Super-Potent Synthetic Opioids Called Nitazenes Are Spreading Across the U.S., with Ohio Bearing the Brunt
Key Insights
Nitazenes (search), synthetic opioids up to 40 times more potent than fentanyl, have caused more than 1,100 confirmed U.S. overdose deaths since 2019, with experts estimating the true toll could approach 2,000.
CDC data show confirmed nitazene-involved deaths rose from 27 in 2020 to 409 in 2024, while DEA seizure reports surged from 43 in 2019 to nearly 2,000 in 2024.
Ohio accounts for more than one-third of all positive nitazene laboratory reports nationally and the highest number of nitazene-related overdose deaths since 2021.
A class of super-potent synthetic opioids known as nitazenes (search) is spreading rapidly across the United States, with confirmed overdose deaths rising sharply and the state of Ohio emerging as the epicenter of the crisis, according to a months-long open-source investigation by Bellingcat.
Developed in the 1950s as potential painkillers, nitazenes (search) never reached the market because they were deemed unsafe for medical use. Yet today these drugs — which can be up to 40 times more potent than fentanyl and 500 times stronger than heroin — are proliferating online and being laced into other substances, putting unsuspecting users at risk of fatal overdoses.
Rising death toll and underreporting
Centers for Disease Control and Prevention (search) data show that confirmed nitazene-involved overdose deaths have risen from 27 in 2020 to 409 in 2024. More than 1,100 fatalities have been confirmed through the CDC's State Unintentional Drug Overdose Reporting System (SUDORS), but experts believe the number of Americans who have died from nitazenes (search) since 2019 could be as high as 2,000.
Alex Krotulski, director of the Center for Forensic Science Research & Education in Pennsylvania, told Bellingcat that deaths are underreported because nitazenes (search) were not routinely tested for. "There are only limited forensic toxicology labs that test for nitazenes, so if a nitazene was present and the lab didn't test for it, the number wouldn't appear in SUDORS," he said. "Also, for labs that do test for nitazenes, they have missed cases prior to their testing."
The most recent years for which CDC data are available, 2023 and 2024, were the deadliest, with 747 confirmed deaths.
Ohio at the center of the crisis
Data from the DEA's National Forensic Laboratory Information System (NFLIS) show that more than one-third of all positive nitazene laboratory reports nationally are linked to Ohio. By March 2025, more than 8,000 nitazene reports had been recorded since 2019, though experts caution that not all laboratories can test for nitazenes (search) and many do not feed into the NFLIS system, meaning these numbers are almost certainly an underestimate.
Separate CDC data show Ohio has recorded the highest number of nitazene-related overdose deaths since 2021. In 2020, there were just four fatalities linked to the drug; in 2021 that number rose to 90. Between 2022 and 2024, there were 200 more deaths.
"Ohio's geography has long been a suspected contributing factor," said Erin Reed, director of RecoveryOhio, citing the state's unique geographic and infrastructural features — including vast land, air, and sea transportation networks — as key reasons for Ohio being a hub for drug trafficking.
Two years ago, Ohio Gov. Mike DeWine issued executive orders to schedule nine different nitazenes (search) and legalized the use of tools to test for drugs including nitazenes. Local organizations like Harm Reduction Ohio are pushing for more drug-checking services, education, and greater accessibility to testing strips and lifesaving medications like naloxone.
Polydrug use and the dealer's choice
Bellingcat obtained medical examiner reports from Ohio's Cuyahoga County for all nitazene-related deaths in 2023 and 2024. The autopsy records show that 45 people — 31 men and 14 women ages 29 to 72 — died after taking nitazenes (search) over the two-year period. In every instance, nitazenes were detected alongside fentanyl, and often with a cocktail of other drugs such as heroin, cocaine, methamphetamine, and benzodiazepines.
"It becomes a brand," said Frank Tarentino, associate chief of operations for the DEA's northeast region. "The unfortunate circumstance that we find ourselves in is that the dealer's choice becomes a deadly decision."
Court records analyzed by Bellingcat show nitazenes (search) have been sold at prices ranging from roughly $4,000 to $12,000 per kilogram, though the DEA's internal estimate puts prices as high as $40,000. Given their potency, even small quantities can be diluted into hundreds of thousands — or potentially millions — of doses once mixed and pressed into pills.
Supply chains and enforcement challenges
A Freedom of Information Act request to U.S. Customs and Border Protection revealed that in 2024 and 2025, 41 consignments of nitazenes (search) were intercepted, primarily arriving by mail from mainland China, Hong Kong, and the United Kingdom. An analysis of federal court records indicates that roughly 90 kilograms of material containing nitazenes have been seized over the past three years, with nearly two-thirds stemming from a single case involving more than 100,000 pills containing isotonitazene.
The evidence suggests that most buyers are individual dealers who purchase relatively small quantities online. "It's street-level or mid-level dealers [in the U.S.] that are introducing the nitazenes (search) into the drug supply, not the big drug traffickers," said Philip Berry, a visiting senior lecturer at King's College London.
The next wave: orphines (search)
In July 2025, China placed the majority of nitazenes (search) under national control. However, drug experts warn that manufacturers are already exploiting loopholes by marketing chemically similar synthetic opioids known as "orphines (search)."
"Orphines (search) have just enough of the molecule difference that it isn't covered by the core definition that China has made," said Jared Brown, scientific affairs officer at the United Nations Office on Drugs and Crime (search) (UNODC). More than 150 cases involving orphines were reported in the U.S. between 2024 and 2025, the majority in Illinois.
This pattern mirrors what occurred after China banned all fentanyl-related substances in 2019: the number of distinct fentanyl analogs reported to the UNODC plummeted, while reports of nitazenes (search) quickly picked up.
"Always adapting, always changing — we call them 'shape shifters,'" said Tarentino. "They're this global Hydra that are always changing, evolving and adapting to their environment and taking full advantage of all of these different loopholes and vulnerabilities that exist."
As of 2025, 48 of 50 U.S. states have reported nitazene seizures, underscoring the nationwide reach of this emerging public health threat.