What Is Isotonitazene and Why Is It So Dangerous?

Since 2019, the synthetic opioid landscape in the United States and Europe has evolved significantly, particularly with the emergence of the 2-benzylbenzimidazole family, commonly referred to as “nitazenes,” as noted by ScienceDirect. Among these, isotonitazene stands out as a particularly hazardous opioid, exhibiting affinities for opioid receptors that make it approximately 100 times more potent than morphine and slightly more so than fentanyl. This substance is often mixed into illicit drugs, much like fentanyl, to enhance potency and reduce production costs. The alarming rise in isotonitazene among unsuspecting users highlights the dangers posed by these powerful synthetic opioids.

Originally developed around six decades ago as a potential alternative to morphine, nitazenes were never made available to the public due to their high risk of addiction and overdose. Their effects mirror those of other opioids, inducing feelings of euphoria, relaxation, drowsiness, pain relief, nausea, vomiting, and irregularities in breathing and heart rate. Experts are increasingly concerned about synthetic nitazenes like isotonitazene, as there is limited knowledge about them, and their potency surpasses that of fentanyl, necessitating further research to comprehend their full impact.

The primary issue with isotonitazene is its illegal sale, often without users’ knowledge that they are consuming it, as it is frequently blended with various substances such as heroin, fentanyl, cocaine, and methamphetamines. This unawareness significantly heightens the risk of fatal overdoses, as individuals may not be ready for its intense effects. Unlike prescribed opioids, isotonitazene is classified as a designer drug, evading regulatory oversight and exhibiting inconsistent potency across different batches. In contrast to fentanyl, which is already notorious for its strength, isotonitazene presents an even greater unpredictability and detection challenge. As a central nervous system (CNS) depressant, it can dangerously slow breathing and heart rate, potentially leading to an isotonitazene overdose if not addressed promptly.

Which of the Following Are Fully Synthetic Opioids?

Opioids can be classified into three main categories: natural, semi-synthetic, and synthetic. This classification includes both prescription medications designed to alleviate pain and illicit substances like heroin, as noted by the National Institute on Drug Abuse. Synthetic opioids are created in laboratories and engineered to mimic the chemical structures of naturally occurring opioids from the opium poppy. While their chemical compositions may resemble those of natural opioids, synthetic variants consist entirely of artificially produced compounds. These synthetic opioids are often utilized as cutting agents in other drugs due to their ability to be manufactured at lower costs while delivering significantly higher potency, which unfortunately leads to a higher risk of accidental overdoses.

The illegal drug market has seen a surge in the availability of more potent synthetic opioids as manufacturers seek to enhance their products with stronger, cost-effective cutting agents. Fentanyl, one of the most prevalent synthetic opioids in the United States, is known to be 50 to 100 times more powerful than morphine. Currently, various analogs of fentanyl are emerging, each with more severe effects and no established medical use. Other synthetic opioids include:

• Tramadol
• Buprenorphine
• Methadone
• Carfentanil
• Acetylfentanyl
• Butyrfentanyl
• 3-Methylfentanyl
• U-47700

A particularly concerning newcomer in the illegal drug scene is isotonitazene, which boasts a potency ranging from 100 to 500 times that of morphine. Isotonitazene-related overdoses are on the rise, primarily because users may unknowingly consume it. Standard toxicology tests typically do not detect this substance, but it can be countered with naloxone, an opioid antagonist used to reverse the effects of opioid overdoses.

How Is Isotonitazene Abused in the United States?

Isotonitazene is exclusively found in illegal drug markets, as it has no recognized medical applications and is not prescribed by healthcare professionals. Typically appearing as a white powder, it can be ingested, inhaled, or injected. Common street names for this substance include nitazene and ISO. It is sometimes manufactured into counterfeit prescription pills that mimic opioids like oxycodone or fentanyl, complicating users’ ability to identify what they are actually taking. Anesthesiology News reports that isotonitazene is being shipped from China, prompting the U.S. Drug Enforcement Agency (DEA) to issue an emergency temporary order classifying it as a Schedule I drug due to its significant potential for abuse, addiction, and overdose.

There are instances of it being mixed with other illicit drugs, especially heroin and cocaine. Users who unknowingly consume it face an increased risk of overdose, as even small quantities can be lethal. Additionally, combining it with stimulants can send mixed signals to the brain and body, heightening the risk of a stroke or heart attack. Furthermore, the potency of this synthetic opioid raises the likelihood of developing dependence and addiction among users.

What Are the Effects of Overdosing on Isotonitazene?

Synthetic opioids like isotonitazene are potent central nervous system (CNS) depressants that can cause respiratory depression, which is the primary cause of death in isotonitazene and opioid overdoses. These substances attach to opioid receptors in the brain and spinal cord, resulting in a decrease in both breathing and heart rate, potentially depriving vital organs of necessary oxygen. If not addressed promptly, respiratory failure can set in within minutes, leading to hypoxia, brain injury, and even death. 

Furthermore, isotonitazene and other opioids can induce hypotension, or low blood pressure, as they depress the cardiovascular system, diminishing blood flow to essential organs and increasing the likelihood of organ failure. Opioids may also trigger nausea and vomiting, raising the risk of aspiration, where vomit enters the lungs and causes choking. Overdoses can be either fatal or non-fatal, but even those that are non-fatal can result in lasting harm. Drug overdoses can lead to comas that may last for hours, days, or even longer, with some individuals never regaining consciousness. Naloxone, an opioid antagonist, can counteract isotonitazene overdoses; however, according to the CDC due to the potency of this drug, multiple doses may be necessary to reverse the effects of the overdose.

How Can Someone Combat Withdrawals from Isotonitazene?

As with other opioids, isotonitazene can lead to severe and distressing withdrawal symptoms when someone tries to quit. Regular use can result in both physical and psychological dependence, but unfortunately, many users are unaware that isotonitazene is present in the drugs they are using until they attempt to stop using or experience an overdose from isotonitazene. The most effective way to handle opioid withdrawal is by seeking assistance from a medical detox center. These facilities offer continuous supervision from healthcare professionals who can provide medications to alleviate withdrawal symptoms from opioid addiction. Moreover, individuals can benefit from emotional support through therapy and support groups, making the challenging journey to recovery a bit more manageable. 

Avoid an Isotonitazene Overdose with Help from Resurgence Behavioral Health

Those who use illegal street drugs are at higher risk than ever of experiencing a deadly overdose due to the rise of potent adulterants like isotonitazene found in various substances. However, overcoming substance use disorders can be incredibly challenging without professional help. Seeking addiction treatment at Resurgence Behavioral Health is one of the most effective ways to prevent an isotonitazene overdose, as our programs address both the physical and psychological aspects of opioid addiction. We offer tailored treatment plans designed to assist individuals in conquering any form of substance addiction, significantly reducing the risk of overdose while providing essential tools for lasting recovery. Our comprehensive care options cater to each person’s unique recovery journey, including medical detox, inpatient care, and outpatient services.

If you would like to speak to one of our intake specialists about your addiction treatment options, contact Resurgence Behavioral Health at 855-458-0050 today. 

External Sources

• ScienceDirect – Isotonitazene, a synthetic opioid from an emerging family: The nitazenes
• National Institute on Drug Abuse – Opioids
• Anesthesiology News – Will Isotonitazene Be Our New Overdose Crisis Drug?
• Centers for Disease Control (CDC) – Nitazene – Related Deaths – Tennessee, 2019 – 2021

David Rofofsky
After growing up in New York, David chose to get help with substance abuse in California because of the state's reputation for top-tier treatment. There, he found the treatment he needed to achieve more than nine years of recovery. He's been in the drug and alcohol addiction rehab industry for eight years and now serves as the Director of Admissions for Resurgence Behavioral Health. David remains passionate about the field because he understands how hard it is to pick up the phone and ask for help. However, once the call is made, someone's life can be saved.

Research | Editorial