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Fentanyl & Nitazenes: Harm Reduction

Ingestion and Overdose Risk: Because fentanyl and nitazenes are so strong and hard to dose, there is an extremely high risk of a fatal overdose. The only way to safely ingest Fentanyl is under strict medical supervision. The fatal overdoses due to fentanyl in the Netherlands were because people ingested medically prescribed fentanyl by smoking or swallowing.

Medically prescribed fentanyl comes in several forms.

  • Transdermal patches that release fentanyl steadily over 48–72 hours
  • Transmucosal products, which use the oral mucosa for rapid absorption:
  • Intravenous or intramuscular injections, typically in hospital settings for acute pain
  • Nasal sprays for fast relief of breakthrough pain

Because swallowed fentanyl is poorly and unpredictably absorbed, true oral pills aren’t used—transmucosal and transdermal systems ensure reliable, controlled dosing.

overdose

Opioid overdose symptoms:

  • Blue/ greyish lips and nails
  • Cold skin
  • Pinpoint pupils
  • Loss of consciousness
  • Gurgling sound while breathing
  • Very reduced or no breathing

What can you do in case of an opioid overdose?

  • Call 112 immediately and follow the instructions of the emergency responder.
  • Try to keep the person awake by applying a pain stimulus, for example by rubbing your knuckles over the person’s ribs and firmly pinching the person’s shoulder muscle.
  • If the person is still breathing: place the person in a stable side position to prevent choking and stay with the person until medical help arrives.
  • In case the person is not breathing, start CPR.
  • In case you have access to Naloxone/ Narcan, administer it.

Naloxone

Naloxone is the international gold standard in terms of reversing the effects of an opioid overdose. It is an opioid antagonist, meaning it blocks the effects of opioids. It quickly restores the breathing of a person and can save someone’s life. Naloxone is administered intravenously, intramuscularly or as a nasal spray. In case of fentanyl or nitazenes, multiple doses every 2-3 minutes are often needed to reverse the effects of an overdose fully.

naloxone in the netherlands

In the Netherlands, the use of naloxone is strictly regulated. It can only be carried and administered by a medical person with a clinical license (ambulance, hospital, general practitioner). This means it is not legal to cary or buy naloxone. Unfortunately it’s not available in drug consumption rooms either. Therefore, in case of an overdose, one must act rapidly.

Calling an ambulance is the only way to access Naloxone, reverse an respiratory depression and save a life.

drug testing

Chocolate chip cookie effect

The so-called “chocolate chip cookie effect” occurs when ultra-potent opioids like fentanyl or nitazenes bind together and distribute unevenly through a batch of street heroin, much like chocolate chips in cookie dough. As a result, one small portion of heroin can contain a lethal “hot spot” even though the rest of the batch seems unaltered—dramatically raising the risk of an unexpected overdose.

Because fentanyl and nitazenes are hundreds of times stronger than heroin, microscopic concentration spikes matter: a single “chip” can be fatal. Even fentanyl test strips can miss these hot spots if you only test one small sample—leading to false negatives and a dangerous false sense of security.

To reduce risk, harm-reduction guidelines recommend vigorously mixing any powdered drug, testing multiple small samples from different parts of the batch, and titrating slowly (starting with very small doses), though no strategy can completely eliminate the risk of ingesting fentanyl or nitazenes when a batch of heroin is spiked.

As painkillers like oxycodone are also illegally counterfeited and can be laced with fentanyl or nitazenes, it is highly recommend to test them. Only by testing your pills, you can get clarity if they contain fentanyl or nitazenes. If this is the case, we advise you not to take them as the risk of overdose is too high.