Missouri agencies partner to alert public to rising nitazene threat

Missouri Department of Health and Senior Services sent this bulletin at 03/24/2026 01:31 PM CDT
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Having trouble viewing this email? View it as a Web page. \| \|
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\| For Immediate Release:
March 24, 2026

Media Contact:
Lisa Cox
Missouri Department of Health and Senior Services
Media Inquiry Form

\| \|

Missouri agencies partner to alert public to rising nitazene threat

DHSS, DPS, DESE and DMH issue joint warning following statewide detections in wastewater

JEFFERSON CITY, MO -- The Missouri Department of Health and Senior Services (DHSS), Department of Public Safety (DPS), Department of Elementary and Secondary Education (DESE), and Department of Mental Health (DMH) are jointly alerting Missourians to the growing presence of nitazenes, a highly potent class of synthetic opioids increasingly detected across the state.

DHSS has issued a health advisory urging vigilance, prevention and expanded access to lifesaving resources such as naloxone.

Nitazenes—some of which are over 5 to 10 times more potent than fentanyl—have recently been identified in counterfeit pills, illicit powders, unregulated cannabis products and vape liquid, often without the user’s knowledge.

“Having access to and knowing how to administer naloxone is becoming increasingly important in our communities,” said DHSS Director Sarah Willson. “It is easy and safe to use and can reverse an opioid overdose and allow a person’s normal breathing to be restored.”

Statewide Wastewater Testing Detects Nitazenes in Schools

Through a DPS-led voluntary school wastewater monitoring program, nitazenes have been detected in 26 of 37 participating Missouri schools since January of this year. This initiative helps communities identify emerging drug trends while protecting individual privacy. These findings align with increases in law enforcement drug surveillance data, emergency department reports and state overdose death investigations collected through DHSS’s State Unintentional Drug Overdose Reporting System.

“Nitazenes are a hidden killer,” DPS Director Mark James said. “Even a tiny amount of nitazenes can cause someone to stop breathing, and they’re increasingly being detected in counterfeit pills – but most people have never heard of them. Protect yourself: avoid using all illicit substances and only use medications obtained directly from a pharmacist with a valid prescription.”

Growing Impact in Missouri

Nitazenes were implicated in 14 Missouri overdose deaths in 2024, more than triple the total number recorded between 2019 and 2023. Health officials warn that traditional drug detection tests do not identify nitazenes, making it more difficult for individuals—and providers—to know when they are present.

Overdose Response and Prevention

Multiple doses of naloxone could be needed to reverse an overdose. Symptoms mirror other opioid overdoses, including slowed or absent breathing, pinpoint pupils, unconsciousness and blue or grey lips or skin. Officials urge Missourians to use naloxone in any suspected opioid overdose, even when unsure which drug is involved. Naloxone is safe to administer in all situations.

The four partnering agencies strongly encourage families, educators and community leaders to:

  - Talk with children and teens about risks of counterfeit pills, illicit substances and unregulated vapes.
  - Understand that any illicit or unregulated substance may be contaminated with nitazenes.
  - Keep naloxone on hand and know how to use it if you may be in a position to witness an overdose or if you live with someone at risk.
  - Seek substance use treatment or recovery support when needed.

Resources Available

  - **988 Suicide & Crisis Lifeline:** Call or text 988 or chat at [988lifeline.org](https://988lifeline.org/) for mental health, substance use or emotional‑distress support.
  - **Substance use treatment locations:** [dmh.mo.gov/behavioral-health/treatment-services/locate](https://dmh.mo.gov/behavioral-health/treatment-services/locate)
  - **Missouri Poison Center:** [missouripoisoncenter.org](https://missouripoisoncenter.org/) or 1‑800‑222‑1222
  - **Time2Act – Missouri opioid misuse prevention:** [time2actmissouri.com](https://time2actmissouri.com/)
  - **Free naloxone:** [getmissourinaloxone.com/pick-up-today](https://getmissourinaloxone.com/pick-up-today)

DHSS, DPS, DESE and DMH remain committed to sharing emerging data, coordinating response strategies and providing the resources needed to keep Missouri communities safe. The agencies will continue working together to monitor nitazene trends, equip schools and families with up‑to‑date information and promote prevention strategies that save lives.

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Mission of the Missouri Department of Health and Senior Services (DHSS):

To promote health and safety through prevention, collaboration, education, innovation and response.

Health.Mo.Gov \| \|

\| \| \| | \| \|
Having trouble viewing this email? View it as a Web page. | | For Immediate Release:
March 24, 2026

Media Contact:
Lisa Cox
Missouri Department of Health and Senior Services
Media Inquiry Form

\| \|

Missouri agencies partner to alert public to rising nitazene threat

DHSS, DPS, DESE and DMH issue joint warning following statewide detections in wastewater

JEFFERSON CITY, MO -- The Missouri Department of Health and Senior Services (DHSS), Department of Public Safety (DPS), Department of Elementary and Secondary Education (DESE), and Department of Mental Health (DMH) are jointly alerting Missourians to the growing presence of nitazenes, a highly potent class of synthetic opioids increasingly detected across the state.

DHSS has issued a health advisory urging vigilance, prevention and expanded access to lifesaving resources such as naloxone.

Nitazenes—some of which are over 5 to 10 times more potent than fentanyl—have recently been identified in counterfeit pills, illicit powders, unregulated cannabis products and vape liquid, often without the user’s knowledge.

“Having access to and knowing how to administer naloxone is becoming increasingly important in our communities,” said DHSS Director Sarah Willson. “It is easy and safe to use and can reverse an opioid overdose and allow a person’s normal breathing to be restored.”

Statewide Wastewater Testing Detects Nitazenes in Schools

Through a DPS-led voluntary school wastewater monitoring program, nitazenes have been detected in 26 of 37 participating Missouri schools since January of this year. This initiative helps communities identify emerging drug trends while protecting individual privacy. These findings align with increases in law enforcement drug surveillance data, emergency department reports and state overdose death investigations collected through DHSS’s State Unintentional Drug Overdose Reporting System.

“Nitazenes are a hidden killer,” DPS Director Mark James said. “Even a tiny amount of nitazenes can cause someone to stop breathing, and they’re increasingly being detected in counterfeit pills – but most people have never heard of them. Protect yourself: avoid using all illicit substances and only use medications obtained directly from a pharmacist with a valid prescription.”

Growing Impact in Missouri

Nitazenes were implicated in 14 Missouri overdose deaths in 2024, more than triple the total number recorded between 2019 and 2023. Health officials warn that traditional drug detection tests do not identify nitazenes, making it more difficult for individuals—and providers—to know when they are present.

Overdose Response and Prevention

Multiple doses of naloxone could be needed to reverse an overdose. Symptoms mirror other opioid overdoses, including slowed or absent breathing, pinpoint pupils, unconsciousness and blue or grey lips or skin. Officials urge Missourians to use naloxone in any suspected opioid overdose, even when unsure which drug is involved. Naloxone is safe to administer in all situations.

The four partnering agencies strongly encourage families, educators and community leaders to:

- Talk with children and teens about risks of counterfeit pills, illicit substances and unregulated vapes.
- Understand that any illicit or unregulated substance may be contaminated with nitazenes.
- Keep naloxone on hand and know how to use it if you may be in a position to witness an overdose or if you live with someone at risk.
- Seek substance use treatment or recovery support when needed.

Resources Available

- **988 Suicide & Crisis Lifeline:** Call or text 988 or chat at [988lifeline.org](https://988lifeline.org/) for mental health, substance use or emotional‑distress support.
- **Substance use treatment locations:** [dmh.mo.gov/behavioral-health/treatment-services/locate](https://dmh.mo.gov/behavioral-health/treatment-services/locate)
- **Missouri Poison Center:** [missouripoisoncenter.org](https://missouripoisoncenter.org/) or 1‑800‑222‑1222
- **Time2Act – Missouri opioid misuse prevention:** [time2actmissouri.com](https://time2actmissouri.com/)
- **Free naloxone:** [getmissourinaloxone.com/pick-up-today](https://getmissourinaloxone.com/pick-up-today)

DHSS, DPS, DESE and DMH remain committed to sharing emerging data, coordinating response strategies and providing the resources needed to keep Missouri communities safe. The agencies will continue working together to monitor nitazene trends, equip schools and families with up‑to‑date information and promote prevention strategies that save lives.

| | \| \|
Mission of the Missouri Department of Health and Senior Services (DHSS):

To promote health and safety through prevention, collaboration, education, innovation and response.

Health.Mo.Gov | |

| \| \|
Having trouble viewing this email? View it as a Web page. | | | | | | |
| | | | | | | |
| For Immediate Release:
March 24, 2026

Media Contact:
Lisa Cox
Missouri Department of Health and Senior Services
Media Inquiry Form

\| \|

Missouri agencies partner to alert public to rising nitazene threat

DHSS, DPS, DESE and DMH issue joint warning following statewide detections in wastewater

JEFFERSON CITY, MO -- The Missouri Department of Health and Senior Services (DHSS), Department of Public Safety (DPS), Department of Elementary and Secondary Education (DESE), and Department of Mental Health (DMH) are jointly alerting Missourians to the growing presence of nitazenes, a highly potent class of synthetic opioids increasingly detected across the state.

DHSS has issued a health advisory urging vigilance, prevention and expanded access to lifesaving resources such as naloxone.

Nitazenes—some of which are over 5 to 10 times more potent than fentanyl—have recently been identified in counterfeit pills, illicit powders, unregulated cannabis products and vape liquid, often without the user’s knowledge.

“Having access to and knowing how to administer naloxone is becoming increasingly important in our communities,” said DHSS Director Sarah Willson. “It is easy and safe to use and can reverse an opioid overdose and allow a person’s normal breathing to be restored.”

Statewide Wastewater Testing Detects Nitazenes in Schools

Through a DPS-led voluntary school wastewater monitoring program, nitazenes have been detected in 26 of 37 participating Missouri schools since January of this year. This initiative helps communities identify emerging drug trends while protecting individual privacy. These findings align with increases in law enforcement drug surveillance data, emergency department reports and state overdose death investigations collected through DHSS’s State Unintentional Drug Overdose Reporting System.

“Nitazenes are a hidden killer,” DPS Director Mark James said. “Even a tiny amount of nitazenes can cause someone to stop breathing, and they’re increasingly being detected in counterfeit pills – but most people have never heard of them. Protect yourself: avoid using all illicit substances and only use medications obtained directly from a pharmacist with a valid prescription.”

Growing Impact in Missouri

Nitazenes were implicated in 14 Missouri overdose deaths in 2024, more than triple the total number recorded between 2019 and 2023. Health officials warn that traditional drug detection tests do not identify nitazenes, making it more difficult for individuals—and providers—to know when they are present.

Overdose Response and Prevention

Multiple doses of naloxone could be needed to reverse an overdose. Symptoms mirror other opioid overdoses, including slowed or absent breathing, pinpoint pupils, unconsciousness and blue or grey lips or skin. Officials urge Missourians to use naloxone in any suspected opioid overdose, even when unsure which drug is involved. Naloxone is safe to administer in all situations.

The four partnering agencies strongly encourage families, educators and community leaders to:

- Talk with children and teens about risks of counterfeit pills, illicit substances and unregulated vapes.
- Understand that any illicit or unregulated substance may be contaminated with nitazenes.
- Keep naloxone on hand and know how to use it if you may be in a position to witness an overdose or if you live with someone at risk.
- Seek substance use treatment or recovery support when needed.

Resources Available

- **988 Suicide & Crisis Lifeline:** Call or text 988 or chat at [988lifeline.org](https://988lifeline.org/) for mental health, substance use or emotional‑distress support.
- **Substance use treatment locations:** [dmh.mo.gov/behavioral-health/treatment-services/locate](https://dmh.mo.gov/behavioral-health/treatment-services/locate)
- **Missouri Poison Center:** [missouripoisoncenter.org](https://missouripoisoncenter.org/) or 1‑800‑222‑1222
- **Time2Act – Missouri opioid misuse prevention:** [time2actmissouri.com](https://time2actmissouri.com/)
- **Free naloxone:** [getmissourinaloxone.com/pick-up-today](https://getmissourinaloxone.com/pick-up-today)

DHSS, DPS, DESE and DMH remain committed to sharing emerging data, coordinating response strategies and providing the resources needed to keep Missouri communities safe. The agencies will continue working together to monitor nitazene trends, equip schools and families with up‑to‑date information and promote prevention strategies that save lives.

| | | | | | |
| | | | | | | |
| \| \|
Mission of the Missouri Department of Health and Senior Services (DHSS):

To promote health and safety through prevention, collaboration, education, innovation and response.

Health.Mo.Gov | | | | | | |

| | | | | | | | | | \| \|
Having trouble viewing this email? View it as a Web page. | |
| | |
| For Immediate Release:
March 24, 2026

Media Contact:
Lisa Cox
Missouri Department of Health and Senior Services
Media Inquiry Form

\| \|

Missouri agencies partner to alert public to rising nitazene threat

DHSS, DPS, DESE and DMH issue joint warning following statewide detections in wastewater

JEFFERSON CITY, MO -- The Missouri Department of Health and Senior Services (DHSS), Department of Public Safety (DPS), Department of Elementary and Secondary Education (DESE), and Department of Mental Health (DMH) are jointly alerting Missourians to the growing presence of nitazenes, a highly potent class of synthetic opioids increasingly detected across the state.

DHSS has issued a health advisory urging vigilance, prevention and expanded access to lifesaving resources such as naloxone.

Nitazenes—some of which are over 5 to 10 times more potent than fentanyl—have recently been identified in counterfeit pills, illicit powders, unregulated cannabis products and vape liquid, often without the user’s knowledge.

“Having access to and knowing how to administer naloxone is becoming increasingly important in our communities,” said DHSS Director Sarah Willson. “It is easy and safe to use and can reverse an opioid overdose and allow a person’s normal breathing to be restored.”

Statewide Wastewater Testing Detects Nitazenes in Schools

Through a DPS-led voluntary school wastewater monitoring program, nitazenes have been detected in 26 of 37 participating Missouri schools since January of this year. This initiative helps communities identify emerging drug trends while protecting individual privacy. These findings align with increases in law enforcement drug surveillance data, emergency department reports and state overdose death investigations collected through DHSS’s State Unintentional Drug Overdose Reporting System.

“Nitazenes are a hidden killer,” DPS Director Mark James said. “Even a tiny amount of nitazenes can cause someone to stop breathing, and they’re increasingly being detected in counterfeit pills – but most people have never heard of them. Protect yourself: avoid using all illicit substances and only use medications obtained directly from a pharmacist with a valid prescription.”

Growing Impact in Missouri

Nitazenes were implicated in 14 Missouri overdose deaths in 2024, more than triple the total number recorded between 2019 and 2023. Health officials warn that traditional drug detection tests do not identify nitazenes, making it more difficult for individuals—and providers—to know when they are present.

Overdose Response and Prevention

Multiple doses of naloxone could be needed to reverse an overdose. Symptoms mirror other opioid overdoses, including slowed or absent breathing, pinpoint pupils, unconsciousness and blue or grey lips or skin. Officials urge Missourians to use naloxone in any suspected opioid overdose, even when unsure which drug is involved. Naloxone is safe to administer in all situations.

The four partnering agencies strongly encourage families, educators and community leaders to:

- Talk with children and teens about risks of counterfeit pills, illicit substances and unregulated vapes.
- Understand that any illicit or unregulated substance may be contaminated with nitazenes.
- Keep naloxone on hand and know how to use it if you may be in a position to witness an overdose or if you live with someone at risk.
- Seek substance use treatment or recovery support when needed.

Resources Available

- **988 Suicide & Crisis Lifeline:** Call or text 988 or chat at [988lifeline.org](https://988lifeline.org/) for mental health, substance use or emotional‑distress support.
- **Substance use treatment locations:** [dmh.mo.gov/behavioral-health/treatment-services/locate](https://dmh.mo.gov/behavioral-health/treatment-services/locate)
- **Missouri Poison Center:** [missouripoisoncenter.org](https://missouripoisoncenter.org/) or 1‑800‑222‑1222
- **Time2Act – Missouri opioid misuse prevention:** [time2actmissouri.com](https://time2actmissouri.com/)
- **Free naloxone:** [getmissourinaloxone.com/pick-up-today](https://getmissourinaloxone.com/pick-up-today)

DHSS, DPS, DESE and DMH remain committed to sharing emerging data, coordinating response strategies and providing the resources needed to keep Missouri communities safe. The agencies will continue working together to monitor nitazene trends, equip schools and families with up‑to‑date information and promote prevention strategies that save lives.

| |
| | |
| \| \|
Mission of the Missouri Department of Health and Senior Services (DHSS):

To promote health and safety through prevention, collaboration, education, innovation and response.

Health.Mo.Gov | |

| | | | | |
Having trouble viewing this email? View it as a Web page. | | For Immediate Release:
March 24, 2026

Media Contact:
Lisa Cox
Missouri Department of Health and Senior Services
Media Inquiry Form

| |

Missouri agencies partner to alert public to rising nitazene threat

DHSS, DPS, DESE and DMH issue joint warning following statewide detections in wastewater

JEFFERSON CITY, MO -- The Missouri Department of Health and Senior Services (DHSS), Department of Public Safety (DPS), Department of Elementary and Secondary Education (DESE), and Department of Mental Health (DMH) are jointly alerting Missourians to the growing presence of nitazenes, a highly potent class of synthetic opioids increasingly detected across the state.

DHSS has issued a health advisory urging vigilance, prevention and expanded access to lifesaving resources such as naloxone.

Nitazenes—some of which are over 5 to 10 times more potent than fentanyl—have recently been identified in counterfeit pills, illicit powders, unregulated cannabis products and vape liquid, often without the user’s knowledge.

“Having access to and knowing how to administer naloxone is becoming increasingly important in our communities,” said DHSS Director Sarah Willson. “It is easy and safe to use and can reverse an opioid overdose and allow a person’s normal breathing to be restored.”

Statewide Wastewater Testing Detects Nitazenes in Schools

Through a DPS-led voluntary school wastewater monitoring program, nitazenes have been detected in 26 of 37 participating Missouri schools since January of this year. This initiative helps communities identify emerging drug trends while protecting individual privacy. These findings align with increases in law enforcement drug surveillance data, emergency department reports and state overdose death investigations collected through DHSS’s State Unintentional Drug Overdose Reporting System.

“Nitazenes are a hidden killer,” DPS Director Mark James said. “Even a tiny amount of nitazenes can cause someone to stop breathing, and they’re increasingly being detected in counterfeit pills – but most people have never heard of them. Protect yourself: avoid using all illicit substances and only use medications obtained directly from a pharmacist with a valid prescription.”

Growing Impact in Missouri

Nitazenes were implicated in 14 Missouri overdose deaths in 2024, more than triple the total number recorded between 2019 and 2023. Health officials warn that traditional drug detection tests do not identify nitazenes, making it more difficult for individuals—and providers—to know when they are present.

Overdose Response and Prevention

Multiple doses of naloxone could be needed to reverse an overdose. Symptoms mirror other opioid overdoses, including slowed or absent breathing, pinpoint pupils, unconsciousness and blue or grey lips or skin. Officials urge Missourians to use naloxone in any suspected opioid overdose, even when unsure which drug is involved. Naloxone is safe to administer in all situations.

The four partnering agencies strongly encourage families, educators and community leaders to:

• Talk with children and teens about risks of counterfeit pills, illicit substances and unregulated vapes.
• Understand that any illicit or unregulated substance may be contaminated with nitazenes.
• Keep naloxone on hand and know how to use it if you may be in a position to witness an overdose or if you live with someone at risk.

• Seek substance use treatment or recovery support when needed.
  Resources Available

• 988 Suicide & Crisis Lifeline: Call or text 988 or chat at 988lifeline.org for mental health, substance use or emotional‑distress support.

• Substance use treatment locations: dmh.mo.gov/behavioral-health/treatment-services/locate

• Missouri Poison Center: missouripoisoncenter.org or 1‑800‑222‑1222

• Time2Act – Missouri opioid misuse prevention: time2actmissouri.com

• Free naloxone: getmissourinaloxone.com/pick-up-today
  DHSS, DPS, DESE and DMH remain committed to sharing emerging data, coordinating response strategies and providing the resources needed to keep Missouri communities safe. The agencies will continue working together to monitor nitazene trends, equip schools and families with up‑to‑date information and promote prevention strategies that save lives.

| | | |
Mission of the Missouri Department of Health and Senior Services (DHSS):

To promote health and safety through prevention, collaboration, education, innovation and response.

Health.Mo.Gov | |

| | \| \|
Having trouble viewing this email? View it as a Web page. | |
| | |
| For Immediate Release:
March 24, 2026

Media Contact:
Lisa Cox
Missouri Department of Health and Senior Services
Media Inquiry Form

\| \|

Missouri agencies partner to alert public to rising nitazene threat

DHSS, DPS, DESE and DMH issue joint warning following statewide detections in wastewater

JEFFERSON CITY, MO -- The Missouri Department of Health and Senior Services (DHSS), Department of Public Safety (DPS), Department of Elementary and Secondary Education (DESE), and Department of Mental Health (DMH) are jointly alerting Missourians to the growing presence of nitazenes, a highly potent class of synthetic opioids increasingly detected across the state.

DHSS has issued a health advisory urging vigilance, prevention and expanded access to lifesaving resources such as naloxone.

Nitazenes—some of which are over 5 to 10 times more potent than fentanyl—have recently been identified in counterfeit pills, illicit powders, unregulated cannabis products and vape liquid, often without the user’s knowledge.

“Having access to and knowing how to administer naloxone is becoming increasingly important in our communities,” said DHSS Director Sarah Willson. “It is easy and safe to use and can reverse an opioid overdose and allow a person’s normal breathing to be restored.”

Statewide Wastewater Testing Detects Nitazenes in Schools

Through a DPS-led voluntary school wastewater monitoring program, nitazenes have been detected in 26 of 37 participating Missouri schools since January of this year. This initiative helps communities identify emerging drug trends while protecting individual privacy. These findings align with increases in law enforcement drug surveillance data, emergency department reports and state overdose death investigations collected through DHSS’s State Unintentional Drug Overdose Reporting System.

“Nitazenes are a hidden killer,” DPS Director Mark James said. “Even a tiny amount of nitazenes can cause someone to stop breathing, and they’re increasingly being detected in counterfeit pills – but most people have never heard of them. Protect yourself: avoid using all illicit substances and only use medications obtained directly from a pharmacist with a valid prescription.”

Growing Impact in Missouri

Nitazenes were implicated in 14 Missouri overdose deaths in 2024, more than triple the total number recorded between 2019 and 2023. Health officials warn that traditional drug detection tests do not identify nitazenes, making it more difficult for individuals—and providers—to know when they are present.

Overdose Response and Prevention

Multiple doses of naloxone could be needed to reverse an overdose. Symptoms mirror other opioid overdoses, including slowed or absent breathing, pinpoint pupils, unconsciousness and blue or grey lips or skin. Officials urge Missourians to use naloxone in any suspected opioid overdose, even when unsure which drug is involved. Naloxone is safe to administer in all situations.

The four partnering agencies strongly encourage families, educators and community leaders to:

- Talk with children and teens about risks of counterfeit pills, illicit substances and unregulated vapes.
- Understand that any illicit or unregulated substance may be contaminated with nitazenes.
- Keep naloxone on hand and know how to use it if you may be in a position to witness an overdose or if you live with someone at risk.
- Seek substance use treatment or recovery support when needed.

Resources Available

- **988 Suicide & Crisis Lifeline:** Call or text 988 or chat at [988lifeline.org](https://988lifeline.org/) for mental health, substance use or emotional‑distress support.
- **Substance use treatment locations:** [dmh.mo.gov/behavioral-health/treatment-services/locate](https://dmh.mo.gov/behavioral-health/treatment-services/locate)
- **Missouri Poison Center:** [missouripoisoncenter.org](https://missouripoisoncenter.org/) or 1‑800‑222‑1222
- **Time2Act – Missouri opioid misuse prevention:** [time2actmissouri.com](https://time2actmissouri.com/)
- **Free naloxone:** [getmissourinaloxone.com/pick-up-today](https://getmissourinaloxone.com/pick-up-today)

DHSS, DPS, DESE and DMH remain committed to sharing emerging data, coordinating response strategies and providing the resources needed to keep Missouri communities safe. The agencies will continue working together to monitor nitazene trends, equip schools and families with up‑to‑date information and promote prevention strategies that save lives.

| |
| | |
| \| \|
Mission of the Missouri Department of Health and Senior Services (DHSS):

To promote health and safety through prevention, collaboration, education, innovation and response.

Health.Mo.Gov | |

| | | | | |
Having trouble viewing this email? View it as a Web page. | | For Immediate Release:
March 24, 2026

Media Contact:
Lisa Cox
Missouri Department of Health and Senior Services
Media Inquiry Form

| |

Missouri agencies partner to alert public to rising nitazene threat

DHSS, DPS, DESE and DMH issue joint warning following statewide detections in wastewater

JEFFERSON CITY, MO -- The Missouri Department of Health and Senior Services (DHSS), Department of Public Safety (DPS), Department of Elementary and Secondary Education (DESE), and Department of Mental Health (DMH) are jointly alerting Missourians to the growing presence of nitazenes, a highly potent class of synthetic opioids increasingly detected across the state.

DHSS has issued a health advisory urging vigilance, prevention and expanded access to lifesaving resources such as naloxone.

Nitazenes—some of which are over 5 to 10 times more potent than fentanyl—have recently been identified in counterfeit pills, illicit powders, unregulated cannabis products and vape liquid, often without the user’s knowledge.

“Having access to and knowing how to administer naloxone is becoming increasingly important in our communities,” said DHSS Director Sarah Willson. “It is easy and safe to use and can reverse an opioid overdose and allow a person’s normal breathing to be restored.”

Statewide Wastewater Testing Detects Nitazenes in Schools

Through a DPS-led voluntary school wastewater monitoring program, nitazenes have been detected in 26 of 37 participating Missouri schools since January of this year. This initiative helps communities identify emerging drug trends while protecting individual privacy. These findings align with increases in law enforcement drug surveillance data, emergency department reports and state overdose death investigations collected through DHSS’s State Unintentional Drug Overdose Reporting System.

“Nitazenes are a hidden killer,” DPS Director Mark James said. “Even a tiny amount of nitazenes can cause someone to stop breathing, and they’re increasingly being detected in counterfeit pills – but most people have never heard of them. Protect yourself: avoid using all illicit substances and only use medications obtained directly from a pharmacist with a valid prescription.”

Growing Impact in Missouri

Nitazenes were implicated in 14 Missouri overdose deaths in 2024, more than triple the total number recorded between 2019 and 2023. Health officials warn that traditional drug detection tests do not identify nitazenes, making it more difficult for individuals—and providers—to know when they are present.

Overdose Response and Prevention

Multiple doses of naloxone could be needed to reverse an overdose. Symptoms mirror other opioid overdoses, including slowed or absent breathing, pinpoint pupils, unconsciousness and blue or grey lips or skin. Officials urge Missourians to use naloxone in any suspected opioid overdose, even when unsure which drug is involved. Naloxone is safe to administer in all situations.

The four partnering agencies strongly encourage families, educators and community leaders to:

• Talk with children and teens about risks of counterfeit pills, illicit substances and unregulated vapes.
• Understand that any illicit or unregulated substance may be contaminated with nitazenes.
• Keep naloxone on hand and know how to use it if you may be in a position to witness an overdose or if you live with someone at risk.

• Seek substance use treatment or recovery support when needed.
  Resources Available

• 988 Suicide & Crisis Lifeline: Call or text 988 or chat at 988lifeline.org for mental health, substance use or emotional‑distress support.

• Substance use treatment locations: dmh.mo.gov/behavioral-health/treatment-services/locate

• Missouri Poison Center: missouripoisoncenter.org or 1‑800‑222‑1222

• Time2Act – Missouri opioid misuse prevention: time2actmissouri.com

• Free naloxone: getmissourinaloxone.com/pick-up-today
  DHSS, DPS, DESE and DMH remain committed to sharing emerging data, coordinating response strategies and providing the resources needed to keep Missouri communities safe. The agencies will continue working together to monitor nitazene trends, equip schools and families with up‑to‑date information and promote prevention strategies that save lives.

| | | |
Mission of the Missouri Department of Health and Senior Services (DHSS):

To promote health and safety through prevention, collaboration, education, innovation and response.

Health.Mo.Gov | | |

| | |
Having trouble viewing this email? View it as a Web page. | | | | | | | |
| | | | | | | | |
| For Immediate Release:
March 24, 2026

Media Contact:
Lisa Cox
Missouri Department of Health and Senior Services
Media Inquiry Form

| |

Missouri agencies partner to alert public to rising nitazene threat

DHSS, DPS, DESE and DMH issue joint warning following statewide detections in wastewater

JEFFERSON CITY, MO -- The Missouri Department of Health and Senior Services (DHSS), Department of Public Safety (DPS), Department of Elementary and Secondary Education (DESE), and Department of Mental Health (DMH) are jointly alerting Missourians to the growing presence of nitazenes, a highly potent class of synthetic opioids increasingly detected across the state.

DHSS has issued a health advisory urging vigilance, prevention and expanded access to lifesaving resources such as naloxone.

Nitazenes—some of which are over 5 to 10 times more potent than fentanyl—have recently been identified in counterfeit pills, illicit powders, unregulated cannabis products and vape liquid, often without the user’s knowledge.

“Having access to and knowing how to administer naloxone is becoming increasingly important in our communities,” said DHSS Director Sarah Willson. “It is easy and safe to use and can reverse an opioid overdose and allow a person’s normal breathing to be restored.”

Statewide Wastewater Testing Detects Nitazenes in Schools

Through a DPS-led voluntary school wastewater monitoring program, nitazenes have been detected in 26 of 37 participating Missouri schools since January of this year. This initiative helps communities identify emerging drug trends while protecting individual privacy. These findings align with increases in law enforcement drug surveillance data, emergency department reports and state overdose death investigations collected through DHSS’s State Unintentional Drug Overdose Reporting System.

“Nitazenes are a hidden killer,” DPS Director Mark James said. “Even a tiny amount of nitazenes can cause someone to stop breathing, and they’re increasingly being detected in counterfeit pills – but most people have never heard of them. Protect yourself: avoid using all illicit substances and only use medications obtained directly from a pharmacist with a valid prescription.”

Growing Impact in Missouri

Nitazenes were implicated in 14 Missouri overdose deaths in 2024, more than triple the total number recorded between 2019 and 2023. Health officials warn that traditional drug detection tests do not identify nitazenes, making it more difficult for individuals—and providers—to know when they are present.

Overdose Response and Prevention

Multiple doses of naloxone could be needed to reverse an overdose. Symptoms mirror other opioid overdoses, including slowed or absent breathing, pinpoint pupils, unconsciousness and blue or grey lips or skin. Officials urge Missourians to use naloxone in any suspected opioid overdose, even when unsure which drug is involved. Naloxone is safe to administer in all situations.

The four partnering agencies strongly encourage families, educators and community leaders to:

• Talk with children and teens about risks of counterfeit pills, illicit substances and unregulated vapes.
• Understand that any illicit or unregulated substance may be contaminated with nitazenes.
• Keep naloxone on hand and know how to use it if you may be in a position to witness an overdose or if you live with someone at risk.

• Seek substance use treatment or recovery support when needed.
  Resources Available

• 988 Suicide & Crisis Lifeline: Call or text 988 or chat at 988lifeline.org for mental health, substance use or emotional‑distress support.

• Substance use treatment locations: dmh.mo.gov/behavioral-health/treatment-services/locate

• Missouri Poison Center: missouripoisoncenter.org or 1‑800‑222‑1222

• Time2Act – Missouri opioid misuse prevention: time2actmissouri.com

• Free naloxone: getmissourinaloxone.com/pick-up-today
  DHSS, DPS, DESE and DMH remain committed to sharing emerging data, coordinating response strategies and providing the resources needed to keep Missouri communities safe. The agencies will continue working together to monitor nitazene trends, equip schools and families with up‑to‑date information and promote prevention strategies that save lives.

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Mission of the Missouri Department of Health and Senior Services (DHSS):

To promote health and safety through prevention, collaboration, education, innovation and response.

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