Within the span of one year, isotonitazene, which is a novel psychoactive substance, was implicated in a fatal overdose spike in the Midwestern United States. Isotonitazene is a potent synthetic opioid that structurally resembles etonitazene that is also a synthetic opioid. The drug was first synthesized and reported in medical literature in the 1950s. The drug has the potency similar to or greater than fentanyl. The drug surfaced in early 2019 in America, Canada, and parts of Europe, supposedly from Chinese vendors. In January of 2020, a coroner in the central Illinois city of Peoria released a toxicology report for a person who died a month prior, and test results came back positive for isotonitazene.
Since the time of this report, there have been more fatal overdose deaths, and the city of Peoria saw a 40% increase in overdose deaths within the first quarter of 2020. There is little information about the toxicity of the drug. However, health care professionals believe the synthetic opioid retains the potential to cause widespread harm and is of public health concern. Toxicology screenings across the United States have identified samples of the drug. All the information has been coming entirely from toxicology reports and not drug seizures. Systematic supply reviews have not flagged the drug by law enforcement—only by a few media reports from Canada.
Although many of the reports seem to signal that the limited presence of the drug in the United States is unlikely to surge anytime soon—the drug is not as widely made in Chinese labs as fentanyl, which means it is not smuggled into the United States as often. However, people are unsettled by it, especially those working within the treatment industry. According to the CDC, in 2018, there were 67,367 drug overdose deaths in the United States. When compared to 2017, the age-adjusted rate of overdose deaths decreased by 4.6%. Synthetic opioids were the main driver for drug overdose deaths. Opioids were involved in 46,802 overdose-deaths, which was 69.5% of all deaths.