{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T17:00:11Z","timestamp":1791565211930,"version":"4.3.4"},"reference-count":27,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T00:00:00Z","timestamp":1769126400000},"content-version":"vor","delay-in-days":22,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Drug and Alcohol Review"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Nitazenes, benzimidazole synthetic potent opioid \u03bc\u2010receptor agonists, have been implicated in increased risk for opioid toxicity. Subtypes of nitazenes, including protonitazene, have been recently detected in multiple overdose cases in Australia. We describe a case report of protonitazene dependence, inpatient withdrawal management and induction onto opioid dependence treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case Presentation<\/jats:title>\n                    <jats:p>A 22\u2010year\u2010old man with no significant medical history presented to a metropolitan emergency department in opioid withdrawal after regular vaping of a product sold as cannabinoids. He required higher than expected buprenorphine doses and other standard treatment including diazepam and olanzapine to manage opioid withdrawal. Blood and urine samples taken in the emergency department later tested positive for protonitazene. Analysis of the vaping liquid was only positive for protonitazene. He was discharged for outpatient follow\u2010up to later receive a 300\u2009mg subcutaneous buprenorphine monthly injection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion and Conclusions<\/jats:title>\n                    <jats:p>This case describes the clinical presentation of dependence, withdrawal and buprenorphine induction for opioid dependence due to chronic protonitazene vaping. Future research may help guide optimal doses of buprenorphine to manage nitazene withdrawal. Vaping devices have increased in popularity, especially amongst youth, which poses public health risks to the community if adulterated with other substances. Detection of nitazenes currently requires specialised laboratories. Protonitazene withdrawal management was complex in this case report. Youth are at risk of harms in vaping products adulterated with other substances, including nitazenes. State\u2010wide toxicosurveillance programs, such as the NSW PRISE program, are essential for coordinating detection, clinical management and community awareness of nitazenes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/dar.70104","type":"journal-article","created":{"date-parts":[[2026,1,24]],"date-time":"2026-01-24T05:21:03Z","timestamp":1769232063000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Management of Opioid Withdrawal Syndrome and Commencement of Opioid Dependence Treatment Following Chronic Use of a Vaping Product Containing Protonitazene: Case Report"],"prefix":"10.1111","volume":"45","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-8784-8973","authenticated-orcid":false,"given":"Daniel","family":"Dutkiewicz","sequence":"first","affiliation":[{"name":"Drug Health Services South Western Sydney Local Health District  Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hester","family":"Wilson","sequence":"additional","affiliation":[{"name":"Centre for Alcohol and Other Drugs NSW Ministry of Health  Sydney Australia"},{"name":"School of Population Health, Faculty of Medicine UNSW Sydney  Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9546-1939","authenticated-orcid":false,"given":"Thanjira","family":"Jiranantakan","sequence":"additional","affiliation":[{"name":"Centre for Alcohol and Other Drugs NSW Ministry of Health  Sydney Australia"},{"name":"Faculty of Medicine and Health The\u00a0University of Sydney  Sydney Australia"},{"name":"Edith Collins Centre, Drug Health Services Royal Prince Alfred Hospital  Sydney Australia"},{"name":"NSW\u00a0Poisons Information Centre Sydney Children's Hospitals Network  Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5270-2798","authenticated-orcid":false,"given":"Peter","family":"Chisholm","sequence":"additional","affiliation":[{"name":"School of Population Health, Faculty of Medicine UNSW Sydney  Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2560-6506","authenticated-orcid":false,"given":"Kaniz","family":"Fatema","sequence":"additional","affiliation":[{"name":"Drug Health Services South Western Sydney Local Health District  Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Hardy","sequence":"additional","affiliation":[{"name":"Drug Health Services South Western Sydney Local Health District  Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,1,23]]},"reference":[{"key":"e_1_2_11_2_1","volume-title":"European Drug Report 2023: Trends and Developments","author":"European Monitoring Centre for Drugs and Drug Addiction","year":"2023"},{"key":"e_1_2_11_3_1","volume-title":"Nitazenes\u2014A New Group of Synthetic Opioids Emerges","author":"United Nations Office on Drugs and Crime","year":"2024"},{"issue":"6","key":"e_1_2_11_4_1","article-title":"Old Drugs and New Challenges: A Narrative Review of Nitazenes","volume":"15","author":"Pergolizzi J.","year":"2023","journal-title":"Cureus"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1021\/acschemneuro.1c00064"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1124\/jpet.123.002052"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/dta.3415"},{"key":"e_1_2_11_8_1","unstructured":"United Nations Office on Drugs and Crime \u201cIncreasing Availability of Nitazenes Calls for Global Response \u201d(2025) Vienna: UNODC Early Warning Advisory on New Psychoactive Substances https:\/\/www.unodc.org\/LSS\/Announcement\/Details\/b47cf39e\u2010f557\u20104001\u201098a8\u2010536af5673e9e."},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1080\/15563650.2025.2504133"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2025.06.619"},{"key":"e_1_2_11_11_1","unstructured":"National Centre for Clinical Research on Emerging Drugs (NCCRED) \u201cEmerging Drug Briefing: Increasing Reports of Nitazene Toxicity in Australia \u201d(2024) NCCRED https:\/\/nccred.org.au\/uploads\/documents\/Nitazenes\u2010Emerging\u2010Drug\u2010Briefing.pdf."},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1093\/jat\/bkab082"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1093\/jat\/bkac062"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/dar.13998"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1080\/15563650.2024.2383692"},{"key":"e_1_2_11_16_1","unstructured":"New South Wales Ministry of Health \u201cPrescription Recreational and Illicit Substance Evaluation (PRISE) Program \u201dSydney: NSW Ministry of Health 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