Four state agencies have joined together to warn Missourians about the growing presence of a highly potent class of synthetic opioids.
According to one of those agencies, the Missouri Department of Health and Senior Services, nitazenes, some of which are up to 10 times more potent than fentanyl, have recently been found in counterfeit pills, illicit powders, unregulated cannabis products and vape liquid, often without the user’s knowledge.
DHSS has issued a health advisory urging vigilance, prevention and expanded access to lifesaving resources such as naloxone, which goes by the brand name Narcan.
"It takes a very small amount of it to have a very big effect," said State Medical Director Dr. Heidi Miller, "and, because it's such a small amount, we're finding that nitazenes are being laced through counterfeit Vicodin tablets, Percoset tablets, Benzo tablets. We're also detecting it in the illicit drug market, so it's been seen in methadone, cocaine, crack, event vapes and cannabis."
She said they're "playing whack-a-mole" to try to keep up with all of the "new chemically synthesized compounds that stimulate the opioid receptor."
Nitazenes in school wastewater
A DPS-led voluntary school wastewater monitoring program has detected nitazenes in 26 of 37 participating Missouri schools since January. Those include Fair Grove, Marionville, Marshfield and Republic Schools in southwest Missouri.
Miller said that "may be a reflection of students or staff at a school or people who are coming into the school, parents or even neighbors in adjacent communities."
The detection of nitazenes in school wastewater systems, she said, "is a reflection of what probably the entire state is at risk for." While overdose deaths are down, according to Miller, they need to be even more vigilant.
Republic Schools Superintendent Matthew Pearce said they participate in the program so they can adjust their drug education strategy accordingly. He said they’re looking at what their next steps are in educating students about nitazenes.
"Do we need to make adjustments based upon, you know, what these samples are finding in how we communicate and educate our students, staff and community? If we do have nitazenes and we find that that's a consistent thing, then we've got to educate ourselves and our community on that," he said.
Pearce said his district keeps naloxone on hand, and nurses and other staff are trained to use it if necessary. They already educate students about the dangers of using drugs, but he said being part of the wastewater study allows them to keep their curriculum up to date.
"It's a great 100,000-foot view of how we need to direct our education efforts for our students, staff and family."
Miller urged people to avoid the risk of overdose in the first place.
"Don't even take one pill that you pick up at a party or a friend gives you," she said. "Like, that one pill could lead to a lethal overdose, so don't even try it."
According to DHSS, the school wastewater findings align with increases in law enforcement drug surveillance data, emergency department reports and state overdose death investigations collected through its State Unintentional Drug Overdose Reporting System.
Mark James is the director of the Department of Public Safety, one of the agencies working together to warn the public about nitazenes. He urged the public in a statement to avoid using all illicit substances and only use medications obtained directly from a pharmacist with a valid prescription.
The agencies, which also include the Department of Elementary and Secondary Education and Department of Mental Health, encourage parents to talk with children and teens about the risks of counterfeit pills, illicit substances and unregulated vapes.
Miller urged people to have naloxone on hand in case it's needed. The nasal spray or injection can be obtained for free, and you can find out more here. Miller said "it's absolutely safe" to use, but a person who's had an overdose reversed by naloxone should be seen by a medical provider right away.
