Northeastern Hospital must pay $1.9 million after failing to keep accurate opioid inventory records - MedCity News

One of the most dangerous and deadly drugs ever to hit the market may be hiding in plain sight, and if we don’t act quickly, we could be facing another devastating wave of overdose deaths among unsuspecting users.

It’s called ISO, short for isotonitazine, lethal synthetic opioid which is 100X to 1000X stronger than morphine and 20X more potent than fentanyl. At the time of this writing, it was discovered in at least 180 people died who likely died of an ISO overdose in 18 states across the country. However, this number is widely believed to be a gross underestimate, as most standard toxicology reviews still do not include ISO detection. There may be countless more deaths misclassified as non-opioid-related simply because the medical examiner did not know or have the means to test for ISO.

ISO: The facts

What makes ISO so dangerous besides its extreme power? ISO can come in powder, tablet, or solution form and can be snorted, injected, and inhaled by smoking or vaporizing. Like fentanyl, ISO is often mixed with other drugs like heroin or even fake Xanax pills, so users have absolutely no idea they’re ingesting it. This means that a casual or experimental user could show up at a party, take the Xanax they were offered just to relax and have a good time, and end up in the emergency room fighting for their life.

Since no one is aware of the ISO’s presence, bystanders may not be prepared to react. Narcan can counteract the effects of ISO, but because ISO is still so new, there is currently no established dosing protocol. Even first responders may not know exactly how to treat an ISO overdose, or worse, may not be able to react quickly enough or have enough Narcan on hand to reverse the immediate and deadly effects of ISO .

A deadly mixture

For those unfamiliar with the drug trade, you may be wondering why illegal drug manufacturers would supplement their products with something so deadly? Wouldn’t they want to keep their customers alive? The answer is poor or sloppy mixing.

ISO belongs to a family of synthetic opioids investigated as potential analgesics in the 1950s, but ISO was determined to have no clinical value. Authorities believe this latest wording was manufactured by a Chinese supplier pending the ban on fentanyl production. So while ISO itself is created by highly skilled chemists, those who mix it into the final product are probably not that sophisticated.

The purpose of mixing ISO (or fentanyl, for that matter) is to increase the effect of the parent drug and deliver a better dose or enhance its addictive properties to keep users coming back for more. But because traders are more concerned with profits than quality, their products are chopped up and mixed with other substances. And since it takes such a minimal amount of ISO to have devastating effects, imperfect mixing can lead to deadly results. This is compounded by the fact that the user may never have taken ISO before, so there is zero tolerance, making overdose even more likely.

Tighter controls have had unintended consequences

But how do drugs like ISO become desirable in the first place? Simply put, through the law of supply and demand. Few would argue that curbing opiate prescriptions is a necessary step toward reducing the epidemic of opiate addiction. But tighter controls on opioids actually have devastating unintended consequences as opioid addicts turn to other drugs.

This shift paved the way for more dangerous drugs like heroin, fentanyl, and ISO to fill the void, causing unprecedented overdose deaths that, tragically, shows no signs of slowing down.

The way forward

It is impossible to avoid what cannot be seen. There is no identifiable way to determine if a drug is adulterated with ISO or any other substance for that matter. As a result, counterfeit Adderall, Xanax, oxycodone and others are becoming less likely to be the specific substance being advertised.

Taking any pill that has been given and not prescribed is a deadly bet. Unfortunately, these stories are becoming more common. The best way to reduce the adverse effects of a substance that many may not know about, let alone be able to detect, would be to stay away from it altogether.

In our rush to save lives, we may have oversimplified the problem by trying to solve a very complex problem with a one-point solution: cutting off access to medicine. In hindsight—and in real time—there is much more that needs to be done to curb our nation’s addiction epidemic.

Photo: Jeffrey Hamilton, Getty Images

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