As with fentanyl, nitazenes causes strong and rapid intoxication, but the two drugs have one important difference – ´those who have overdosed on nitazenes do not respond as well to life-saving treatment.

Overall a total of 332 people died from drug overdoses 2021-2024, 262 of whom were men. State prosecutor Raigo Aas said this rise in deaths is the result of the new synthetic opioid. "One main reason is the spread of nitazenes – they cause half of all drug overdose deaths."

National Institute for Health Development (TAI) data shows that between 2018 and 2021, an average of 30 to 40 people died from drug overdoses in Estonia each year. In 2022, the number of fatal overdoses was double that at 80. Lately, the figure has lingered at around a hundred: In 2023, 113 people died from overdoses, while in 2024 the figure was exactly 100. Of that 100, 42 deaths were the result of nitazene abuse.

The remaining fatalities are the result of overdoses or misuse of other narcotics, such as amphetamines, cocaine and cannabis. "Most fatal cases involve polydrug use, which increases the risk of overdose on top of already dangerous substances," said Marin Vaher, senior specialist in the drug addiction department at TAI.

The youngest victim of a nitazene-related overdose from 2024's figures was age 2, while the oldest was 55. The average age of those who died of an overdose stood at 38 years.

Estonia stands out in Europe both for the extent of nitazene use and the severity of its consequences. "The problem is biggest in Estonia and also in Latvia. Most likely biggest in Estonia," Aas noted.

No response to life-saving treatment

Isotonitazene is a potent synthetic substance/opioid, commonly referred to as nitazene. Nitazenes were first observed to be spreading in Estonia from about three years ago.

"If someone overdoses on fentanyl, naloxone is used to resuscitate them. This is used by ambulances and police and is widely available in Estonia. But with nitazenes, naloxone's effect is not as good as it is with fentanyl," Aas went on.

In situations where naloxone has previously saved lives, it may prove too weak with nitazenes. Katri Abel-Ollo, head of the drug field at TAI, told ERR that resuscitating people who have overdosed on nitazenes requires substantial doses of naloxone.

Hundreds of euros profit from one gram

Nitazene is mainly sold in single doses, packaged in small foil folds. One dose costs an average of about €25, and the price tends to range between €20 and €30.

"Single doses are very small amounts – we're talking about milligrams here," Aas clarified. One gram typically yields a couple of dozen single doses.

A gram of nitazene has a street value of anything from €150 to €300, but since this amount can yield up to 30 single doses, this makes it a lucrative product to be peddling. For instance, if 30 doses were made up from one gram of nitazene and each gets sold for the average price of €25, the dealer would make about €750 per gram, which could total a net profit of up to €600 per gram. "We do have people here who earn significant income this way," Aas conceded.

While the quantities of nitazenes may seem small, their effects are extremely powerful, and precise dosing is critically vital: Even a tiny difference of just one milligram could result in overdose and potentially a fatality.

"The amounts may not seem big in terms of mass, but they are sufficient to get a huge number of people intoxicated. For this reason, a few hundred grams or one to two kilograms is a very, very large quantity," explained Aas.

Nitazenes arrive in Estonia as contraband from Latvia, mostly in powder form, but sometimes as concentrate – a pure substance which must be diluted and mixed with other substances. The substance itself originates mostly from China or India.

Into Estonia via Latvia

"It can be said that 99 percent of this substance is brought from Latvia by criminals – either people from Estonia go there to get it, or it is sent from Latvia to Estonia," Aas explained.

Nitazenes are smuggled into Estonia in the hundreds of grams or in quantities of single kilograms. These relatively small volumes make the drug easy to conceal inside clothing or bags and to bring across the open Schengen border between Latvia and Estonia, usually by car or even bus.

Nevertheless, the Tax and Customs Board (MTA) has sometimes been able to intercept large quantities of synthetic opioids, including nitazene, while inspecting vehicles crossing the border.

Once inside Estonia, smugglers often hide the drugs in a cache, which can even be located in the forest and later accessed by the dealer on the Estonian side of the border.

In the largest nitazene-related criminal case seen in Estonia so far, Latvian nationals Atvars Kozlovskis and Arturs Jegorovs were apprehended and Harju County Court last year convicted them for bringing a total of 2.8 kilograms of nitazene into Estonia – an amount that could in theory intoxicate five million people. Some of the substance reached circulation, though about half of it was intercepted.

An anomaly in the Baltics

Strangely, this particular narcotic seems to have been more popular in the Baltic states than elsewhere.

"What's peculiar with nitazenes is that they spread mainly in the Baltic states – Estonia, Latvia, Lithuania. This is an anomaly that is hard to explain – no one can give a good reason why it's so," Aas said.

Such a widespread abuse of nitazenes is currently not being seen elsewhere in Europe. "We are, in a negative sense, so to speak, pioneers," Aas added.

Nitazenes were originally developed in Switzerland as painkillers, back in the late 1950s. The present-day product forms part of the opioid epidemic in the U.S.

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