One of the most dangerous and deadly drugs to ever hit the market could be hiding in plain sight, and if we don’t take swift action, we could be facing another devasting wave of overdose deaths among unsuspecting users.

It’s called ISO, short for isotonitazine, a deadly synthetic opioid that is 100X to 1000X stronger than morphine and 20X more potent than fentanyl. As of this writing, it’s been detected in at least 180 deceased individuals who likely died from ISO overdose in 18 states around the country. However, it’s widely assumed this number is grossly underestimated because most standard toxicology screenings don’t yet include ISO detection. There could be countless more deaths miscategorized as non-opioid related, simply because the coroner didn’t know or have the means to test for ISO.

ISO: The facts

What makes ISO so dangerous, aside from its extreme potency? ISO can be present in powder, tablet or solution form and can be snorted, injected and inhaled by smoking or vaporizing. Like fentanyl, ISO is often mixed into other drugs like heroin or even counterfeit Xanax pills, so users have absolutely no idea they’re ingesting it. That means a casual or experimental user might show up at a party, take a Xanax that’s offered to them just to relax and have a good time, and end up in the ER fighting for their life.

Because no one is aware the ISO was present, bystanders may be ill-equipped to respond. Narcan can counteract the effects of ISO, but because ISO is still so new, there is no currently established protocol for dosing. Even first responders may not know exactly how to treat ISO overdose, or worse, may not be able to respond quickly enough or have enough Narcan on hand to reverse ISO’s immediate and deadly effects.

A deadly concoction

For those unfamiliar with the drug trade, you might be wondering why illicit drug manufacturers would lace their product with something so deadly? Wouldn’t they want to keep their customers alive? The answer is poor or careless compounding.

ISO belongs to a family of synthetic opioids investigated as potential analgesics in the 1950s, but ISO was determined to have no clinical value. Authorities believe this most recent formulation was produced by a Chinese vendor in anticipation of a fentanyl production ban. So, while ISO itself is created by highly skilled chemists, those who are mixing it into the end product aren’t likely as sophisticated.

The goal of blending ISO (or fentanyl, for that matter) is to increase the effect of the primary drug and to deliver a better high or to enhance its addictive properties to keep users coming back for more. But because dealers are more concerned with profits than quality, their products get cut and blended with other substances. And because it takes such a miniscule amount of ISO to have devastating effects, imperfect blending can lead to deadly results. This is compounded by the fact that the user may have never ingested ISO before, so they have zero tolerance, making an overdose even more likely.

Tighter controls led to unintended consequences 

But how do drugs like ISO even become desirable? Simply put, through the law of supply and demand. Few would argue that clamping down on opioid prescriptions was a necessary step toward reducing the plague of opioid addiction. But tighter opioid controls have actually had devastating unintended consequences, as opioid-addicted individuals turned to other drugs.

This shift paved the way for more dangerous drugs like heroin, fentanyl and ISO to fill the void, driving an unprecedented overdose death rate that, tragically, shows no signs of slowing down.

The path forward

It is impossible to avoid what can’t be seen. There is no identifiable way to determine whether or not a drug has been adulterated with ISO, or any other substance for that matter. As a result, counterfeit Adderall, Xanax, oxycodone and others are becoming less and less likely to be the particular substance that is advertised.

Taking a pill of any kind that was given and not prescribed is a lethal gamble. Unfortunately, these stories are becoming more and more commonplace. The best way to reduce the adverse effects of a substance many may not know about, let alone be able to detect, would be to stay away from it completely.

In our haste to save lives, we may have oversimplified the issue by trying to solve a very complex problem with a single-point solution: cutting off access to the drug. In hindsight—and in real-time—there’s much more that needs to be done to curb the epidemic of addiction in our country.

Photo: Jeffrey Hamilton, Getty Images