O is for Opioids and the emergence of ‘Iso’.
Opium has been used by human beings for over 3,000 years and possibly much longer. Although disputed, some scholars believe that opium is mentioned Sumerian clay tablets that date from around 2100 BC. As such they are the world's oldest recorded lists of medical prescriptions. Opium could well have been in use as a medicine for over a millennia at that point.
The story of opium is a fascinating tale in its own right but the actual form of the drug doesn’t see a major change until the German chemist Friedrich Sertürner first extracted an active alkaloid in 1804. He named it after the Greek god of dreams, Morpheus. He noted that it was six times stronger than opium and that because lower doses could reduce the risk of a patient becoming dependent on it. That went well. The marketing of the drug as a form of pain medication began a few years later in 1817.
As the 19th century progressed other alkaloids such a codeine and heroin were isolated and put on sale. The 20th century saw many more products based on opium become part of the medical armoury. Some were semi-synthetic whereby compounds were isolated from the opium poppy such as oxycodone, oxymorphone, and hydrocodone. Others were fully synthetic, being synthesised from petrochemical building blocks. Examples include buprenorphine, methadone and fentanyl.
All opioids are measured against a standard oral dose of morphine, usually 10mg. Heroin is usually put at between two and five times the strength of morphine, methadone around three times and fentanyl between 50-100 times. Carfentanyl has been rated at up to 10,000 times the strength of morphine in some medical papers. Such figures have led to some eye-catching newspaper headlines, but the issue comes down to the amount used or dosage. When the amount of the opioid is being measured in micrograms the possibility of someone administering or using an incorrect dose is substantially increased.
As a comparison most drinkers would be able to reasonably picture in their minds how many pints or bottles it would take to become drunk or to blackout. An opioid user may find this much more difficult task and they would also have the added difficulty that they may not know the strength of the opioid they are using. Such difficulties have led to a surge of fatal overdoes, especially in the United States where in 2018 over 30,000 people passed away following an overdose of a synthetic opioid, usually fentanyl.
It’s quite instructive to look at the process as how new opioids become more prevalent and in time can become a major health concern within a country.
It’s something of a modern urban myth that New Psychoactive Substances (NPS) are ‘cooked up’ by some James Bond-like villain in his evil lair to sell online to unsuspecting guinea pigs. Most NPS are in fact ‘discovered’ by the systematic trawling of scientific papers for likely-looking candidates to be sold online at a profit. Unfortunately one of the unintended side-effects of greater academic freedom is that such information is much more readily available then in the past. Even when such papers were available in the past they would as likely as not been gathering dust in the cellars of a university library or pharmaceutical company lab. Nowadays such information is often digitised and freely available online.
There is a highly likely that the opioid Isotonitazene was discovered via this method. During the mid-1950s, attempts were made to develop better and safer opioid analgesics. Efforts led to the discovery of a series of 2-benzylbenzimidazole compounds with levels of analgesic potency substantially greater than that of morphine. This group of structurally distinct opioid analgesics included Isotonitazene, as well as Etonitazene and Metonitazene. A patent was duly granted in 1960 to Ciba Pharmaceuticals in Switzerland, but not one of these 2-benzylbenzimidazoles ever became an authorised medicine. It took over sixty years for Isotonitazene to re-surface in 2019, when it was first identified on the illicit drug market.
Some of the other compounds in the newly discovered group such Etonitazene and Conitazene were added to the United Nations Single Convention on Narcotic Drugs of 1961 because of the potential risks they posed to public health. Whether such controls are in place or not it’s the case that some chemical laboratories, often in China, will agree to produce quantities of a ‘research chemical’ for a price. From that it’s a small step to it ending up on the streets of the major drug markets of Europe and North America.
Depending upon who the wholesale purchasers are the product will usually appear in one of two ways. Some will be sold through online or ‘bricks-and-mortar’ headshops based in countries or jurisdictions that have not specifically already banned the substance. They will often ‘brand’ the product in an attempt to increase the sales of their new product. Many online headshops are content to deliver to Irish addresses using discreet packaging which is also designed to avoid the machines and dogs employed by customs authorities. Some companies even offer 100% money-back guarantees if customs succeed in intercepting such products. These companies are commonly legitimate tax-paying companies even if they are operating right on the margins of what is legal. There is some evidence that some of these online companies may be set-up or controlled by organized criminal gangs (OCG’s). The initial market is likely to be people who deliberately seek out the product in order to be of the first to ‘self-experiment’, the so-called ‘psychonauts’.
The second route to market is through the operations of Organised Criminal Gangs (OCG’s) who control all or part of the supply chain of illegal drugs bought by the public. They may try to market such drugs as Isotontiazene as a stand-alone product. It’s here that the slang for the unbranded form of the drug will evolve. Unsurprisingly Isotonitazene was quickly shortened on the street to ‘Iso’, but ‘Toni’ (the middle part of the drug name) also emerged.
Drug dealers are more likely to use the drug as an additive to their existing stocks of other opioids such as heroin. As Isotonitazene is approximately 70x the strength of morphine the addition of Isotonizene will add potency and also to their bottom line. Many of those who purchase a street-level opioid will be unaware that they are using a substance that presents an increased risk to them. As with all stronger forms of opioids such as Isotonitazene and fentanyl the risks of respiratory failure, overdose and death rise are significantly increased.
The presence of Isotonitazene in most countries probably went unnoticed by authorities for some time. Many laboratories don’t currently screen for the drug and others would not have possessed the equipment to measure the very low concentrations that Isotonitazene may present in. In addition laboratories were operating at times with reduced capacity due to restrictions put in place by the continuing presence of the COVID-19 virus.
Initial reports of a new substance such as Isotonitazene began to appear at the local and later national level. Six of the 28 counties of the European Union (EU) had reported cases of Isotonitazene to the EMCDDA early warning system by the end of March 2020. Sweden’s report came from a customs seizure whist sampling in Belgium triggered another report. The report from the United Kingdom stemmed from a biological sample taken at an autopsy. Police in Latvia had made a seizure in January of 2020 and other reports trickled in from Germany and Estonia. While the detected quantities were relatively small, their high potency and the geographical spread of reports led to the processes of the early warning system (EWS) of the EMCDDA swinging into operation. This process has been significantly ‘beefed up’ in recent years making reports available to all member countries as speedily as possible. Interim reports were soon issued and the full risk-assessment for Isotonitazene was published by November of the same year. The report noted that up to that point some 23 people had died with traces of Isotonitazene in their bodies (2 in the EU and 21 in North America). The role that Isotonitazene actually played in each case is however still an unknown.
Parallel to these reports press reporting also grew. In general news reports tended to originate from local media picking up on stories from local emergency departments rather than relaying the findings of official reports. In addition some of the more fleet-of-foot health and police departments in affected areas began to put out health alerts as well. Soon larger news outlets pick up the stories at which point the temptation to sensationalize the story for the sake of circulation or viewing figures crept in.
At the time of writing there are no reports of any use of Isotonitazene in Ireland. Mentions of the drug on Irish websites were no more than links to European reports. It is difficult to predict if Isotonitazene will become a feature of the Irish drugs scene, but access to unbiased information concerning its effects is clearly important for all workers within the drugs field.
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