A new synthetic opioid has arrived on the streets of Milwaukee County and health officials say is as powerful as fentanyl. Isotonitazene, nicknamed “iso,” is a synthetic version of etonitazene, an opioid that was first reported in 1957.
Despite it’s highly addictive qualities, and long history, the drug is not yet on the Drug Enforcement Administration’s (DEA) controlled substances list. According to a press release issued by Milwaukee’s Health Department, that means iso is considered legal. The department warns, “it is believed that this new opioid holds the potential to cause widespread harm.”
In June 2020 the drug was temporarily placed on the DEA’s schedule 1 list, alongside heroin, psychedelics and cannabis. “As the United States continues to experience an unprecedented epidemic of opioid misuse and abuse,” reads an agency web page on the temporary listing, “the presence of new synthetic opioids with no approved medical use exacerbates the epidemic. The trafficking and abuse of new synthetic opioids are deadly new trends.”
In May, the state Department of Justice (DOJ) issued a notice to law enforcement about the growing concern over isotonitazene. The drug, by that time, had been identified in several drug overdose deaths in Milwaukee County, as well as in a growing number of cases across the state. “Although these substances may be found as an individual component in a sample,” reads the notice, “they are often found together or in combination with controlled substances such as heroin and fentanyl.”
The high potency of iso means that several doses of Naloxone, better known as Narcan, are often required to revive a person who has overdosed. “Isotonitazene has been marketed on the internet as a legal replacement for controlled opiates,” reads the DOJ alert. Because it’s similar in structure to Etonitazene, which is classified at Schedule 1, iso may soon find itself permanently placed on the DEA’s top list of controlled substances.
Milwaukee’s Medical Examiner’s Office has documented seven cases so far in 2020 of overdoses associated with iso. Sara Schreiber, forensic technical director for the office, told Wisconsin Examiner, “only one has acute [and] the rest have been in combination with other substances.” Milwaukee County may be on its way to having a record year for overdose deaths, shattering a record set just a year ago.
“We are seeing a general trend of iso use among white men between the ages of 26-52,” states the health department’s press release. “ We are also finding that iso is often being used with other drugs, which increases a user’s risk of an overdose and death.”
The department is also requesting the public’s input and help. “We are asking the public to be aware of this new drug. Like with any opioid use, addiction treatment harm reduction experts recommend people avoid using alone, and carry Naloxone, which can be used to reverse an overdose. The potency of isotonitazene may require more than a usual dose of Naloxone to restore breathing.”
Lastly, the press release adds, “if you or somebody you know is suffering from substance misuse, please contact our Milwaukee Overdose Response Initiative at (414) 286-5230.”