What Is Isotonitazene and Why Is It Dangerous?

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Synthetic opioids such as fentanyl and oxycodone have become major drugs of abuse over the last decade. One of the newest drugs to emerge is isotonitazene, which can be deadly for first-time users. It’s part of a growing trend of novel synthetic opioids appearing on the black market and poses a significant challenge for public health and law enforcement agencies.

Read more to learn why some are calling this synthetic pain medication the “new fentanyl.”

What Is Isotonitazene?

Since the late 80’s, the United States has faced a growing opioid crisis, characterized by fatal overdoses in the tens of thousands each year. For most of the last decade, synthetic opioids like fentanyl and oxycodone have been the most dangerous drugs of the crisis.

Since the Chinese ban on fentanyl production in 2019 and increasing US regulation on Oxycodone production, several new opioids have entered the illicit drug market. One of the newer synthetic opioids to emerge is isotonitazene.

First synthesized in the 1950s, isotonitazene comes in both tablet and powder form. Originally, the drug was part of the pharmaceutical industry’s attempt to develop safer opioid medications. Isotonitazene, commonly referred to on the street as “ISO,” belongs to a chemical class of nitro benzimidazoles. In medical settings, this class of compounds is often used for its antimicrobial properties.

More importantly, isotonitazene is the first opioid of this class to be discovered on the black market in recent years. Unfortunately, the differences in the drug’s chemical structure complicates efforts to treat overdoses from fentanyl or other opioids contaminated with ISO.

How Potent is Isotonitazene?

ISO is significantly more potent than more traditional opioids like morphine, and has been associated with the risk of fatal overdose, similar to other opioids. A study in mice found ISO to be significantly more potent than morphine. And according to in vitro pharmacological evidence, it’s 20 times as potent as fentanyl.

Due to its potency, difficulty of detection, and increasing availability, some have labeled isotonitazenethe “new fentanyl.”

Since its appearance in the US in 2019, at least several hundred deaths have been attributed to Isotonatizene. In an effort to deal with this new threat, it has temporarily been made a Schedule I drug by the US Attorney General. This designation will last for two years while new legislation to address it is pending.

Perhaps the worst part: studies show that patients who overdosed on fentanyl mixed with ISO, compared to just fentanyl alone, required more naloxone (Narcan) to be resuscitated. This makes synthetic opioids mixed with ISO more resistant to the actions of first responders.

Isotonitazene in the News

Law enforcement data indicates that isotonitazene is increasingly prevalent in the United States illicit drug market. In April 2019, the United States Customs and Border Protection seized 1.6 grams of isotonitazene in California.

Since then, it has shown up across California, in places such as San Francisco and Santa Rosa. Worldwide, it has continued to increase in prevalence, according to 2024 data from the United Nations Office on Drugs and Crime.

Isotonitazene has been called the new fentanyl due to how potent it is. Some reports have called it 20 to 100 times more potent than fentanyl. While direct comparisons are difficult, it’s  safe to say it’s much more potent than both morphine and oxycodone.

Like other opioids, isotonitazene can cause respiratory depression, where breathing becomes shallow or stops altogether. This is the primary cause of fatal opioid overdoses. The risk is higher with more potent synthetic opioids like isotonitazene.

This high potency, combined with the fact it’s often marketed by dealers as being some other, less potent opioid, means an unsuspecting user runs a high risk of overdose.

What Does the Science Say?

According to a study taken in Milwaukee and Chicago, over a one-and-a-half-year period there were 40 ISO-related deaths – 4% of the total deaths from synthetic opioids as a whole. Since then, ISO has been causing between 40 to 50 deaths a month, with several hundred deaths per year.

While that figure may not seem like a lot, compared to the thousands that die of fentanyl or other opioids, it’s important to keep in mind that Isotonitazene is very new on the scene. As a result, only a few jurisdictions routinely test for it in overdose cases. Therefore, while we can’t know the full extent of ISO’s danger, it’s certainly not “safe” by any means.

It’s also worth noting: when fentanyl first emerged in the early-2010’s, its death count was also in the low hundreds. Then, starting in 2016, it began spiking, and is now at almost 2,000 deaths per year.

Both drugs can also be cut with other, relatively less potent opioids for a cheaper but stronger high. And both can themselves become more potent over time. Thus, the danger of synthetic opioids like ISO should not be underestimated.

And ISO isn’t just being found in just opioids, either – USA Today reported in 2020 that people dying of cocaine overdoses in Illinois and Indiana were found to also have ISO in their system. This is a versatile drug that can show up in any number of substances, including prescription medication.

Finally, ISO is likely not the last synthetic opioid we’ll see. Drug dealers are constantly refining their techniques, coming up with new drugs by slightly tweaking the chemical structure of old ones to avoid detection. Unfortunately, authorities have little way of predicting what will be the next “new fentanyl,” meaning they will continue having to play catch-up with criminals.

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What Are the Signs and Symptoms of Synthetic Opioid Abuse?

Abuse of synthetic opioids like Isotonitazene can lead to various signs and symptoms, both physical and behavioral. It’s important to recognize these signs, as synthetic opioids can be particularly dangerous due to their high potency.

Here are some of the signs and symptoms of ISO abuse:

  • Drowsiness or sedation
  • Shallow, slow, or difficult breathing
  • Constricted (small) pupils
  • Nausea and vomiting
  • Itching or flushed skin
  • Constipation
  • Slurred speech
  • Poor coordination
  • Mood swings, anxiety, irritability, or euphoria
  • Decreased motivation
  • Withdrawal from social activities or responsibilities
  • Doctor shopping (visiting multiple doctors to obtain prescriptions)
  • Illicit drug-seeking behaviors, such as buying drugs from non-medical sources
  • Financial problems related to drug procurement

Signs of an ISO overdose include:

  • Blue nails
  • Clammy skin
  • Breathing trouble
  • Unconsciousness
  • Blue or purple fingernails
  • Vomiting
  • Pinpoint pupils
  • Drowsiness

If you see someone suffering an overdose from isotonitazene, call medical authorities immediately.

What is Isotonitazene Treatment in Orange County?

Upon enrolling in our Orange County drug rehab for ISO abuse, you will first go through an assessment process. This evaluation will look for any co-occurring medical or mental health disorders.

Following that, you will collaborate with our experts to develop a specific treatment plan. As with any substance abuse disorder, treatment for isotonitazene addiction must start with detoxification, followed by residential inpatient treatment. This way, trained medical professionals can help manage the uncomfortable withdrawal symptoms.

MAT for Isotonitazene Addiction

Like other forms of opioid use disorder (OUD), ISO addiction is best treated with a combination of therapy to address emotional or behavioral issues underlying the addiction and medication to suppress withdrawal symptoms and manage cravings. This is known as medication-assisted treatment (MAT).

Research shows that the combination of therapy and medication is the most effective treatment approach for opioids and drugs that impact the brain’s opioid receptors. This is because it treats the whole person – a core tenet of South Coast Behavioral Health’s approach to treatment.

Some MAT drugs used to treat ISO addiction include:

  • Methadone: Methadone is an opioid agonist, meaning it acts on the brain’s opioid receptors to reduce cravings and withdrawal symptoms.
  • Buprenorphine: This has a “ceiling effect” to prevent abuse and is often in conjunction with naloxone. Buprenorphine reduces cravings and withdrawal symptoms.
  • Clonidine: This can treat anxiety, agitation, muscle aches, and sweating.
  • Naltrexone: This blocks the euphoric effects of opioids to prevent a relapse.

Therapy for Isotonitazene Addiction

Individual therapy sessions, group therapy, 12-step programs, and holistic therapies such as yoga and meditation may all be part of your treatment as well.

Our professionals will be with you every step of the way through your isotonitazene treatment. Aside from 24/7 support, you’ll also benefit from the relaxing and tranquil environment our facilities provide, allowing you to focus on recovery without distractions.

Throughout your stay in rehab, you can participate in a wide range of activities and therapies that promote self-reflection, self-care, and personal development. Our goal is to help you not only overcome your addiction, but also lay the groundwork for a healthier, more fulfilling life.

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Choosing the Right Opioid Rehab Center in Orange County

If you or a loved one are struggling with isotonitazene addiction, South Coast Behavioral Health is here to help you. We have a variety of levels of care to offer.

This begins with our medical detox program, in which, after an intake assessment,  you will receive around-the-clock care from our fully-certified medical detox team, who will make your detoxification as comfortable as possible. We have gender-specific rehab programs in Orange County for men and women. To lower the risk of relapse following detox, we also offer medication management to address any cravings you may experience.

After, you’ll enter our residential treatment program. There, while living full-time at the facility, you’ll take advantage of both individual and group therapy sessions as our therapists help you address the factors underlying your addiction.

Our partial hospitalization program offers a compromise between the structure of inpatient treatment and the freedom of outpatient care. You can receive care five to seven days a week for several hours each day, returning home in the evening.

Finally, our intensive outpatient program is yet another step on the road back to full recovery. You’ll attend therapy three to five days a week for group and individual sessions, each session lasting roughly three hours.

Throughout the entire treatment process, you’ll also take advantage of recreational activities, educational seminars, recovery meetings, and build valuable and lifelong bonds with others going through treatment with you.

Get Help For Isotonitazene Addiction Today

No matter how bad isotonitazene addiction may seem, rest assured South Coast can meet your needs. Give us a call today at 866-881-1184 or contact us to start healing today. Our friendly and professional intake team will be happy to answer any questions you might have.

Pierce Willans
Kelly McIntyre
Medically Reviewed by Kelly McIntyre, MS, LMFT
Read More About addiction Treatment & Recovery
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