More powerful than fentanyl: Rise in synthetic opioids in drug supply prompts health alert

Hamilton County Public Health is alerting the community to a rapid increase in the region's drug supply of a group of dangerous synthetic opioids.

The opioids, known as nitazenes, are the latest public health threat flagged by health officials during an opioid epidemic that has taken the country by storm and only recently seen signs of ebbing in the region.

Nitazenes range from being 75 to 1,500 times stronger than morphine. Depending on their chemical composition, they can be stronger than fentanyl, which is 100 times stronger than morphine and the primary cause of overdose deaths in the nation, according to federal drug law enforcement officials.

Due to their potency, nitazenes are cause a high risk of respiratory depression, a condition where someone is breathing too slowly or shallowly, which can result in cardiac arrest.

Nitazenes arrives on the heels of xylazine, another dangerous drug contaminating Hamilton County's drug supply during the opioid epidemic. Originally intended to be an animal tranquilizer, xylazine extends the euphoria for drug users but can also create skin damage so severe that amputation is necessary.

Both nitazenes and xylazine are the products of policy that criminalizes illicit drug use and a market that responds by churning out increasingly dangerous drugs, said Tasha Turner-Bicknell, a harm reduction worker, nurse and associate professor at the University of Cincinnati College of Nursing.

"That kind of Prohibition-type of drug war, really, is like pouring gasoline on the illicit drug market," she said. "That market is always looking for something that is cheaper, faster and more potent."

Nitazene spiked in 2023, but test strips are not legal or widely available

Nitazenes were created in the 1950s to be painkillers but never received approval for medical use due to their large potential for addiction and overdose.

Analogues of nitazene were first detected in Hamilton County's drug supply as early as 2021, but the number has exploded in the past two years. In 2023, 87 drug seizures in Hamilton County contained nitazene – more than nine times the same number in 2022.

"We've seen a significant increase here as of late," said Turner-Bicknell.

Test strips that can help people who use drugs to detect nitazene are available for purchase online, but the harm reduction organizations that Turner-Bicknell works with, including Cincinnati-based organizations such as Caracole and the Jimmy Heath House, do not yet distribute them. Nitazene cannot be detected with fentanyl test strips, according to a report from Hamilton County Public Health.

Still, such test strips are not legal in the state of Ohio, where the state criminal code defines any equipment or product involved in the testing of illicit drugs, excluding fentanyl, as "drug paraphernalia."

While fentanyl test strips were decriminalized in Ohio last April, the legislation did not cover testing strips for other drugs such as xylazine and nitazene. Turner-Bicknell said that this creates a lag in public health workers' ability to help the people suffering due to the opioid epidemic.

"There was a real push from harm reduction activist advocates to make the legislation more broad so that all drug checking could be legalized and we could move much more quickly," she said.

"Here we are not even a year later, with another drug adulterant that we are talking about needing test strips for," said Turner-Bicknell.

"We need to be more ahead of what's happening in the illicit drug market, and to have legislation that allows us to use all the tools at our disposal."

Nearly 40,000 Ohioans have died from drug overdose since 2015, according to public health data analyzed by Harm Reduction Ohio, a nonprofit that distributes overdose-reversing medication in Ohio.