and Dehydration
• Liver Damage: Fatty Liver, Hepatitis, and Cirrhosis
• Increased Risk of Heart Disease and High Blood Pressure
• Cognitive Decline and Memory Problems
• Elevated Risk of Addiction and Alcohol Use Disorder