Medical professionals at the University of Florida are warning of a new deadly drug that is spreading into Florida.
Isotonitazene is a synthetic opioid that was first developed in the 1950s to be a stronger painkiller than morphine, but has never been approved for medical use in the United States.
In 2022, the use of a synthetic combination of N-Desethyl Isotonitazene was reported by NPS Discovery, an open-access drug early warning system in the U.S. Now, UF physicians say they have been seeing an increase in Isotonitazene-related overdoses in Florida.
The drug, also referred to as “ISO,” can reportedly be 20 times stronger than fentanyl. Attorney General Ashley Moody issued an executive order in 2022 adding ISO and other nitazene compounds to the Schedule I drug list because of their ease of accessibility and high potential for abuse and death.
ISO has been linked to overdose deaths in Miami-Dade, Orange, Palm Beach, Pasco, Pinellas, and Polk counties since 2022, according to UF researchers. At least one ISO-related overdose was reported in Marion County this summer.
UF Health Psychiatrist and physician Dr. Kent Matthias told the media that it is very likely ISO has been made all over Florida as well, but because of its synthetic nature, it is much more difficult to detect its presence and differentiate it from other opioids.
“From what my patients tell me, they think they’re gonna buy Oxycodone and the pill looks just like it,” Matthias said. “In reality, it’s either fentanyl or, it looks like more increasingly now, one of these variants like ISO.”
Matthias says even overdose-reversal methods like administering Narcan nasally can prove to be less effective when dealing with ISO.
“Because it’s so much stronger, it typically takes higher doses of Narcan to reverse it… It might take two, three, or four of those to start someone’s breathing again,” Matthias said. “If synthetics continue down this path, we’ll have to either change the dose of Narcan we’re giving people or go down this path of new medications for reversing it.”
Some of the newer overdose-reversal medications, like Opvee, have been approved at the national level. Similarly to naloxone (also known as Narcan), Opvee blocks the effects of opioids, but with a much higher affinity, thus creating a quicker solution that acts more effectively with drugs like ISO which are much stronger and have longer-lasting effects.
Matthias said ISO is being found most commonly in pressed pills and powders bought off the street — but because most law enforcement’s drug tracking system technologies have not yet caught up, it is left undetected until an overdose occurs and ISO is revealed to be the cause of death.
As a recovery and addiction specialist, Matthias recommends people with addictions to substances keep multiple doses of Narcan on hand if they intend to use, or use the substance while supervised by someone who could administer Narcan in the event of an overdose.