Could there be a new synthetic opiate that is already adding to the addiction crisis? Experts say yes, and that this new opiate already shows signs of infiltrating the street. It’s called isotonitazene. It comes in a white or off-white powder form or is pressed into counterfeit opioid pills, often in less than sterile surroundings.
Considered the newest designer opioid to hit the streets, it has been detected in the blood of overdose fatalities in Indiana, Ohio, and Illinois, as well as being found in a drug raid last year in eastern Canada. In February, police in Halifax, Nova Scotia reportedly seized nearly 2,000 white tablets from a residence and when analyzed, isotonitazene was identified.
Efforts to Stop Its Spread
At this point, the war on isotonitazene has just begun. According to Dr. Lakshmi Sammarco, the Hamilton County, Ohio, coroner, “We only see what we test for. We’re going to start looking for it.” Sammarco thinks now that isotonitazene is a known threat, her office will get a standard test for it so that it can be added to current toxicity screens, and subsequently used for individuals in her county who overdose. “We will probably look back at some overdose deaths to see whether it was present,” she added.
Meanwhile, Peoria County, Illinois coroner Jamie Harwood said recently that isotonitazene was detected in an overdose death last year in his county. According to Harwood, when a toxicology screen came back with no matches to known opioids, he dug deeper to determine the cause of death. Harwood knew that the deceased individual had a history of substance use disorder. “We didn’t have a cause of death,” Harwood said. “It didn’t show up on a normal tox screen.” That’s when his team did an extended toxicity screen to determine how the person died and discovered isotonitazene. “We probably will see it again,” Harwood said.
What Exactly Is Isotonitazene?
Unlike the powerful synthetic opiates, like fentanyl, at the center of the nation’s current epidemic, it is not a fentanyl analog. Interestingly, its availability isn’t fueled by negligent prescription or ethically challenged doctors. Instead, derivatives of the drug appear to be coming to America from international shores and have been sold online recently, according to addiction specialist Mina Kalfas.
Isotonitazene Is a Known Danger but Is It Illegal?
Sammarco said that isotonitazene is derived from a known analgesic opioid. That opioid is etonitazene, a drug first identified in the 1950s and one that is explicitly illegal. Nonetheless, isotonitazene is not illegal because it has yet to be included on the U.S. Drug Enforcement Administration’s controlled substances list. Some addiction treatment specialists warn that as with any opioid, individuals not use the drug alone and carry naloxone with them. Yet other experts say that isotonitazene’s apparent potency could require more than a typical dose of naloxone, an opioid overdose antidote, to restore breathing.
According to Kalfas, the presence of isotonitazene, and similar synthetic drugs, underscore his belief that the opioid epidemic cannot be limited by eliminating one or more drugs. Instead, he says that drug treatment, prevention, and harm reduction need to be emphasized. “Just as soon as we kill one rat, another one pops up,” Kalfas said. “The attitude of ‘let’s just get rid of it’ doesn’t work,” said Kalfas, noting that drugs such as meth and fentanyl have overtaken heroin use in some areas.
Even though the new drug threat is known to several authorities, not everyone is aware of its menacing presence. Tom Fallon, investigative commander for the Hamilton County Heroin Task Force, said he was not aware of isotonitazene. Tom Synan, Newtown Police Chief and a coordinator with the Hamilton County Addiction Response Coalition was also unaware of isotonitazene, even though he has meetings with the Office of National Drug Control Policy about new drugs. Synan said that it is likely isotonitazene will get to the Cincinnati area or that it could already be there.
“We should always be anticipating a new version of a drug,” Synan said. “We’ve learned about these issues since 2016.” He’s referring to the fact that in 2016 northern Kentucky and southwest Ohio were overwhelmed with overdoses after the synthetic opioids carfentanil and fentanyl inundated the drug supplies in those regions. “We will always be reacting when it comes to changes in the drug supply,” Synan said. “It’s why we have to make sure we have the resources needed to keep people alive and connect them to services—so that we can reduce deaths and reduce harm.”
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