Naloxone Dosing and Hospitalization for Nitazene Overdose: A Scoping Review

Nitazene compounds are high potency, synthetic opioids, recently detected in the United States illicit opioid supply. This is a scoping review to summarize the available body of literature on naloxone and hospitalization reports in response to nitazene compound overdose.

This review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) extension for Scoping Reviews. PubMed, ProQuest, and Google Scholar were accessed. Articles were limited to full-text peer-reviewed publications appearing in scholarly journals between January 2018 and December 2024. Total naloxone dose (in mg, primary outcome) and total length of stay (LOS, in hours, secondary outcome) were recorded.

Of 109 articles screened, 103 were excluded (44 non-human; 35 no nitazene exposure, 9 no naloxone administered, 9 post-mortem data only, 3 non-overdose, 2 non-English, and 1 full text unavailable), leaving 6 articles included. Data were described on 19 distinct patients with nitazene compound overdose (meto-, isoto-, proto-, and eto-nitazene), all of whom had naloxone data, and 10 of whom had LOS data. Median total naloxone doses were the following: metonitazene 6.00mg; etonitazene 3.06mg; isotonitazene 3.00mg; protonitazene 1mg (p=0.4). Mean hospital LOS were the following: metonitazene 360 hours; etonitazene 122.25 hrs; isotonitazene 32.67 hrs; protonitazene 20 hrs.

This scoping review reveals a paucity of data on nitazene compound overdoses and identifies a gap in our current opioid crisis response. Most nitazene cases reviewed involved hospitalization, had high naloxone dosing, and relatively long LOS. Differences in naloxone dose and hospital LOS could underscore the unpredictable and potent nature of these substances.