Ohio Bans More Nitazenes, Claiming They Cause Deaths on Their Own

    Ohio has temporarily banned nine nitazene analogs as Schedule I controlled substances, making sale and use within the state illegal. In the process, Governor Mike DeWine (R) took the bold step of portraying nitazenes as substances that are causing overdose deaths on their own, without any other drug contributing. This is a distortion of how nitazenes function in the United States drug supply, and it’s unusual if not unheard of for a government representative to state it so plainly.

    On June 4, DeWine signed an emergency executive order proposed by the State of Ohio Board of Pharmacy, authorizing the Board to categorize the nine analogs as Schedule I. A lot of misleading claims accompanied the announcement, but all of them were par for the course when talking about nitazenes. Except for this: “In multiple unintentional drug poisonings,” DeWine’s office stated in a press release, “nitazenes have been the only compounds identified as a contributing factor.”

    The governor’s office did not respond to Filter’s short-notice inquiry about the source of the claim. However, it’s safe to assume it refers to three deaths reported by the Drug Enforcement Administration in early 2021, where the only substance identified was metonitazene—partly because DeWine’s office made a much quieter reference to that data in 2022, and partly because there aren’t really any other US reports to support the claim. Ohio Department of Health overdose reports do not include data on nitazenes.

    There isn’t a market for nitazenes on their own.

    Nitazenes is the more common term for benzimidazole opioids, a class of novel synthetic drug first identified in the US unregulated drug supply in 2019. Usually they show up in combination with other opioids, typically fentanyl, but are found mixed with benzodiazepines, too; as “downers,” they produce broadly similar effects. There isn’t a US market for nitazenes on their own.

    In Europe, where less-potent heroin remains much more dominant and fentanyl has not saturated the supply as it has in the US, harm reductionists have expressed concern. But in the US the situation is different.

    “Those drugs have increased in the drug supply, but overdose death rates have been flat or declining while this happened,” Harm Reduction Ohio stated in March, referring to nitazenes as well xylazine. The “evidence does not yet point to increased overdose death as being an effect.”

    Fentanyl test strips don’t detect nitazenes, since they’re separate classes of opioids. But since naloxone is effective for all opioids, it does work on nitazenes. Reports that nitazene-involved overdoses require more naloxone than fentanyl due to being more potent appear unfounded.

    Nitazene analogs are often introduced as “up to 40 times more potent than fentanyl,” but such apparent potency is not reflected in real-world US experiences. Nitazene potency is still being established, so existing research can be somewhat contradictory, but on the whole these substances are believed to be more potent than fentanyl. The analog currently most prevalent in the US supply, metonitazene, is less potent than most others, and about on par with fentanyl.

    CDC overdose mortality data don’t distinguish nitazenes from fentanyl or any other synthetic opioids.

    Media or law enforcement reports about drug deaths will usually state that the substances in question were “related” to the death, or use similar language like “involved” or “contributed to.” These terms make it sound like those substances caused the deaths, but that is not necessarily the case.

    A death described, for example, as “isotonitazene-related,” indicates that isotonitazene was listed on a death certificate. This may be because a forensic pathologist investigated the death and concluded beyond a reasonable doubt that the effects of isotonitazene caused the person to die.

    It could also be the result of someone with much less medical training, whose job is to submit the death certificate information as quickly as possible, writing down every substance that the toxicology report identified in the person’s system—up to 20—without specifying whether all of them had been determined to contribute to the death. If the report doesn’t say otherwise, whoever analyzes the data later will assume that the substance was “related” to the death, as the Centers for Disease Control and Prevention does. CDC overdose mortality data, however, don’t distinguish nitazenes from fentanyl or any other synthetic opioids.

    No state has pursued criminalization of nitazenes quite so aggressively as Ohio.

    Numerous states have similarly scheduled one or more nitazene analogs, including Florida, Wisconsin, Missouri. But no other state has pursued criminalization of nitazenes quite so aggressively as Ohio, which has now temporarily scheduled 17 nitazene analogs in total.

    DeWine and the state pharmacy board first scheduled isotonitazene by emergency executive order in 2020, and an additional seven analogs in 2022. That move was quickly followed by a public warning from the Ohio Bureau of Criminal Investigation, which was then echoed by State Attorney General Dev Yoast. Yoast was the first US government official to describe nitazenes as “Frankenstein opioids.”

    When a “new” unregulated substance makes the news and a particular location is described as a “hotspot,” what’s almost always happening is that a forensics lab in that region started testing for it. Once those results emerge, other labs rush to find the same thing. News outlets then rush to report on the new drug that’s exploding in popularity, and politicians rush to show their constituents they’re cracking down on the new scary drug threat of the day, whether or not it’s causing the most harm.

    The US overdose crisis principally revolves around fentanyl, and anything else remains a very distant second. Nitazenes can cause respiratory depression and fatal overdose. But the attention they receive from media and law enforcement is wildly out of proportion with their very small role in the US overdose crisis. They are not prevalent; just new and shiny.

     


     

    Image via State of Ohio State Board of Pharmacy

    • Kastalia is Filter‘s deputy editor. She previously worked at a number of other media outlets and wouldn’t recommend the drug coverage at any of them. When not at Filter, she works with drug users in NYC and drug checkers in North Carolina to track hyperlocal supply changes, and cohosts a national stimulant users call with Isaac Jackson.

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