Highly potent novel synthetic opioid emerges in region’s drug supply
By Timothy Schafer Local Journalism Initiative Reporter
The new secret killer has made its presence known in Nelson.
A new potent synthetic opioid — isotonitazene — is being abused for its opioidergic effects and has infiltrated the region’s controlled substance drug supply, an Interior Health drug advisory issued Nov. 15 warned.
Fake dilaudid tablets containing isotonitazene (five per cent) contain a very high risk of overdose, the advisory stated.
“Isotonitazene is equally or more potent than fentanyl,” the advisory pointed out. “This means that these fake tablets may be more than 20 times stronger than real dilaudid/hydromorphine tablets.”
Deaths involving synthetic opioids have increased ten-fold from 2013 to 2018 in the United States, with 36,509 nationwide in 2019. Although the largest share of synthetic opioid deaths involve fentanyl, novel synthetic opioids are continuously emerging.
First synthesized in the 1950s, isotonitazene has a similar potency to fentanyl and does not have an established medical use.
Drug checking is one way for people to ensure the dilaudid does not contain isotonitazene, the IH advisory explained.
“The only way to be sure a tablet is genuine is if you get it directly from a pharmacist,” it read.
The emergence of highly potent novel synthetic opioids like isotonitazene underscores the need for comprehensive health services for people with opioid use disorder, the U.S. National Library of Medicine urges.
Acute health risk
According to the U.S. Department of Justice, isotonitazene — similar to fentanyl and other mu-opioid receptor agonists — binds to, and activates the mu-opioid receptor.
“It is well established that substances that act as mu-opioid receptor agonists have a high potential for addiction and can cause dose-dependent respiratory depression,” an article on the opioid stated.
Respiratory depression in an overdose can lead to apnoea, respiratory arrest and death — a risk exacerbated by the use of other CNS depressants.
The opioid fentanyl continues to be the major factor in overdose deaths, detected in 85 per cent of expedited toxicological testing in 2023.
Conversely, a coroners’ service initiative to monitor for the presence of safer supply drugs has found hydromorphone in only three per cent of such tests.
By the numbers
By health authority, in 2023, the highest number of unregulated drug deaths were in the Vancouver Coastal and Fraser health authorities (477 and 454 deaths, respectively), making up 57 per cent of all such deaths during 2023.
The B.C. Coroner said, in September, that drug toxicity is the leading cause of death in the province for those aged 10 to 59, far larger than homicides, suicides, accidents and natural diseases combined.
At least 12,929 people have died since the province declared a toxic drug public health emergency in April 2016.
The Doctors of BC.ca estimated that almost 400,000 British Columbians suffer from some form of addiction or substance misuse.
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