Except when purchasing medicines from a pharmacy or an approved online pharmacy, the short answer is that you cannot know. Unfortunately, an increasing number of reports from seizures and overdoses show that it is not uncommon for people to receive something other than what they ordered. Either the substance is not the same as the one ordered, or it may contain other substances. The strength of the substance you receive may also be much higher than expected.

You should therefore be extremely cautious about trusting a seller or supplier, and you should take precautions such as dividing the dose if you nevertheless choose to use the substance you have purchased.

In recent years, new groups of synthetic opioids have appeared in Europe. One possible reason is that the Taliban have cracked down on opium cultivation in Afghanistan, which has reduced the availability of heroin. This increases the risk that synthetic opioids will take over the market.

The use of synthetic opioids carries a greater risk of serious overdose than established opioids, as many of them are significantly stronger (more potent) than heroin and are therefore more difficult to dose safely.

Nitazenes are a group of opioids that were developed in the 1950s with the intention of using them as pain-relieving medications. However, clinical testing showed that they had no advantages over morphine as pain medications, and they were therefore abandoned. The first reports of nitazenes being used in recreational drug contexts appeared as late as 2019, and currently more than 20 different nitazene compounds have been described.

Nitazenes act in the same way as other opioid drugs and medications and produce the same effects, such as pain relief, reduced consciousness, respiratory depression, potential for dependence, and constricted pupils. Nitazenes vary in strength, but some may be more than 100 times stronger than morphine.

Fentanyl is a powerful opioid that was developed in the 1960s. It was used in operating rooms and later also as patches for cancer pain. Fentanyl is considered to be 50–100 times stronger than morphine.

Fentanyl was first seized as an illegal drug in Norway in 2016, and according to Kripos it has resulted in several dozen fatal overdoses, including among teenagers as young as 15.

It is easier to miscalculate a dose and ingest more than intended when highly potent opioids are present in a substance. Sometimes people may ingest these substances without knowing that the drug they are taking has been mixed with strong opioids.

With large doses of fentanyl, and probably some very potent nitazenes, the effects and overdose symptoms can appear very quickly. In such cases, it is extremely important that treatment begins immediately.

Source: Lecture by Arne Skulberg / Bergen, September 2024

Source: rusfeltet.no/kunnskapsdatabase

Even if you do not use opioids—neither regularly nor recreationally—there is a real risk that any illegal drug you buy, for example cocaine, may contain a synthetic opioid.

Unfortunately, statistics from both Norway and Europe show that this is an increasing trend. You therefore cannot be completely certain that the substance you take does not contain a synthetic opioid.

If this happens, the effects of the newer synthetic opioids may occur much faster than is typical for other opioids. In practice, this means that the brain can quickly become so affected that it becomes difficult to stay awake, and the respiratory center may stop functioning. In the worst case, this can lead to death.

In Norway, there has been a large increase in deaths among young people who do not have a known history of drug use. These are young people who only use drugs occasionally, usually at parties, and who most often bought the drugs online. There is also reason to believe that many of the victims in recent years did not know that they had ingested opioids.

There is always a risk when consuming substances purchased online or through other unknown channels. If you have a substance and do not know what it contains, you should not use it.

However, if you still choose to take the substance, it is possible to reduce the risk of overdose.

First, you should test what the substance actually contains. This can be done using test strips or specialized analytical devices. This service has until now been limited in availability, but is now being developed under the direction of the Norwegian Directorate of Health and is available in some cities. You can read more about it on this page: overdosefare.no

It is important to know that you only get answers about the substances you test for. Often, new substances will not appear in the analysis, whether using a test strip or a more advanced analysis. It must therefore be emphasized that testing can give a false sense of security.

The most important thing you can do is therefore never use substances alone. Be with someone you trust who knows what you plan to do and who can react if you collapse. It is recommended to take a smaller amount first to test the strength. This will also reduce the risk of overdose.

It is also important to know what to do if you suspect that someone has overdosed, especially those you are with when taking the substance.

Naloxone nasal spray is free and easy to administer. The nasal spray is part of first aid in overdose situations. You can obtain naloxone nasal spray by contacting one of many centers across Norway (link below), or you can have it prescribed by your doctor and pick it up yourself at a pharmacy.

The best thing you can do if you have a substance and do not know what it contains is not to use it.

The second best option is to have the substance analyzed in order to try to rule out that it contains a substance that could cause a fatal overdose. However, there are no guarantees, and no commonly available analysis methods can detect all substances that exist.

At present, private individuals cannot have substances tested at public laboratories, but it is likely that this will change in the near future. However, some non-profit organizations and user organizations currently offer testing and/or test strips in Norway.

You can find updated information about this on this page: overdosefare.no

Naloxone is a medication that was developed in the 1960s and began to be used in hospitals during the 1970s and 1980s. Naloxone counteracts the effects of opioids and only works if opioids are present in the body.

Naloxone works by binding to the same receptors in the brain as opioids and displacing the opioids from those receptors. When the opioids are displaced from the receptors, they lose their effect. In other words, naloxone reverses the effects of opioids.

The most important effect of this reversal during an overdose is that the patient begins breathing again.

Naloxone was originally administered as an injection. In recent years, naloxone has also become available as a nasal spray. It is safe and easy to use, and it is recommended to have naloxone available when using opioids.

The nasal spray can be used as first aid by people who witness an overdose. This allows treatment to begin before the ambulance arrives.

However, it is extremely important that life-saving first aid is also provided, such as attempting to wake the person and, if necessary, providing breathing support. You must always call 113 immediately to summon an ambulance.

Naloxone has a shorter duration of action than many opioids, and its effect will begin to wear off after about 30 minutes. This is another very important reason to call 113 immediately.

Naloxone itself has few side effects, but it will remove pain relief and the intoxicating effects of opioids. This means that pain may return and people who are dependent on opioids may experience withdrawal symptoms.

In Norway, there is a national website where you can learn how to respond in such situations, and medications that can be used as antidotes also have their own pages with training materials.

In short, the most important things are:

• Always call 113 immediately for help. If synthetic opioids are involved, you may have very little time to react.
• Ensure the airway is clear.
• Administer naloxone.
• If there is no pulse or breathing – begin CPR and continue until medical personnel arrive.
• If your friend improves, monitor them closely while waiting for help.
• If your friend worsens again, give more naloxone and start CPR again if necessary.

Training resources: Forside – Nalokson

If you do not want to speak with your general practitioner, you can find more information at the link below: Forside – Nalokson

You can also find a list of naloxone distribution sites, and the staff there can help answer any questions you may have.
nalokson.uio.no/hvordan-finne/