One of the scariest things about drugs is that they’re constantly evolving. New drugs reach the market and do damage before laws and public perception can catch up (for an example of this, look at our post on 7-Hydroxymitragynine aka 7-OH). The result is the spreading of addiction, overdose incidents, and even deaths before enough alarm bells are able to be sounded.
In this post, we’re going to take a close look at the top five emerging synthetic drugs in North Carolina. Our goal here isn’t just to spread awareness, but also arm you with knowledge about potential avenues towards recovery should you or a loved one fall prey to some of these new synthetic drugs.
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Top 5 Emerging Synthetic Drugs in NC: The top five emerging synthetic drugs in NC include Acetyl fentanyl, carfentanil, synthetic cannabinoids (k2 or spice), gas station heroin (tianeptine), and Nitazenes.
What is Acetyl Fentanyl? Acetyl fentanyl is a synthetic opioid that is less active than fentanyl and more potent than heroin.
Why Do People Take Acetyl Fentanyl? People take acetyl fentanyl to self medicate for pain relief and sedation.
Side Effects of Acetyl Fentanyl. Side effects of acetyl fentanyl include nausea, dizziness, and fatal hypoventilation.
What is Carfentanil? Carfentanil is a synthetic opioid that is stronger than fentanyl
Why Do People Take Carfentanil? Individuals take carfentanil accidentally or because they developed a tolerance for fentanyl.
Side Effects of Carfentanil. Side effects of carfentanil include delirium, confusion, and breathing issues.
What are Synthetic Cannabinoids (K2/Spice)? Synthetic cannabinoids are man-made substances that may make the THC found in cannabis.
Why Do People Take Synthetic Cannabinoids (K2/Spice)? People take synthetic cannabinoids to feel different effects than cannabis, or because they didn’t realize what they were taking.
Side Effects of Synthetic Cannabinoids (K2/Spice). Side effects of synthetic cannabinoids like K2 and spice include nausea, vomiting, and respiratory failure.
What is Gas Station Heroin (Tianeptine)? Gas station heroin is a nickname for tianeptine, an antidepressant.
Why Do People Take Gas Station Heroin? People take gas station heroin to self medicate for anxiety or major depression disorder.
Side Effects of Gas Station Heroin Side effects of gas station heroin include nausea, vomiting, and sweating.
What are Nitazenes? Nitazines are a class of synthetic opioids that vary in potency but can be several times stronger than fentanyl.
Why Do People Take Nitazenes? Nitazines are a class of synthetic opioids that vary in potency but can be several times stronger than fentanyl.
Side Effects of Nitazenes. Nitazines of some of the same side effects as other fentanyl analogues, including nausea, fever, respiratory depression.
FAQS about Top 5 Emerging Synthetic Drugs in NC: A Guide to the New Science of Recovery. Answers to common questions around the five emerging synthetic drugs in North Carolina.
Top 5 Emerging Synthetic Drugs in NC:
Right now, there are five specific synthetic drugs in North Carolina that both law enforcement and medical professionals are trying to sound the alarm about. These include:
- Acetyl fentanyl (sometimes shortened to Acetylfentanyl)
- Carfentanil
- Synthetic cannabinoids (K2 or spice)
- Gas station heroin (tianeptine)
- Nitazenes (synthetic opioid that is becoming common in NC).
Each of these drugs has their own uses and dangers, which we’ll go into below.
What is Acetyl Fentanyl?
Acetyl fentanyl is a synthetic opioid that is similar to fentanyl both structurally and pharmacologically. According to the US Department of Justice, law enforcement and public health reports have been sounding the alarm on this particular synthetic drug since 2013.
Acetyl fentanyl is noted to be less active than fentanyl and more potent than heroin. This is important to note because its usage is often similar to the way individuals will use heroin. In a two-year period, acetyl fentanyl was detected in 18 autopsy cases in North Carolina. These individuals were between 21 and 42 years old.
Acetyl fentanyl was listed as the sole cause of death in 25% of cases.
Why Do People Take Acetyl Fentanyl?
Acetyl fentanyl is an injectable synthetic opioid that, like fentanyl, is sometimes used by individuals self-medicating for pain relief, sedation, and to produce an effect of euphoria. Acetyl fentanyl has never been approved for medical use in the United States.
Side Effects of Acetyl Fentanyl
Because acetyl fentanyl is a fentanyl analog, its side effects are similar to those of fentanyl itself. These include:
- Constipation
- Nausea
- Confusion
- Headaches
- Dizziness
- Fatal hypoventilation (also known as respiratory depression)
NOTE: If you or a loved one are currently using synthetic drugs like acetyl fentanyl or any of the others featured on this list, it’s important to note that recovery is possible. At Southeastern Recovery Center, we’re committed to helping individuals throughout North Carolina receive help for their addiction to synthetic drugs.
What is Carfentanil?
Carfentanil is a synthetic opioid that is noted to be even stronger than fentanyl. In fact, the Drug Enforcement Administration (DEA) estimates that Carfentanil is around 100 times more potent than fentanyl, and 10,000 times more potent than morphine.
A study from the CDC on the illegal manufacturing of fentanyl and carfentanil in the role these two drugs play in overdose deaths included North Carolina and the scope of its data. This data found that during 2023, across several states such as NC approximately 72,000 drug overdose deaths involved legally manufactured fentanyls (IMFs) such as carfentanil.
Why Do People Take Carfentanil?
Some individuals may take carfentanil if they’ve already developed a tolerance for fentanyl. Developing a tolerance for fentanyl is a key sign of fentanyl dependence and addiction. A fentanyl tolerance means that you require higher dosages to feel the effects he once felt, which can naturally lead to individuals either seeking out more fentanyl or seeking out a stronger synthetic drug, which they would find in carfentanil.
Other individuals may take carfentanil without realizing, meaning to take fentanyl or another drug instead. The DEA has noted that within the past year, carfentanil has begun to be pressed into pills that resemble prescription medications. This often leads to unintentional consumption.
Side Effects of Carfentanil
Carfentanil can cause side effects that are similar to other opioids, including:
- Sleepiness
- Delirium
- Confusion
- Breathing issues (sometimes fatal)
Naloxone can help reverse the symptoms of a carfentanil overdose, similarly to how it can be used for fentanyl overdoses.
What are Synthetic Cannabinoids (K2/Spice)?
Synthetic cannabinoids are man-made substances that mimic the nature of THC (the primary compound found in cannabis AKA marijuana). While synthetic cannabinoids are chemically similar to cannabis, they have a reputation for producing different effects. Some are used for relaxation and euphoria, while others might alter your perception and sense of time passage.
Synthetic cannabinoids are known as either “K2” or “Spice.”
Many synthetic cannabinoids are illegally manufactured and sold, and have been associated with severe health problems such as heart attacks, seizures, and kidney failure. North Carolina has banned the sale, manufacture, and possession of synthetic cannabinoids such as K2 and spice since 2011. Still, a study conducted at the University of North Carolina Greensboro found that 1.9% of surveyed collegiate student athletes reported lifetime use of synthetic cannabinoids.
Why Do People Take Synthetic Cannabinoids (K2/Spice)?
In some cases, individuals may accidentally use synthetic cannabinoids like K2 and Spice while trying to use regular cannabis. Not everyone is aware that synthetic cannabinoids have a slightly different chemical composition and therefore slightly different effects in regular cannabis.
Other individuals may seek out K2 and spice because they want these alternative effects, like having an altered sense of time, feeling stimulated and energetic, or experiencing a dreamlike state. Additionally, synthetic cannabinoids are in some cases more affordable than marijuana and other drugs.
Side Effects of Synthetic Cannabinoids (K2/Spice)
Side effects of synthetic cannabinoids like K2 and spice include:
- Nausea
- Heart attacks
- Vomiting
- Agitation
- Respiratory failure
What is Gas Station Heroin (Tianeptine)?
Gas station heroin is a nickname given to tianeptine, which is an atypical tricyclic antidepressant. This drug is meant to be used to treat mental health disorders such as anxiety or major depressive disorder. However, the FDA has recently sounded the alarm on tianeptine products being linked to serious harm, overdoses, and even death.
Like the nickname gas station heroin suggests, tianeptine is easily available at gas stations and even online. While tianeptine is not approved by the U.S. Food and Drug Administration for medical use, individuals are still able to get their hands on it depending on the state they live in.
North Carolina recently added tianeptine to its Schedule II controlled substance list, placing gas station heroin among the ranks of illegal drugs such as cocaine, fentanyl, and opium.
Why Do People Take Gas Station Heroin?
Gas station heroin or tianeptine is taken by individuals looking to self-treat mental health disorders such as anxiety or major depression disorder.
Other individuals take gas station heroin in search of a sense of euphoria, due to the surge of serotonin in the brain that the drug can produce. This makes gas station heroin not unlike heroin or morphine, which also explains the nickname it’s been given.
Side Effects of Gas Station Heroin
Gas station heroin can produce addiction and withdrawal symptoms in individuals that are not unlike opioid withdrawals. Side effects of gas station heroin include:
- Drowsiness
- Hypertension
- Nausea
- Sweating
- Vomiting
- Respiratory depression
While it’s somewhat understandable why individuals might try to treat mental health disorders like anxiety or depression at home, synthetic drugs I gas station heroin represent the danger of doing so. Instead, it’s much more effective to seek medical professionals to deal with mental health disorders. At Southeastern Recovery Center, we help individuals receive personalized treatment for mental health struggles such as anxiety, depression, and PTSD.
What are Nitazenes?
Nitazines are a class of synthetic opioids also known as benzimidazole-opioids. There are several types of nitazines, such as butonitazenes and etodesnitazenes and N-pyrrolidino protonitazenes. The most common nitazine is ISO. However, it’s worth noting that all nitazines other than butonitazenes and etodesnitazenes are noted to be stronger in potency than fentanyl, at a rate of anywhere from five times to around 40 times stronger.
A 2024 report from the DEA noted that nitazines are an emerging synthetic opioid group that are adding to the opioid threat across the United States. They credit some of its spread to the presence of the cartel and states including North Carolina.
Why Do People Take Nitazenes?
People take nitazines because they’re seeking out some of the effects common to opioids like it, including a sense of euphoria and relaxation. In some cases, individuals take nitazines entirely by accident, sometimes due to the drug being mixed with or disguised as others.
Individuals who have developed a dependence on fentanyl will require higher doses of the drug to feel the effects. This can lead them to naturally want nitazines, which are noted to be more potent than fentanyl in most compositions.
Side Effects of Nitazenes
As a synthetic opioid, nitazines share many of the same side effects as fentanyl and other fentanyl analogues. These include:
- Nausea
- Vomiting
- Fever
- Respiratory depression
FAQS about Top 5 Emerging Synthetic Drugs in NC: A Guide to the New Science of Recovery
What is nitazine?
Nitazine is a synthetic opioid that is more potent than fentanyl and is becoming more common across the United States.
Are nitazenes stronger than fentanyl
Yes, most nitazines are stronger than fentanyl, including the most common type.
What is Gas Station Heroin?
Gas station heroin is the nickname for tianeptine, which was originally a drug to treat major depression disorder but has become abused in a manner similar to opioids.
What are some synthetic cannabinoids?
Some synthetic cannabinoids include K2 and spice, both of which produce different effects than regular cannabis.
Why are synthetic drugs dangerous?
Synthetic drugs are man-made, which means plenty of opportunity for human error to impact the potency, appearance, and presence of these drugs. Individuals who take a synthetic drug may not even be aware of it, which makes them more likely to experience overdose. Additionally, synthetic drugs being relatively unknown makes it harder for agencies such as the FDA and DEA to spread awareness of their dangers to the general populace before lives are lost.
Sources:
U.S. Department of Justice, Drug Enforcement Administration. Acetylfentanyl. 2018, https://www.deadiversion.usdoj.gov/drug_chem_info/acetylfentanyl.pdf. Accessed 20 Jan. 2026.
U.S. Department of Justice, Drug Enforcement Administration. AAFS 2016 – H89. https://www.aafs.org/sites/default/files/media/documents/AAFS-2016-H89.pdf. Accessed 20 Jan. 2026.
U.S. Department of Justice, Drug Enforcement Administration. Attachment to DEA 2016 Fentanyl Analog Information. 2018, https://www.dea.gov/sites/default/files/2018-07/hq092216_attach.pdf. Accessed 20 Jan. 2026.
Lauren J. Tanz et al. Detection of Illegally Manufactured Fentanyls and Carfentanil in Drug Overdose Deaths — United States, 2021–2024. Morbidity and Mortality Weekly Report, vol. 73, no. 48, 5 Dec. 2024, https://www.cdc.gov/mmwr/volumes/73/wr/mm7348a2.htm. Accessed 20 Jan. 2026.
U.S. Drug Enforcement Administration. Carfentanil: A Synthetic Opioid Unlike Any Other. DEA, 14 May 2025, https://www.dea.gov/stories/2025/2025-05-14/carfentanil-synthetic-opioid-unlike-any-other. Accessed 20 Jan. 2026.
Thompson, Richard C., et al. Synthetic Cannabinoid Use and Descriptive Norms among Collegiate Student-Athletes. Journal Name, https://pmc.ncbi.nlm.nih.gov/articles/PMC4945387/. Accessed 20 Jan. 2026.
U.S. Food and Drug Administration. Tianeptine Products Linked to Serious Harm, Overdoses, Death. FDA, https://www.fda.gov/consumers/consumer-updates/tianeptine-products-linked-serious-harm-overdoses-death. Accessed 20 Jan. 2026.
Organization of American States. https://www.oas.org/ext/DesktopModules/MVC/OASDnnModules/Views/Item/Download.aspx?type=1&id=1045&lang=1. Accessed 20 Jan. 2026.
U.S. Department of Justice, Drug Enforcement Administration. Street Report – Jan. 2024 – FINAL. Jan. 2024, https://www.dea.gov/sites/default/files/2024-01/Street%20Report%20-%20Jan%202024%20-%20FINAL.pdf. Accessed 20 Jan. 2026.
