Top 5 Takeaways

  1. Nitazene Potency and Prevalence: Nitazenes, potent illicit synthetic opioids, have been increasingly found in toxicology reports and death certificates, with some analogs more potent than fentanyl.
  2. Surveillance Data Analysis: Analysis of Tennessee State Unintentional Drug Overdose Reporting System (TN SUDORS) data from 2019–2021 revealed 52 nitazene-related deaths, with a significant increase in 2021.
  3. Demographic Trends: In 2020 and 2021, most nitazene-related deaths were among white males, with the average age around 40 years. The majority of cases in 2021 involved metonitazene.
  4. Substance Use and Routes of Administration: All nitazene-involved overdoses included multiple substances, predominantly fentanyl, methamphetamine, and amphetamine. Injection was the most common route of administration.
  5. Naloxone Use and Need for Awareness: Naloxone, effective in reversing overdoses, was underutilized. Increased awareness, testing, and harm reduction strategies are crucial.

Original Article Author and Citation

Corresponding Author

Jessica Korona-Bailey,; 724-299-5502

Suggested Citation

Roberts A, Korona-Bailey J, Mukhopadhyay S. Notes from the Field: Nitazene-Related Deaths — Tennessee, 2019–2021. MMWR Morb Mortal Wkly Rep 2022;71:1196–1197. DOI:


The MMWR article highlights the emerging issue of nitazene-related deaths in Tennessee. Nitazenes, powerful synthetic opioids, have been increasingly recorded in death certificates and toxicology reports. The Tennessee Department of Health conducted a detailed analysis of these deaths through the TN SUDORS, revealing a notable increase in nitazene-related fatalities, particularly in 2021.


The study involved a text search for “nitazene” in death certificates and toxicology reports from January 1, 2019, to December 31, 2021. The data, collected from the TN SUDORS, included sociodemographic information and circumstances of the overdose deaths.


The analysis showed a rise in nitazene-related deaths, with a shift in the predominant analogs involved over the years. It highlighted the challenge in detecting these substances, as standard toxicology panels often miss them. The study also underscored the role of multiple substance use in these fatalities and the importance of widespread naloxone availability and use.


The increasing prevalence of nitazene-related deaths underscores the need for heightened awareness, improved testing, and enhanced surveillance. There’s a vital need for more comprehensive strategies to address and mitigate the risks associated with these potent substances.

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