COVID-19 ISO Insights

Amid the Pandemic, Old Illicit Synthetic Opioid Returns With a Vengeance

September 28, 2020

By: Christopher Sirota, CPCU

Back in April 2020, we posted about statistics from a CDC analysis which mentioned that, while prescription-involved opioid overdose death rates dropped by 13.5% from 2017 to 2018, death rates involving synthetic opioids (excluding methadone, which is reportedly used to treat opioid addiction), had actually increased by 10%. The CDC noted that 31,355 of the 46,000 opioid overdose deaths in 2018 that they evaluated had resulted from synthetic opioids.

A major synthetic opioid is fentanyl, and much effort have been made to limit access in recent years. The New York Times reported that, in 2016 and 2017, 97% of the fentanyl seized by U.S. law enforcement came from China. In response, per the Times, China tightened the regulatory structure that had previously enabled mass shipments of fentanyl abroad. As a result, shipments of fentanyl to the United States from China “declined significantly” from 2018 to 2019.

However, Vice has reported that these measures have led to an increase of fentanyl development in Mexico, potentially negating the benefits from restricting U.S. imports from China.

Pandemic Impact

In April 2020, one article published in the Wall Street Journal noted that the illicit drug supply chain had been slowed down by the pandemic, but fentanyl was less affected than cocaine or heroin.

According to another Wall Street Journal article, 13% of adults in a June 2020 survey "had started or increased substance use to deal with stress or emotions related to Covid-19."

Although Federal data pertaining to 2020 opioid use is reportedly not available yet, the Journal sought data directly from the top 50 U.S. counties by population, and determined that data from the 21 of the 30 counties that responded indicated an increase in opioid overdoses during the pandemic. Some specific examples include one county in Nevada, which experienced an 8% increase in fentanyl overdoses during the first six months of 2020, and Los Angeles County, which saw "overdoses [rise] 48% to 247 in the first month and a half of the pandemic compared with the same period a year earlier."

Stronger than Fentanyl: Isotonitazene "ISO" Returns

In June 2020, the Drug Enforcement Administration (DEA) placed isotonitazene, a synthetic opioid reportedly created in the 1950s but never used pharmaceutically, on Schedule I of the Controlled Substances Act (CSA). Per the DEA:

Since 2014, numerous synthetic opioids structurally related to fentanyl and several opioids from other structural classes have begun to emerge in the illicit drug market […and] has been reported in Canada, Estonia, Germany, Latvia, Sweden, and the United States.

The population likely to abuse isotonitazene appears to be the same as those abusing prescription opioid analgesics, heroin, tramadol, fentanyl, and other synthetic opioid substances. This is evidenced by the types of other drugs co-identified in isotonitazene fatal overdose cases.

The DEA has identified 19 fatal overdoses in the U.S. relating to this synthetic opioid since August 2019.

According to a related article in ABC News, the aforementioned fentanyl restrictions by China have been partly suspected as cause for the illicit drug market to seek an alternative opioid, such as isotonitazene. Per ABC News, isotonitazene is stronger than fentanyl, perhaps as much as 60 times more potent than morphine. In addition, ABC News notes that isotonitazene may have been under the radar, in part because, until the DEA's action, it was not illegal in the U.S., and, as such, it was not typically a substance that would be identified in routine post mortem examinations.

ABC News adds that the increased awareness of isotonitazene in the market has spurred the development of a new urine drug test that can rapidly identify isotonitazene. This is reportedly important in life or death situation. Although Naloxone spray, the common potentially life-saving treatment for opioid overdoses, is considered effective to reverse the effects of isotonitazene overdose, the standard dosage will not work, which could thus render its application fatally ineffective; a higher and repeated dosage of Naloxone spray is reportedly needed during an isotonitazene overdose.