Highly potent opioid found in Missouri schools' wastewater

In mid-February, Hallsville School District administrators were informed that Hallsville High School’s wastewater had tested positive for nitazene. 

“We wanted to play it pretty close to our chest for a little bit,” said Columbia/Boone County Public Health & Human Services spokesperson Austin Krohn. “You don't want to let these things cause any kind of panic.” 

Nitazenes are illegal opioids that are 5-10 times more potent than fentanyl and hundreds of times stronger than morphine. Krohn said nitazenes have been found in counterfeit pills, marijuana products, vape liquid, cocaine and more. 

He said they have been working closely with Hallsville Schools administrators to ensure they are up to date on nitazenes and are well stocked with naloxone, an opioid overdose reversal medication. 

Dr. Heidi Miller, the Chief Medical Officer for the Missouri Department of Health and Senior Services, said nitazenes were first isolated in the 1950s. 

“And we realized that, because they were so potent, they weren't safe for human consumption,” Miller said. “However, in the illicit drug market — that's the illegal, unregulated drug market — since about 2019, we've started to see nitazenes pop up in the drug supply.” 

The Missouri State Highway Patrol has been finding nitazenes in the state’s illicit drug supply since 2023. Capt. Scott White said that, much like fentanyl, tiny amounts of nitazenes are often pressed into counterfeit pills, which look like prescription medications.

They can also be found laced into other non-opioid drugs, in an effort to make them more addictive. 

“It's like a chocolate chip cookie to where you don't know how big a piece you're getting,” White said. “So, that's another danger of it, there's zero quality control.” 

He said they aren’t sure how nitazenes are getting into the country, but they suspect the pathway is similar to the one used to smuggle fentanyl. 

While nitazenes are not as common as fentanyl, DHSS reports 14 nitazene-related overdose deaths in Missouri in 2024, which is more than three times the number in the previous five years combined. 

Miller said while this is concerning, the state has been able to identify the potential threat and start prevention efforts early —  thanks to wastewater surveillance at schools, such as Hallsville High School.

She said Missouri has been a leader in wastewater surveillance when it comes to monitoring for infectious diseases, such as flu and COVID-19. But last year, the state began a pilot program using wastewater technology to test for the presence of drugs at schools. 

“Folks have to keep in mind that a school wastewater system is also a reflection of the immediately adjacent community,” Miller said. “So, it may reflect illicit drug use in the community, or someone who's traveling to that community, or to teachers or students, and so it is representative of the communities.” 

The Missouri Department of Public Safety operates the voluntary surveillance program, which spokesman Mike O’Connell said is at no cost to the schools. They simply have to coordinate with wastewater sample collectors. 

In the first year of the program, 37 schools volunteered to have their wastewater tested — largely in rural and suburban areas of the state.

O'Connell said at the beginning of the year, 10 of those schools had tested positive for the presence of nitazenes, but less than two months later, that number had grown to 26, which prompted state agencies to issue a joint advisory. 

O’Connell said DPS hopes more schools will join the voluntary surveillance program, but also noted the program’s capacity is somewhat dependent on funding. 

He said the program is currently slated to see its funding halved in the next fiscal year, which might mean not testing all interested schools at once.

Rebecca Smith

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KBIA

“So, if we get higher interest we can expand and move around, rotating the schools that are in it to get the best view and to use the money that's been appropriated for this in the most efficient way to serve the most schools in the most communities.” 

Since the positive tests came back, DPS, the Highway Patrol’s school resource officers, DHSS and the Department of Mental Health have all been working with school officials to make sure they are knowledgeable about nitazenes and know how to react if an overdose occurs. 

Back in Boone County, the health department has also been working with Hallsville Schools administrators. They have shared educational materials, held an overdose response training event for the entire community and are making sure the schools are well-stocked with naloxone, an opioid overdose reversal medication. 

Krohn said naloxone is effective on nitazenes, but due to their potency, it may take several doses of the medication to fully revive someone. 

He added that nitazenes are likely present throughout much of the state — not just in Hallsville and at other schools which tested for the presence of the drug. And it’s also possible they’re laced into other drugs that people don’t expect to be potentially lethal. 

So, he strongly encouraged people to carry naloxone, as anyone can be impacted by opioid overdose.

“This isn't just people struggling with addiction. This is your grandma that got prescribed too many pain meds for her surgery. This is the kid who got into the medicine cabinet… whatever it is and needs naloxone now.” 

He said if you suspect someone is experiencing an opioid overdose — slow or no breathing, non-responsive, a blue or gray tint to the mouth and hands — immediately call 911 and administer naloxone.

There are free naloxone distribution boxes located throughout Columbia and Boone County. 

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