{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T08:40:56Z","timestamp":1792226456398,"version":"4.4.0"},"reference-count":26,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T00:00:00Z","timestamp":1791417600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T00:00:00Z","timestamp":1791417600000},"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":[[2026,11]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Nitazenes are synthetic opioids with potent \u03bc\u2010receptor activity. There are increasing reports of nitazene overdoses worldwide. We report on a case series of protonitazene and metonitazene dependence responding to high dose medication for the treatment of opioid dependence in both inpatient and outpatient settings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case Presentation<\/jats:title>\n                    <jats:p>Six young adult males, five with multicultural backgrounds, presented to a public hospital in metropolitan Sydney, Australia in severe opioid withdrawal after ongoing nitazene use. Five were regularly vaping what they believed to be cannabinoids or nicotine, later toxicologically confirmed as protonitazene. One case had intentional recreational use of confirmed metonitazene. All six were commenced on opioid dependence treatment, four in the inpatient setting and two as outpatients. Four remain engaged with treatment while two were lost to follow\u2010up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion and Conclusions<\/jats:title>\n                    <jats:p>This case series describes the diagnosis and management of nitazene dependence in metropolitan Sydney, Australia. Similar to fentanyl dependence in international literature, high doses of buprenorphine were required. Complexities included unintentional nitazene exposure through vaping, initial diagnostic confusion, delay in toxicological testing and treatment retention with local alcohol and other drug services. The management of nitazene dependence was initially complex due to diagnostic, medication and patient factors. All cases were successfully managed with either methadone or buprenorphine in the New South Wales opioid dependence treatment program. This case series describes potential management strategies for future cases of nitazene withdrawal and dependence. Public and clinician awareness is important to ensure early diagnosis and successful management.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/dar.70277","type":"journal-article","created":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T05:05:36Z","timestamp":1791522336000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Diagnosis and Management of Nitazene Dependence in Sydney, Australia: A Case Series"],"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"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7193-9566","authenticated-orcid":false,"given":"Hester","family":"Wilson","sequence":"additional","affiliation":[{"name":"School of Population Health, Faculty of Medicine UNSW Sydney  Sydney Australia"},{"name":"Centre for Alcohol and Other Drugs NSW Ministry of Health  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\/0000-0002-9546-1939","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 University of Sydney  Sydney Australia"},{"name":"Edith Collins Centre, Drug Health Services Royal Prince Alfred Hospital  Sydney Australia"},{"name":"NSW Poisons Information Centre Sydney Children's Hospitals Network  Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-8203-4983","authenticated-orcid":false,"given":"Christine","family":"Harvey","sequence":"additional","affiliation":[{"name":"Centre for Alcohol and Other Drugs NSW Ministry of Health  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"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8396-3686","authenticated-orcid":false,"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":[[2026,10,8]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.neuropharm.2025.110470"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF02161117"},{"key":"e_1_2_11_4_1","volume-title":"National Opioid Pharmacotherapy Statistics Annual Data Collection [Internet]","author":"Australian Institute of Health and Welfare","year":"2025"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/dar.14079"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.52922\/ti04060"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.5694\/mja2.52605"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/dar.13998"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2025.06.619"},{"key":"e_1_2_11_10_1","volume-title":"2025\u2014Public Drug Warnings","author":"NSW Health","year":"2025"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/dar.70104"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.BRS.0000083174.84050.E5"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.books.9780890425787"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.3109\/00952998709001515"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-3565(25)12294-5"},{"key":"e_1_2_11_16_1","volume-title":"Prescription, Recreational and Illicit Substance Evaluation (PRISE) Program [Internet]","author":"NSW Ministry of Health"},{"key":"e_1_2_11_17_1","volume-title":"NSW Opioid Treatment Program (OTP)\u2014Medical Practitioners","author":"NSW Ministry of Health","year":"2024"},{"key":"e_1_2_11_18_1","volume-title":"Long\u2010Acting Injectable Buprenorphine (LAIB) for Opioid Dependence Treatment [Internet]","author":"NSW Health","year":"2024"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2024.1401676"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/dar.13228"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40429\u2010025\u201000655\u20106"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1097\/ADM.0000000000001362"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1097\/ADM.0000000000001324"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph18115574"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.1111\/1758\u20105899.70000"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1111\/add.70027"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2009.07.001"}],"container-title":["Drug and Alcohol Review"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/dar.70277","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/dar.70277","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/dar.70277","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T08:00:24Z","timestamp":1792224024000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/dar.70277"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,8]]},"references-count":26,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2026,11]]}},"alternative-id":["10.1111\/dar.70277"],"URL":"https:\/\/doi.org\/10.1111\/dar.70277","archive":["Portico"],"relation":{},"ISSN":["0959-5236","1465-3362"],"issn-type":[{"value":"0959-5236","type":"print"},{"value":"1465-3362","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,8]]},"assertion":[{"value":"2026-03-01","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-28","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-08","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70277"}}