International Overdose Awareness Day 2026

August 31st marks International Overdose Awareness Day, so to mark the occasion, the Australian Injecting & Illicit Drug Users League (AIVL) hosted a webinar covering a range of critical topics: identifying and responding to GHB overdoses, the rise of nitazenes, novel benzodiazepines, and the role of early warning systems in harm reduction.

I came into the webinar with four questions in mind for the panel of harm reductionists. I wanted to hear their thoughts on these complex issues, but due to time constraints, only one of my questions was answered. Rather than leave the others hanging, I decided to turn them into reflections in this article, alongside my thoughts on the one answer I did receive. My hope is that this article will be useful to anyone reading it, and indirectly, to anyone affected by these issues, in our shared goal of reducing overdose deaths worldwide. And, as usual, at the end of the article you will find some links I have dug up and provided which are relevant to the topics of discussion at hand for both reference as well as for food for thought.

What I Learned from the Webinar

The question I was able to get answered was:
"What is the most effective way to educate the average drug user about early warning systems? Sometimes the information can be too complex for many people to understand. How can these systems be made accessible and familiar to drug users for harm reduction purposes? For example, where I live, The SOAR Initiative sends text alerts about batches of drugs linked to rising overdose rates, but it doesn’t provide enough detail about what is circulating. How could a system strike a balance between accessibility and specificity?"

The panel’s response made it clear that there is no single “best” approach. Effectiveness depends on knowing the audience and tailoring the sophistication of the message accordingly. Misconceptions about the intellectual capacity of people who use drugs often lead to oversimplified systems—as seen with The SOAR Initiative. The ideal approach balances speed with depth of information. Peer leaders in local communities are essential here, helping ensure that information reaches people quickly and in a way they understand.

Accessibility also includes language. Many systems currently lack translations, which limits their reach. I experienced this firsthand while researching Germany’s novel psychoactive substances market; without help from a local contact, I would not have obtained a full picture. Multilingual access is crucial if early warning systems are to serve everyone effectively.

Reflections on My Unanswered Questions

1. The Future of Novel Benzodiazepines

I asked:

"Where do you see the novel benzodiazepine market headed? Bromazolam was recently banned in China and has been the most prevalent novel benzodiazepine in the U.S. What might replace it? Ethylbromazolam is less potent, while clobromazolam (phenazolam) is longer-lasting and significantly more potent. Phenazolam is concerning because even small doses can cause severe respiratory depression. Could this ban lead to an uptick in benzodiazepine-related overdoses?"

I had already explored this in a recent article (Designer Benzodiazepines: The Drugs Outpacing Both Legislators and Medical Professionals Alike), but I wanted perspectives from experts who are tasked with monitoring adulterants in drug samples' opinions as they tend to be able to see the trends in markets much sooner than the rest of us. Drug markets are interconnected; trends in one region often ripple across others. Understanding these shifts is essential for effective harm reduction everywhere.

2. Overdose Treatment for Nitazenes

I asked:

"Considering the similarities between fentanyl and nitazenes, should overdose treatment protocols remain the same? I’ve heard that nalmefene may be advantageous over naloxone due to a higher binding affinity for the mu-opioid receptor. Since nalmefene is new in the U.S., there hasn’t been much discussion yet."

Nalmefene (Opvee) is 5–10 times more potent than naloxone and lasts 8–11 hours, compared to naloxone’s 1–2. This extended duration reduces the risk of re-narcotization and gives rescuers more time to get the victim medical attention. And, its superior potency should theoretically make it more advantageous over naloxone when dealing with attempting to reverse the effects of drugs such as etonitazine for example which is said to be 1000 to 1500 times the potency of morphine.

However, the use of nalmefene is not without challenges. Multiple doses may still be required in cases of extremely high opioid intake since the body still has to clear the opioid before the person is out of harm's way, and nalmefene also precipitates withdrawal in opioid-dependent individuals. Many harm reductionists and medical professionals are particularly concerned that nalmefene’s long duration can lead to agonizingly long lasting precipitated withdrawals that require medical management, which could put additional strain on emergency services if a dependent user is treated with such after they overdose. When forming ones opinion on this subject though, one should keep in mind that, while painful, these withdrawals are preferable to death or severe brain damage which would be the outcome if an overdose is not properly treated in a timely fashion.

Opvee (intranasal nalmefene) is not yet as widely available as naloxone (Narcan). Raising awareness of the potential benefits and improving access to nalmefene before nitazenes become more widespread could save lives and significantly reduce overdose fatalities in ways not possible with naloxone alone. Though, it seems to be quite a challenge getting some harm reductionists and medical professionals on board with the concept due to the long lasting precipitated withdrawals that may be caused by administration of nalmefene in opioid dependent individuals, so this one may need to go back to the drawing board until we can come up with something just as potent (if not more potent) that doesn't last quite as long. So far, the only alternative candidate I have found is diprenorphine, which is 10 to 50 times more potent than naloxone, but it is for veterinary use only. However, it does fit the bill in terms of it being an ultra-potent mu opioid receptor antagonist capable of reversing the effects of even the most potent of the nitazenes that wouldn't also cause lengthy precipitated withdrawals in opioid dependent individuals. Perhaps soon there will come a day when an FDA approved version of diprenorphine (or similar) shows up on the scene, but by then the nitazene problem will have already gotten quite out of hand if today's trends keep up. Either way, for now, our options remain limited to nalmefene and naloxone.

If anyone reading has any thoughts on this one, I greatly encourage readers to reach out to discuss!

3. Potential Market Shift from Nitazenes to Fentanyl

I asked:

"With nitazenes rising outside North America, how likely is it that demand for ultra-potent opioids could shift toward fentanyl? Markets may be primed for this, similar to how methamphetamine has spread into Europe."

Nitazenes are gaining traction worldwide, and users are quickly developing tolerance to ultra-potent opioids. Fentanyl may become appealing wherever nitazenes gain popularity if it is introduced in these markets due to the fact that fentanyl use is less risky and supply lines are already well established by the drug cartel. Alongside powdered forms of fentanyl, counterfeit fentanyl-based pharmaceuticals could rise in affected regions as well, posing major risks for individuals without substantial tolerance who mistakenly believe they are taking less potent opioids. Nitazenes are already replacing heroin in some regions following Afghanistan’s production ban in 2022, and the aforementioned drug trading routes make it plausible that fentanyl and its analogs will follow since fentanyl is a substance that the cartel is more familiarized with manufacturing and distributing than they are the nitazenes which are currently coming from other sources. Since the primary goal of the drug cartel is to stay in business and profit, it is only logical for them to take the markets back over by introducing fentanyl at a competitive price point thus driving out the nitazenes at some point. Once the markets become saturated with fentanyl, the cartel can then begin to slowly raise prices without fear that users will switch back to nitazenes since the trouble involved in acquiring those versus the readily available fentanyl is much greater. If anything, there may be fentanyl on the market laced with nitazenes by local dealers, but the predominant substance will remain fentanyl at that point. Staying alert and proactive in harm reduction efforts is essential in limiting the potential risks associated with these market adaptations.

Final Thoughts

These are my reflections on the questions I hoped to have answered by the AIVL panel. While only one was directly addressed, thinking through all four has helped clarify current and potentially future trends and related harm reduction strategies. I will continue to follow up with the panel and share any responses received, along with my thoughts.

In honor of International Overdose Awareness Day, I hope this article helps inform, support, and empower harm reduction efforts. Stay informed, stay cautious, and take care of each other.

Full Recording of AIVL's International Drug Overdose Awareness Day Webinar
Drug Early Warning Systems
Designer Benzodiazepines: The Drugs Outpacing Both Legislators and Medical Professionals Alike
Mexican drug cartels operating in the European Union (touches on fentanyl potentially entering the EU market with ease)
American College of Medical Toxicology and the American Academy of Clinical Toxicology Position Statement: Nalmefene Should Not Replace Naloxone as the Primary Opioid Antidote at This Time
Diprenorphine - Wikipedia Entry
Nalmefene - Wikipedia Entry
Opvee's Official Website