Isotonitazene: More Potent Than Fentanyl and Spreading Through North America


Plus: The pandemic spurs an increase in alcohol-related liver transplants; and teen weed vaping rises dramatically

By William Wagner

A new menace is upon us, making it yet more difficult to put an end to the opioid epidemic. This one is called isotonitazene, a highly lethal synthetic opioid that is appearing with greater frequency in North America.

In this week’s “From the Journals,” we also highlight the connection between the COVID-19 pandemic and alcoholic hepatitis, as well as the steep increase in teen weed vaping.

From the Canadian Community Epidemiology Network on Drug Use (CCENDU):
The Appearance of Isotonitazene

A recent warning by the CCENDU on the possible presence of isotonitazene in parts of Canada is sparsely worded, but it tells us much about where the opioid epidemic has been headed. The CCENDU alert is a reminder of how complex the opioid epidemic has become. Synthetic opioids like isotonitazene continue to snake into the supply chain of illicit drugs, often producing deadly outcomes before public health officials even learn of their existence. Isotonitazene is stronger than fentanyl, a synthetic opioid that is exponentially stronger than heroin. And so on.

Isotonitazene already has made inroads in the United States. By 2020, according to a report in USA Today, the drug had been connected to overdose deaths in Ohio, Illinois and Indiana. And it seems inevitable that other designer opioids aren’t far behind, if they aren’t here already. “Just as soon as we kill one rat, another one pops up,” Mina Kalfas, MD, an addiction specialist in northern Kentucky, told USA Today. “The attitude of, “Let’s just get rid of it’ doesn’t work.”

Or as a July 2021 study published in the Journal of Analytical Toxicology ominously states: “Synthetic opioids constitute one of the fastest-growing groups of new psychoactive substances (NPS) worldwide.”

From the JAMA Network:
Alcoholic Hepatitis and the Pandemic

The JAMA Network reports on more collateral damage from the COVID-19 pandemic: alcohol-related liver transplants. The article is the result of a University of Michigan study that, in part, identified a significant rise in registrations for the national organ transplant waiting list related to alcoholic hepatitis. Alcoholic hepatitis, as the JAMA Network study states, “can develop after a short period of alcohol misuse.”

[T]his study provides evidence for an alarming increase in alcoholic hepatitis associated with known increases in alcohol misuse during COVID-19.”

—Maia S. Anderson, University of Michigan

The findings square with numerous other studies that have revealed an increase in alcohol and substance use during the pandemic. “[T]his study provides evidence for an alarming increase in alcoholic hepatitis associated with known increases in alcohol misuse during COVID-19,” Maia S. Anderson, MD, a general surgery resident at Michigan Medicine and the first author of the study, said in a news release. “And it highlights the need for public health interventions around excessive alcohol consumption.”

From JAMA Pediatrics:
Teen Weed Vaping Skyrockets

The teen vaping trend extends to marijuana, according to researchers from the University of Queensland in Australia. From 2013 to 2020, they report in JAMA Pediatrics, the percentage of U.S. and Canadian teens who had vaped weed in the previous year nearly doubled, going from 7% to 13%. Furthermore, the number of teens during that time period who had vaped weed in the previous month rose from 2% to 8%. The data was culled from 17 different studies. The researchers write in JAMA Pediatrics that “more effective preventative and response measures are required.”

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