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Isotonitazene (ISO): The New Deadly Synthetic Opioid Hitting American Streets

Waismann Method®

Waismann Method® Alcohol and Opioid Treatment Specialists Since 1998


A new synthetic opioid more potent than fentanyl is sweeping across the United States

Waismann Method® Experts Warn that Iso May be Responsible for a New Wave of Overdoses in the U.S.A.

We need to provide accessible mental healthcare, effective medical detoxification, and widespread education about prevention to people at risk for opioid addiction.”
— Clare Waismann

BEVERLY HILLS, CALIFORNIA, UNITED STATES, June 23, 2020 / -- A new synthetic opioid more potent than fentanyl is sweeping across the United States, warn experts from the Waismann Method of Advanced Treatment of Opioid Dependence. Called isotonitazene, or “iso,” the drug has caused more than five times as many overdose deaths this year compared to the same time last year. “Iso is an extremely dangerous drug,” commented Clare Waismann, founder of the Waismann Method. “It’s so powerful that even a tiny amount can cause an almost instant overdose.” 

Iso is a synthetic (lab-made) version of the opioid etonitazene. Scientists first discovered etonitazene in 1957, but it was never approved for medical use because it is highly addictive. Etonitazene is about 60 times as potent as morphine. Iso, the synthetic version, is 100 or more times as potent as morphine. 

Iso is an off-white or yellow powder. Like fentanyl, it can be cut into other drugs to increase their potency. Many people end up using iso unintentionally, as they do not realize their drugs have been cut with the substance. Because iso is so new, drug users may be unfamiliar with its effects. Drug enforcement agents in Canada recently seized 1,900 pills that turned out to be iso. 

“ISO” Consequences to the Opioid Crisis

 Geopolitical changes regarding drug manufacturing drive the increase in iso in the United States. After a pressure campaign by the U.S., China banned fentanyl and its derivatives in April 2019. Chinese chemists immediately changed course, developing new opioids based on other chemical structures. Iso is one of these. Because it is so new, it is still legal in the U.S. Ohio issued a notice in May that it will place iso on its list of Schedule I substances, and other states are likely to follow. 

Public health experts are alarmed at the rapid rise of iso. Last summer, there were about six iso-related overdose deaths per month in the U.S. Now, it is up to 50 to 60. That is likely an underestimate of the actual number, as toxicology reports do not routinely include tests for iso. The first iso-related deaths occurred in Illinois and Indiana, where it was detected in people who had used cocaine. While the opioid reversal drug Narcan seems to be effective in reversing iso-related overdose, police warn that it may take several doses to work. 

Waismann warns that the rise of iso and other synthetic opioids represents the next wave in the ongoing U.S. opioid crisis. She continued, “The continued emergence of new and more potent substances is a perfect example of why we cannot fight the opioid epidemic solely by eliminating drugs. Instead, the issue must be addressed at its root cause. We need to provide accessible mental healthcare, effective medical detoxification, and widespread education about prevention to people at risk for opioid addiction.”  

The spread of iso comes at a critical time for the response to the U.S. opioid epidemic. The COVID-19 pandemic has worsened mental health symptoms for many people. It has also restricted access to mental health treatment, meaning people turn to unhealthy coping strategies like opioid abuse. Obtaining high-quality care through a medically assisted detoxification program can help to reverse opioid dependence. Being opioid-free gives patients the opportunity to engage in a supportive aftercare program to address the root causes of their drug-seeking behavior. Only by increasing access to this comprehensive treatment approach will we see an improvement in the U.S. opioid epidemic. 

About the Waismann Method® Opioid Treatment Specialists

Clare Waismann is a Certified Addiction Treatment Counselor. She founded the Waismann Method® more than two decades ago to provide an effective medical solution for opioid use disorder. She has been a tireless advocate for patients struggling with opioid addiction, speaking out about medically assisted options, unfair stigma, and mental illness.

Waismann Method® is a successful, medical-based opioid detoxification treatment. Since 1998, the facility has provided patients from around the world treatment for opioid dependence in a private full-service accredited hospital located in So. California. Dr. Michael H. Lowenstein, our medical director, is a quadruple board-certified M.D. Dr. Lowenstein is also world-renowned for his expertise in medically assisted opioid treatment (including rapid detox), pain management, and anesthesiology.

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