Nitazenes are a class of synthetic opioids often dubbed “Frankenstein drugs” due to their creation in clandestine labs and their extreme potency, some variants are reported to be 2 to 40 times stronger than fentanyl according to the Ohio Attorney General. These compounds are now increasingly found in the illicit drug supply, frequently combined with fentanyl or other substances to heighten their effects.

In Ohio, nitazene-related overdose deaths have risen precipitously. Whereas only three deaths were confirmed in 2020, the state recorded an average of 57 nitazene-involved fatalities annually between 2021 and 2022. In 2023, the confirmed count reached 77 nitazene-related overdose deaths, highlighting a growing public health crisis that is still underreported due to testing limitations according to Governor Mike Dewine and Spectrum News.

As these highly potent substances continue to proliferate in Ohio and beyond, it’s important to understand their risks and the broader consequences they pose to individuals and communities.

What are Nitazenes?

Nitazenes are a powerful class of synthetic opioids originally developed in the 1950s as potential pain relievers but never approved for medical use. Chemically distinct from fentanyl, several nitazene variants are estimated to be 2 to 40 times more potent than fentanyl, with some, like isotonitazene and etonitazene, potentially 100 times more potent depending on the analog. Functioning as selective μ-opioid receptor agonists, their high potency and frequent mixing with other illicit drugs have made nitazenes responsible for numerous overdose deaths in the U.S. and beyond.

These substances are manufactured in clandestine labs and sometimes sold as or mixed into fentanyl, heroin, counterfeit pills, or stimulants, without the user's knowledge, significantly increasing overdose risk.

What Do Nitazenes Look Like?

Nitazenes take on multiple forms, making them difficult to identify without testing. Their appearance mimics other opioids, which increases the risk of accidental ingestion.

Common forms of Nitazenes include:

• Powder: Typically white, off-white, or tan in color.
  
  
• Pills: Pressed to resemble legitimate prescription opioids like oxycodone.
  
  
• Liquids: Found in solutions for nasal or injectable use.
  
  
• Blotter paper: Absorbed into paper strips similar to those used for LSD.

What Are the Effects of Nitazenes?

The effects of Nitazenes are similar to the effects of heroin or fentanyl however they are far more intense. These drugs act on the central nervous system and can quickly overwhelm the body, especially in small doses.

Common effects of nitazenes include:

• Euphoria
  
  
• Extreme sedation or unconsciousness
  
  
• Respiratory depression
  
  
• Drowsiness or confusion
  
  
• Slowed heart rate and blood pressure
  
  
• Nausea and vomiting
  
  
• Potential overdose and death

Why are Nitazenes called the Frankenstein Drug?

Nitazenes are called the "Frankenstein Drug" because they are synthetic opioids created in labs and are far more potent than many naturally derived opioids. The nickname reflects their dangerous, unpredictable nature. These drugs are chemically engineered without medical oversight, and altered to evade detection and regulation.

Their extreme potency combined with their unknown composition and appearance, makes nitazenes a frightening and deadly presence in the illicit drug supply.

How Do Nitazenes Compare to Other Opioids?

Nitazenes are up to 250 to 900 times more potent than morphine, significantly surpassing the strength of heroin; for context, fentanyl is typically about 50 times stronger than heroin, making nitazenes far more dangerous even in minuscule amounts according to the Inter-American Drug Abuse Control Commission (CICAD), Organization of American States (OAS). “Information Bulletin: The Emergence of Nitazenes in the Americas”, Washington, D.C., 2024. 

Here’s how they compare:

• Heroin: Approximately 2–5 times more potent than morphine.
  
  
• Fentanyl: Roughly 50 times stronger than heroin.
  
  
• Nitazenes (e.g., isotonitazene, etonitazene): Range from 5–9× the potency of fentanyl (≈250–900× morphine), with some analogs reaching up to 4,300× potency.

This extraordinary potency, combined with the fact that nitazenes are mixed into other drugs without users’ knowledge, dramatically raises the risk of overdose and death.

How to Get Treatment for Nitazene Addiction in Ohio?

To get treatment for Nitazene addiction in Ohio, individuals should seek out professional addiction services that provide comprehensive care for opioid use disorders. For severe opioid addictions, detox and inpatient treatment is the best course of action to start. 

Treatment options include:

• Medical Detox: Supervised withdrawal management to ensure safety and comfort.
  
  
• Medication-Assisted Treatment (MAT): Use of FDA-approved medications to reduce cravings and prevent relapse.
  
  
• Residential Treatment: A live-in program offering intensive therapy and 24-hour support.
  
  
• Partial Hospitalization Program (PHP): Structured day treatment for individuals needing a high level of care without overnight stays.
  
  
• Intensive Outpatient Program (IOP): Flexible therapy schedules for those balancing recovery with daily responsibilities.
  
  
• Outpatient Counseling: Ongoing individual or group therapy to support long-term recovery.
  
  
• Peer Support and Recovery Services: Access to support groups and recovery coaching to reinforce sobriety.
  
  

Ohio residents should begin treatment by contacting a licensed addiction treatment provider like Woodhaven Treatment Center for an initial assessment and guidance on the most appropriate level of care.

How common is Nitazene addiction?

Nitazene addiction is becoming more common as these synthetic opioids are increasingly found in the illegal drug supply. The Ohio Bureau of Criminal Investigation reported that nitazenes were identified in toxicology cases across multiple counties, highlighting their growing presence in the state.

Is Nitazene a legal medication?

No. Nitazenes are not approved for medical use in the United States and are considered Schedule I substances under the Controlled Substances Act, meaning they have a high potential for abuse and no accepted medical use.

Can you die from taking Nitazene?

Yes. Nitazenes are extremely potent opioids, some variants are significantly stronger than fentanyl, and even small amounts can cause fatal overdoses, especially when mixed with other drugs.

What are the symptoms of Nitazene overdose?

Symptoms of Nitazene overdose include slowed or stopped breathing, unconsciousness, bluish lips or fingernails, pinpoint pupils, and unresponsiveness. Immediate medical intervention with naloxone (Narcan) is critical.

What are the Street Names for Nitazene?

Street names for nitazenes are still emerging due to the drug’s relatively recent appearance in the illicit market, but they are sold under misleading or generic names that hide their potency. Known or reported street names include:

• "Synthetic Heroin" – due to its opioid effects
  
  
• "Frankenstein" – referring to the drug’s extreme potency and synthetic origin
  
  
• "ISO" – short for isotonitazene, a common nitazene variant
  
  
• "Fake Fentanyl" – used when nitazenes are misrepresented or unknowingly mixed with fentanyl
  
  
• "Nitaz" – a shortened slang variation
  
  

Because nitazenes are found mixed into other substances (like counterfeit pills or heroin), users  don’t even know they are taking them, which significantly increases the risk of overdose according to the DEA Public Safety Alert, Oct 2022 and Ohio Department of Health Bulletins.