What Is the Dangerous New Drug Isotonitazene?

Key Takeaways

• Isotonitazene is a highly potent synthetic opioid (nitazene class) originally developed in the 1950s but never approved for medical use due to its high overdose and addiction risk.
• It reappeared in the illicit drug supply around 2019 and has been linked to overdose deaths in the U.S. and internationally, often appearing in counterfeit pills or mixed drug supplies.
• The drug is extremely dangerous because of its potency and unpredictability, with effects similar to or stronger than fentanyl, causing rapid respiratory depression, coma, and death at very small doses.
• Most users are unaware they are taking it, since it is often mixed into other substances and cannot be identified without laboratory testing, increasing the risk of accidental overdose.

Question: 

What is the drug Isotonitazene?

Answer: 

Isotonitazene is a powerful synthetic opioid in the nitazene class that was first developed in the 1950s but never approved for medical use because of its extreme overdose risk. It re-emerged in the illicit drug supply around 2019 and has since been detected in counterfeit pills and mixed drug products across the U.S. and other countries. According to the article, it is considered comparable to or even stronger than fentanyl in potency, meaning only tiny amounts can suppress breathing and quickly lead to coma or death. A major concern is that users often do not know they are consuming it, since it is commonly mixed with other drugs and cannot be detected without specialized laboratory testing. This hidden presence significantly increases the risk of accidental overdose. The article also emphasizes that isotonitazene acts on the central nervous system, and its respiratory-depressing effects are the primary cause of fatal outcomes in overdose cases, making it especially dangerous.

In the fall of 2019, a new synthetic opioid made its debut in the U.S. The drug, called isotonitazene (ISO), is as dangerous and deadly as fentanyl, prompting the U.S. Drug Enforcement Administration (DEA) to send out national warnings nationwide. What exactly is ISO, and why is it such a threat in the world of opiates?

What Is Isotonitazene?

Isotonitazene (ISO) or “new fentanyl,” is one of the newest synthetic opioids gaining popularity within the world of designer drugs. ISO belongs to the benzimidazole class of opioids. Its potency is similar to fentanyl, and it can be found in pill form, powder, and liquid. Isotonitazene was first synthesized in the 1950s as an opioid alternative for medical use and remained in obscurity until 2019 when it was identified by authorities in the Midwest U.S. In 2020, the DEA classified ISO as a Schedule I substance.

The primary source of isotonitazene is China, where it’s manufactured, marketed, and then exported worldwide. It’s typically mixed with other drugs to create a more potent and cheaper end product. In 2022, the DEA reported that most of the ISO they analyzed was in the form of “cheap filler” for other illicit substances, such as heroin, or sold as counterfeit versions of opioids like hydromorphone.

The population that’s likely to abuse isotonitazene appears to be the same as those abusing prescription opioid analgesics, heroin, tramadol, fentanyl, and other synthetic drugs. As with many synthetic opioids, isotonitazene’s effects range from euphoria and numbness to breathing difficulty, coma, and death.

Why Is Isotonitazene Dangerous?

The major concern is that the potency of isotonitazene can—and has—caused deadly overdoses in unsuspecting victims. While there’s still limited study data available because ISO is so new to the scene, overdose deaths involving the drug have been reported in Europe, Canada, and the midwestern U.S.

Because isotonitazene is produced and distributed illegally, many users are unaware of its strength and potential risks. People can unwittingly consume doses that far exceed safe limits, increasing the likelihood of unintentional overdoses and other health risks. The drug acts on the central nervous system, depressing respiratory function. This effect, coupled with its potency, heightens the risk of respiratory failure—a critical factor in each fatal opioid overdose.

Tragically, many overdose victims have no idea they’re ingesting this dangerous and extremely potent drug. According to the DEA, ISO currently can only be properly identified after a lab test, so most people don’t realize they’re buying it until it’s too late.