Published: 08/25/2026 | Author: Terri

Across 2023 and 2024, a medical examiner in one Ohio county reviewed 45 deaths involving nitazenes. In every single one, fentanyl was present too. That pattern is the clearest available picture of how these synthetic opioids are actually reaching people, which is hidden inside other drugs rather than sold under their own name.

Nitazenes are up to 40 times more potent than fentanyl and as much as 500 times stronger than heroin. They have now been seized in 48 of the 50 US states.

The findings come from a months-long investigation by Bellingcat, published June 18, 2026, and co-published with STAT and Signal Ohio. Reporters reviewed dozens of criminal court proceedings, filed federal, state, and county records requests, and obtained medical examiner reports.

What Nitazenes Are

Nitazenes were developed in the 1950s as potential painkillers and were never approved for medical use because they were judged unsafe. They resurfaced in the illicit market decades later.

They are sold predominantly online, on both the open and dark web, and are typically laced into other substances to increase potency. Someone buying what they believe is oxycodone, fentanyl, or even a stimulant like cocaine may receive something considerably stronger without knowing it.

The US Drug Enforcement Administration began tracking nitazene seizures around 2014 but saw a marked increase starting in 2019.

How Fast the Numbers Moved

Confirmed nitazene reports in the DEA’s National Forensic Laboratory Information System rose from 43 positive tests in 2019 to nearly 2,000 in 2024, the most recent year with complete figures. By March 2026, more than 8,000 nitazene reports had been logged since 2019.

Overdose deaths followed a similar curve. The Centers for Disease Control and Prevention confirmed 27 nitazene-involved deaths in 2020 and 409 in 2024. More than 1,100 fatalities have been confirmed in total through the CDC’s State Unintentional Drug Overdose Reporting System.

Experts believe the real figure is higher, possibly around 2,000 since 2019. Alex Krotulski, who directs the Center for Forensic Science Research and Education in Pennsylvania, told Bellingcat that only a limited number of forensic toxicology laboratories test for nitazenes at all. If a lab does not test for one, it will not appear in the data, and labs that do test have missed earlier cases.

That undercount matters for anyone assessing risk. The absence of nitazenes in local statistics may reflect testing capacity rather than the actual supply.

Inside the Ohio Numbers

Ohio accounts for more than a third of all positive nitazene laboratory reports nationally between 2019 and 2024, and has recorded the highest number of nitazene-related overdose deaths in the country since 2021. The state logged four such deaths in 2020, 90 in 2021, and roughly 200 more between 2022 and 2024.

Within Ohio, records obtained from the state’s Bureau of Criminal Investigation show Scioto, Butler, and Cuyahoga counties account for almost half of all nitazene detections by weight.

Medical examiner records from Cuyahoga County, which includes Cleveland, give the clearest picture of who is dying. Across 2023 and 2024, 45 people died after taking nitazenes, 31 men and 14 women, ranging in age from 29 to 72. All but one death was ruled accidental.

In every one of those 45 cases, nitazenes were detected alongside fentanyl, frequently with drugs like heroin, cocaine, methamphetamine, or benzodiazepines in the mix as well.

Why Mixtures Are the Whole Story

The consistency of that pattern is the practical takeaway. Nitazenes are not displacing fentanyl in the supply. They are being added to it.

Frank Tarentino, associate chief of operations for the DEA’s Northeast Region, said dealers mix nitazenes into other drugs to make them stronger and more addictive, and that poly-drug operations selling many substances at once have become the norm rather than the exception.

AmandaLynn Reese, chief program officer at Harm Reduction Ohio, a nonprofit supporting people who use drugs, described nitazenes as a live risk to her community and said she expects to see more of them. Her organization is pushing for wider drug checking services, better access to test strips, and more naloxone in circulation.

What Protects People

Naloxone still reverses nitazene overdoses. Because these compounds can be dramatically more potent than fentanyl, reversal may require more than one dose, so having several on hand matters.

Fentanyl test strips are widely available and worth using, but they do not detect nitazenes. A negative fentanyl strip is not a clean bill of health. Where drug checking services operate, they can identify compounds that strips cannot.

Ohio has moved on both fronts. The governor issued executive orders scheduling nine nitazenes and legalized the use of tools that test for them.

The Supply Keeps Adapting

China placed most nitazenes under national control in July 2025. Drug experts told Bellingcat that manufacturers are already marketing chemically similar compounds that fall outside those rules, a pattern that repeats what happened after China banned fentanyl-related substances in 2019 and nitazene reports climbed shortly after.

For people in recovery or using drugs now, the practical implication is that the supply changes faster than testing and regulation can follow.

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