Following a drug bust earlier this summer, West Palm Beach police sought to warn the public about the local emergence of a dangerous drug even more potent than fentanyl: isotonitazene, known as ISO by its street name.
This synthetic opioid isn’t new but it’s become a growing problem nationwide, including in South Florida.
The drug has been found in contaminated opioids as well as black market benzodiazepines, or depressants, that relieve anxiety and reduce seizures, and is comparable to Xanax. It typically gets pressed into pills and marketed as fentanyl or oxycodone, for instance, but it’s more powerful and more deadly. Researchers say it's 20 to 200 times stronger than fentanyl.
READ MORE: Scientists may have found way to make fentanyl a less dangerous drug – and save lives
Because it can be so deadly, healthcare providers, first responders and law enforcement want to raise awareness about it.
In July, Lt. Joseph Herb with the West Palm Beach Police Department told reporters during a press conference that officials seized over 40 pounds of the drug from a storage facility and a home in Palm Beach County.
West Palm Beach police say they uncovered the dangerous opioid from the nitazene class called N-Desethyl Isotonitazene or "ISO". It is 50 times stronger than #fentanyl. #Poison Help 1-800-222-1222. https://t.co/eTsodyi6nF
— FL Poison Control (@FloridaPoison) July 19, 2024
“If you take two of these, it will kill ya,” Herb said.
They found the drug in different forms, including as a powder and in bricks, but most concerning to Herb, he said, was finding it pressed into oxycontin pills and Percocet.
“That’s kind of scary”
This is “scary” because people overdose on these pills, said Herb, who added it poses "a big problem" in South Florida.
Florida Attorney General Ashley Moody two years ago issued a statewide warning to Floridians about the illicit drug, noting that federal officials reported its first appearance in the U.S. in 2019.
Dr. Kent Mathias, an assistant professor of psychiatry and addiction at the University of Florida College of Medicine, said reversing the effects of isotonitazene with Narcan is difficult outside a hospital. Narcan has been distributed to police and other first responders nationwide for drug overdose victims.
With this particular drug, it typically requires a higher dose than comes in a standard reversal kit to be effective," said Matthias. "The average person or even some first responders don't carry multiple doses of Narcan."
Why standard Narcan isn’t enough
What’s more, ISO lasts for four, even up to six, hours. During that time, a person can feel the effects of the drug. Unfortunately, other deadly side effects are activated. For example, respiratory depression or shallow breathing can occur, leading to carbon dioxide in your blood.
Narcan, the brand name for naloxone, works over a shorter amount of time — 60 to 90 minutes. It takes opiates off the brain’s receptors during that time and restores a person’s breathing.
“After an hour and a half, it doesn't work anymore,” Mathias said. “You could stop breathing again because the Narcan's wearing off, but the isotonidazine's still in their system. Higher doses of Narcan and repeated doses of Narcan will be required to save people.”
"Education is really the key to combat this and to continue looking at addiction as a public health issue, which is what it is. That's how you save lives."Dr. Kent Mathias
Mathias wants people across South Florida and the state to become more aware of it to save lives. It will be hard to know a pill has isotonitazene in it, other than the sign being that a Narcan dose won't be enough.
According to the U.S. Drug Enforcement Administration, synthetic opioids like isotonitazene are only identified in a person’s system in a lab test after death, and for that reason, state or federal agencies don’t know exactly how many people get hospitalized for this particular drug. They only know about it during a forensic exam.
Even without exact numbers, people need to know about it.
“If there's breath, there's hope, but if you're dead, then we can never get you sober and clean,” Mathias said. “If we can institute little things like having somebody with you, if you're going to use, they can give you Narcan and call 911."
When anyone is experiencing an overdose, call 911 immediately. To find access to Narcan or agencies that help with addiction, visit isavefl.com.
