A fatal and strong opioid, dubbed “ISO,” first entered the illicit drug market in the United States last year and, since August 2019, has claimed the lives of at least 19 Americans, alarming drug experts and causing the Drug Control Administration (DEA) to make arrangements. Most of the deaths occurred in the Midwest, but ISO also occurred in Canada and Europe.
ISO, short for isotonitazene, “is a white or yellow powder [that] can be combined with substances,” said Dr. Roueen Rafeyan, a leading physician at the Gateway Foundation and an assistant professor of psychiatry at Northwestern University.
It is a manufactured opioid, also called “synthetic opioid,” similar to fentanyl, but even more potent, Rafeyan said.”In humans, it’s probably 60 times more potent than morphine,” he added.
Since the onset of the opioid epidemic, doctors and law enforcement have been dealing with waves following waves of new illicit substances.First, they were prescription painkillers. Then, when legislative adjustments made these products more difficult to market, the market turned to heroin and, later, much more potent artificial fentanyl.
Today, experts worry that ISO is the newest harmful illegal opioid that is killing people.ISO has existed since the 1950s, but until now it was not thought to pose a risk to human health, until now.It wasn’t until June this year that the DEA first classified it as a “List I” drug, meaning it “has no lately accepted medical use and one of the main possibilities for abuse,” such as heroin.
“[This] went through the radar,” said Dr. Harshal Kirane, medical director of Wellbridge Addiction Treatment and Research.
It is a derivative of etititazeno, an artificial opioid first developed through pharmaceutical corporations to treat pain, “but because it was strong and had side effects, it was never used for medical purposes,” Rafeyan explained.
So why does ISO look devastating?
“One of the main reasons ISO, in particular, has resurfaced now is that China has banned fentanyl and all its derivatives in 2019,” Kirane said.As fentanyl is suddenly less available, brands began generating other artificial opioids to meet demand, he said.
As the new child in the community, ISO can also “evade regulation,” dr.Rebecca Trotzky-Sirr, assistant professor of clinical emergency medicine at the University of Southern California and medical director of criminal fitness services at LAC USC.In other words, the manufacture, distribution, ownership and use of ISO was not illegal until the DEA made it a Schedule I drug.
But regulation is not the only thing ISO has controlled to evade, but it has also deceived doctors and others who suffer with the use of substances.
“Routine testing doesn’t stumble upon that,” and although 19 other people are known to die from ISO overdoses, that’s likely and probably underestimated, Rafeyan said.ISO similar to only 19 deaths after those bodies underwent autopsies.
Rafeyan described a disturbing organization of instances with devastating consequences due to ISO’s invisibility, where “known cocaine users [bought] cocaine, consumed it, overdosed and died, and believe it is similar to fentanyl, but in fact, the instances are changing .YO ASI.”
Amid the coronavirus pandemic, Trotzky-Sirr said: “We see that other people are turning to other providers to get their medications and there are more unknowns.”
Gateway Foundation, the country’s largest non-profit pharmacological remedy center, is actively conducting urine drug control that will stumble upon ISO, with the goal of producing effects “in a few hours,” Rafeyan said.
He also stressed the importance of immediate testing for others with an overdose to adhere to ISO survival therapy.A drug called Naloxone, also known as Narcan, reverses the effects of opioids and can prevent you from dying from overdose if given quickly.
“There are some reports that Narcan works for [ISO], but you want higher doses and repeated doses,” Rafeyan said.The ISO test will condition that a patient who has used ISO receives a popular amount of naloxone ” and does not work, and providers and doctors are beginning to think it could be anything else, “without a life-saving opportunity.
Naloxone comes as a nasal spray that can be administered through the public to those suspected of having an opioid overdose.
Overall, Kirane said, “ISO represents the next step in this continuous cycle of more potent and easier-to-achieve artificial opioids.”
So what can we do about it? Spreading the word and making naloxone available are two steps to get started.
“It is vital that everyone knows [ISO], the fitness care community, as well as the general population,” Rafeyan said.
Trozky-Sirr said: “Naloxone must be administered to many members of our network and our patients.”
Heather J.Kagan, M.D., is an internal resident physician at Johns Hopkins Hospital and a contributor to the ABC News Medical Unit.
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