Isotonitazene vs Fentanyl

Is Isotonitazene the New Fentanyl?

For those that are not involved in drugs — whether that’s using them or working with those affected by them — it can be hard to keep track. Eager to draw in readers, lurid headlines will shout of the dangers of the latest drug with a hard-to-pronounce name, but for most people it might be the first and the last they hear about it.

Isotonitazene, more easily known as ISO or Toni, might be the latest of those drugs. It has garnered even more headlines after Florida’s Attorney General issued a warning linking the drug to an increase in overdose drugs. Many are comparing it to Fentanyl, a powerful opioid painkiller that is frequently used recreationally. The danger of Isotonitazene, it is claimed, is that it is many times more powerful than Fentanyl and just one hit can kill.

What is Isotonitazene?

ISO, like fentanyl, is an opioid. This class of drugs is frequently used medically for pain relief, and fentanyl is perhaps best known for treating chronic pain. However, because of the risk of addiction, opioid painkillers are strictly controlled. Fentanyl, for example, will generally only be prescribed when other forms of pain-relief are no longer effective, most commonly for cancer.

Both Isotonitazene and fentanyl are synthetic opioids — manmade rather than being derived from the opium poppy — and are known for their strength. Fentanyl is typically considered to be around 100 times stronger than morphine, while some claim that ISO can be up to 500 times more powerful. The difficulty in assessing strength is that, because it is made illegally, there are no controls on its manufacture or independent assessment of potency or purity.

Perhaps some of its perceived danger comes from its origin. It is derived from benzimidazole opioids. First synthesized by CIBA Pharmaceuticals in the 1950s, the extreme potency of these drugs, between 1,000 and 1,500 stronger than morphine, means they have never had clinical use. Instead, for the first fifty years since their creation, their only purpose was for research.

However, in the late 90s, the first example of a drug derived from a benzimidazole opioid was found in Europe. Then, in 2019, Isotonitazene was identified in several overdose fatalities in North America and Europe. The sudden rash of deaths, combined with the geographical spread, that followed has raised fears that ISO is becoming more and more widespread, and the deaths so far might just be the beginning of an epidemic.

Is Isotonitazene a hidden killer…?

Opioid drugs can create feelings of pleasure and euphoria in users. But, like any drugs, they come with a range of side effects. Some of these might be considered relatively minor, such as a dry mouth or constipation. However, there are more significant dangers, too. There is a link between long-term opioid use and heart problems, including arrhythmia and increased risk of heart attack. But the biggest immediate risk for users, and first responders, is respiratory depression.

All opioids work on the central nervous system, it’s one of the reasons they are so effective at pain relief. But unfortunately, they are something of a blunt instrument, and also block receptors which manage breathing. Breathing is, ordinarily, something we never think about, it is unconscious and responds to the body’s needs.

Opioids effectively make the nervous system underestimate the need to breathe, meaning less oxygen gets to the brain, and more carbon dioxide remains in the body. And, of course, the more powerful the opioid, the more powerful the effect. And it’s the potency of Isotonitazene that is believed to be behind the spate of overdoses. Users seeking euphoria are, instead, choking themselves to death.

Even when help is sought, an Isotonitazene overdose can still play some tricks. Since it’s a relatively new drug, it is usually not included in drug screens. An over-dosing patient might make it to hospital, but with nothing showing up on tests, treatment might end up fatally delayed. And even if treatment is given, the power of Isotonitazene means that the standard treatment of naloxone — the so-called Lazarus drug — is not always enough to overcome its effects.

With dealers often lacing drugs with other compounds to enhance the effect, and the sometimes less than rigorous manufacturing conditions, the danger of ISO could be in almost any drug. With no way of knowing exactly what is in a package, or the strength of the contents, any drug might contain a fatal amount of ISO.

The fear of Isotonitazene is such that even those who do not take drugs worry about it. Opioids can be absorbed through the skin, fentanyl, for example, can be administered as a patch that is slowly absorbed. This has resulted in first responders being concerned about potential exposure, and even overdose, when attending calls.

In just a few years, it seems, Isotonitazene has become a drug from which no-one is safe.

Is the ISO panic a false alarm?

Of course, the idea of a lethal drug, that can kill in just one dose, has advantages for some. No-one can deny that news sources love sensationalist stories, and there are few stories that do this better than the tragedy of a death from just one, foolish, experiment with drugs. And it makes a great tale for those campaigning against drugs too. When a dangerous drug like ISO is out there, and could be in anything you buy, why would you take the risk of dying for a hit?

But some suggest the dangers of Isotonitazene are overstated. One of the most compelling arguments is that while ISO is killing people, hardly any ISO is seized. ISO rarely features in busts, and the drugs that law enforcement recover have remained largely unchanged since the first Isotonitazene deaths were identified.

Isotonitazene might have its own trafficking networks that, so far, have gone undetected, but this seems unlikely, especially since the drug has, obviously, found its way into users’ hands. Some suggest this backs up the concerns about the lethality of ISO, it is killing people even without a significant supply making its way into the West.

A related, if more cynical, argument is made about the incentive for drug dealers. More potent drugs have benefits for traffickers and dealers: the more potent, the more value and easier to transport the drugs become, but there is a tipping point. Dealers rely on repeat custom, and there’s no business sense in supplying drugs that can kill customers the first time they use them. Even if there were a supply of the drug, it would quickly have been replaced by something that had more viability.

And some drugs researchers have argued that Isotonitazene had already been and gone by the time it was hitting the headlines. Using ISO and the drug they believe was its successor, brorphine, as examples, they suggest that such drugs have a life cycle of just 12-18 months. In their model, the drugs rapidly come to prominence, becoming a feature of the drugs market for around six months or so, during which law enforcement becomes aware of them. The drugs market then begins to adapt, anticipating changes in enforcement and regulation, so that by the time a drug is mainstream knowledge manufacture and supply has already moved on.

… or just too soon to tell?

Unfortunately, it’s probably impossible to tell exactly what place Isotonitazene has in the current market. When both the drugs trade and law enforcement have to keep their work secretive, it’s only possible to pick up parts of the story and try to piece them together. In time, a fuller picture might emerge, as people from both sides of the law share their secrets.

Until then, there are only a few firm conclusions we can make. One is that Isotonitazene can definitely be fatal. Derived from an incredibly powerful synthetic opioid, there is no doubt that an overdose can kill, and that it already has been responsible for the deaths of many drug users. What’s less clear are the circumstances of those deaths. We don’t know if they were aware they were taking ISO, or if the drug they were taking had been cut without their knowledge.

And we know the potency of illegal drugs can vary enormously. While illegal labs are often surprisingly sophisticated, they are still far short of the standards of clinical pharmaceutical manufacture. But while this might pose a risk for those taking Isotonitazene, it is a risk that has always been present with illegal drugs. Ultimately, the drug-taker has to rely on a chain of trust that goes all the way from their dealer to the manufacturer. And while killing their clients might not be in their interests, it’s hard to argue it is a supply chain driven by moral integrity.

Isotonitazene might have been the new fentanyl, and brorphine might be the new ISO, and, sooner or later, something else will take their place. The one thing we can be sure of is that the drugs industry — legal and illegal — is constantly innovating, and law enforcement is constantly responding, and news stories with hard-to-pronounce drug names will be with us for a long time.

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