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ISO, the newest cause of opioid overdoses

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The relative scarcity of fentanyl on the illicit drug market, caused by China banning its production in August of 2019, has cause a new deadly drug to emerge – Isotonitazine, known as ISO. 


ISO is a derivative of etonitazene, a synthetic opioid first developed by pharmaceutical companies in the 1950’s to treat pain. It is infrequently used in the medical community because of its high potency and dangerous side effects. 


A recent article in U.S. News and World Report stated that ISO is causing 40 to 50 overdose deaths per month in the United States (up from about 6 per month in the summer of 2019). It has been detected in the blood of overdose victims in Indiana, Wisconsin and Illinois where, in some cases, it was mixed with cocaine. The Drug Enforcement Administration (DEA) has now reclassified the potent synthetic opioid as a Schedule 1 drug with a high risk of abuse by users. 


ISO comes in the form of a white, off-white or yellow powder that can be mixed with other substances (e.g., heroin, cocaine) or pressed into tablets. It is believed to be as potent, or slightly more potent than fentanyl. 


"Symetria Recovery has been quick to identify this new problem with ISO that is emerging and has completed internal education regarding it," states Symetria Recovery Chief Medical Officer Dr. Abid Nazeer.   "It has been confirmed that isotonitazene related overdose deaths are on the rise both nationally, and even more so locally.   Symetria has a large presence in Illinois, which is a state seeing one of the highest rates of ISO related fatalities.   This drug is the latest potent synthetic opioid to be manufactured and is giving rise to the same difficulties as Fentanyl.  It is very lethal, being cut into a variety of other drugs unknowingly, not picked up on drug screens, and easily obtained on the dark web.  These qualities are a recipe for fueling another surge in the opioid epidemic.  Treatment professionals on the front lines of this battle need to be aware of the possibility that ISO is now available and being used by their patients." 


ISO is particularly concerning to health practitioners because it is not easily detected in routine toxicology tests. 


There are some reports that overdoses due to ISO can be treated with Narcan, a medication that reverses the effects of opioids. However, increased amounts or multiple doses may be necessary. 


Some side effects of ISO can be: 


  • Respiratory failure 
  • Nausea 
  • Vomiting 

For more information regarding opioid, heroin, prescription drugs or street drugs and alcohol recovery, rehab, addiction or substance use, please contact www.symetriarecovery.com. For yourself or a loved one, comprehensive help is available.   





Dale Willenbrink
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