A powerful and little-known synthetic opioid called nitazene is fuelling a deadly drug crisis across the three Baltic States, with Estonia reporting a threefold rise in overdose deaths in recent years, ERR.ee reported on July 15.

Nitazenes are similar in effect to fentanyl, causing rapid and intense intoxication. But there's a critical difference: people who overdose on nitazenes are far less likely to respond to naloxone, the emergency treatment commonly used to reverse opioid overdoses.

The drug, virtually unknown in most of Europe, has taken deep root in Estonia, Latvia and Lithuania, and is now responsible for a significant share of drug-related fatalities.

“What’s peculiar with nitazenes is that they spread mainly in the Baltic states – Estonia, Latvia, Lithuania,” said Estonian State Prosecutor Raigo Aas. “This is an anomaly that is hard to explain – no one can give a good reason why it’s so,” ERR.ee reported.

Estonia has borne the brunt of this trend. Between 2021 and 2024, 332 people in the country died from drug overdoses – most of them men. Prosecutor Aas estimates that nitazenes are responsible for roughly half of those deaths.

This makes nitazenes especially lethal. Even small amounts can be fatal, with as little as a one-milligram difference in dose tipping the scale from intoxication to death. Sold in tiny foil packets, a single dose typically costs €20 to €30 – a low barrier of entry for a high-risk substance.

The drugs are mainly trafficked into Estonia from Latvia, often as a fine powder but sometimes in a more concentrated, pure form. Once inside the country, dealers cut the substance with other materials and sell it in street-ready portions. Most of the raw product, according to the authorities, originates in China or India, ERR.ee said.

The spread of nitazenes in the Baltic region stands in stark contrast to the rest of Europe, where synthetic opioids are far less common. While countries like the UK and Germany remain preoccupied with heroin or prescription opioid misuse, the Baltics have become a rare European epicentre of nitazene abuse.

The reasons for this regional concentration remain unclear. Some experts speculate that established trafficking routes, price factors, or even early supply experiments could have created a market that spiralled quickly. But so far, no definitive explanation has emerged, ERR.ee said.