CLEVELAND, Ohio – Drug experts and law enforcement agencies across the state are carefully monitoring the emergence of new, dangerous synthetic opioids that have made their presence in Ohio, including Cuyahoga County.
The benzimidazole compounds, commonly called nitazenes, surfaced in the county in December 2020, “when we first detected fatalities through toxicology,” Cuyahoga County Medical Examiner Dr. Thomas Gilson said.
“We went from two deaths in the end of 2020 to 62 deaths through 2021. Most occurred in association with fentanyl,” he said.
A bulletin recently released by the Ohio Bureau of Criminal Investigation says nitazene compounds were first synthesized in the 1950s to research pain-relieving effects. They are no longer approved for medical use anywhere in the world, the Ohio Attorney General’s Office says, but they are being made in illegal labs.
In the past 20 years, the opioid crisis has led to thousands of deaths in Ohio, and the top drivers of unintended overdoses in the state remain fentanyl and carfentanil. Officials see nitazenes as an emerging and dangerous trend.
Ohio Gov. Mike DeWine announced in early April an executive order banning seven new nitazene compounds as they have a high potential for abuse and addiction. DeWine’s order says that the substances could likely be abused in the same manner as other opioids such as heroin.
BCI reported that in the first quarter of 2022, Ohio reported 143 nitazene cases, up from 27 in the same quarter of 2021.
Where is this coming from?
Citing literature, Lindsey Bohrer, a spokeswoman for the Ohio Department of Public Safety, said there is an indication that some of the nitazene compounds may be originating from China.
“What generally occurs is that clandestine chemists scour research papers and patents from the mid-20th century,” she said. “These serve as a database for underground chemists to manufacture non-fentanyl synthetic opioids such as nitazenes.”
Dennis Cauchon, president of Harm Reduction Ohio, an organization that supports drug policies based on science, health, compassion and human rights, said the nitazenes fall under the category of a “shiny new object.”
“The more we crack down on substances, the more we crack down on even more deadly substances,” he said. “These kinds of synthetic drugs are constantly coming out and being produced.
How potent are nitazenes?
The compounds have different potencies, but they either hover just under fentanyl’s potency, are equal to fentanyl’s potency, or just higher than fentanyl’s potency, according to data provided by Ohio Department of Public Safety to cleveland.com and The Plain Dealer. Fentanyl, for instance, has been shown to have a far greater potency than heroin.
For instance, one of the compounds, N-pyrrolidino etonitazene, is 20 times more potent than fentanyl. Others are less potent than fentanyl.
Matthew Vanyo is the director of the Westshore Enforcement Bureau Task Force, which serves Bay Village, Fairview Park, Lakewood, North Olmsted, Rocky River and Westlake. He said the fact that some nitazanes are 10 times more potent than fentanyl “is so scary.”
“We’ve been experiencing an opioid epidemic probably since early to mid-2016 in Cuyahoga County, Northeast Ohio and the state of Ohio,” said Vanyo, the former Olmsted Township police chief.
“I think it’s more important than ever before to use our enforcement efforts, which we have been doing, [finding] where this stuff is coming from, prosecuting people aggressively and proactively who are trafficking this stuff.”
What does it look like?
Unfortunately, it’s hard to tell what the compounds look like because nitazenes are frequently mixed together with other drugs, preventing experts from pointing to a specific appearance, Gilson said. He said he also can’t give advice on how to avoid them because they tend to be sold as a white, tan or gray powder.
“The medical examiner’s office took some pictures of some drugs that have fentanyl in them versus drugs that don’t have fentanyl in them, and you can’t tell from looking at them whether or not they have the [synthetic opioid] in them,” said Beth Zietlow-DeJesus, a spokeswoman for the Cuyahoga County Alcohol, Drug Addiction and Mental Health Services Board.
“It would be the same as the nitazenes. [Fentanyl] is what has been driving our overdoses for years now. [Drug dealers are] putting fentanyl or any other synthetic opioid, even carfentanil, into drugs on the street,” she said. “That includes cocaine, crack cocaine, illicit pressed pills that are counterfeit to look exactly like prescriptions like a Xanax or oxycodone. They’re made by the cartels and pressed into pills.”
What are law enforcement agencies saying about nitazenes?
Many in law enforcement fear nitazenes, as they, like fentanyl, are so commonly mixed with other street drugs. Parma Heights Police Detective Adam Sloan said when a person is arrested on charges of possessing fentanyl, the department tests the drug. It rarely comes back as just fentanyl. It often has several different substances mixed in with it, Sloan said.
“You have no idea what is in the drug supply right now,” Zietlow-DeJesus.
“We support what’s called harm reduction efforts which means we encourage everybody who’s going to use to test their drugs to see if it has fentanyl in it before they use so that they can use in a safer way,” she said. “We want people to always be carrying naloxone and make sure if they’re going to use that someone nearby has naloxone.”
Zietlow-DeJesus stresses that nitazenes and fentanyl can be anywhere and to be extra careful when taking drugs from off the street if going to use.
“Just when you thought it was bad enough when trying to get a handle on this stuff, these synthetics are now coming up,” Vanyo said. “It’s going to make our jobs in law enforcement that much more difficult because I think you’re going to see possibly -- I don’t know for sure and I hope not -- overdoses increase.”