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Worse Than Fentanyl? New Opioid Isotonitazene Deepens Opioid Issue

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Isn’t it enough that fentanyl exists? We’ve got people dropping like flies in the US and beyond, with a lot of these deaths attributable to the extremely powerful opioid. Now it looks like an even more potent opioid, isotonitazene, might make the already awful opioid situation, even worse.

What is isotonitazene?

Isotonitazene – aka Iso – is an opioid drug, derived from benzimidazole, an aromatic organic compound. It’s in the nitrobenzimidazoles chemical classing of opioids, which makes it structurally different than other opioids like fentanyl. This drug is thought to be more potent than fentanyl slightly, and about 2.5X the strength of hydromorphone – often more recognizable under its trade name Dilaudid.

Its said that isotonitazene is 20-100 times more powerful than fentanyl, which is about 100X stronger than morphine (which goes in line with isotonitazene being 500X morphine). One truth is, as very little research exists on the compound, the specifics are unclear. Another truth is, it was not isotonitazene that was originally taken off the street in 2019, but a structural analogue called etonitazene, which has shown to provide 1000X the analgesia level in mice than morphine, but only about 60X the potency level in humans.

Isotonitazene is said to have half the potency of etonitazene, and is expected to have that same discrepancy between animals and people. If the original studies were done on animals, then the 500-1000X stronger than morphine might simply relate to animal studies. Most medical sources say it’s only slightly stronger than fentanyl.


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Isotonitazene, as an opioid, has similar characteristics to fentanyl and other opioids, in that it relieves pain, as well as providing the same side effects of nausea, itchiness, and the possibility of overdose due to the depression of the respiratory system. On August 20th, 2020, the DEA did something it has so far refused to do with other opioids like fentanyl, and put isotonitazene in Schedule I on the Controlled Substances list.

Why it classified this drug as 100% illegal, and not the ones more currently responsible for the growing number of opioid overdose deaths, is not immediately clear. Though it fits into the opioid class of drugs, its considered a ‘designer drug’ because it’s synthetic; though realistically, all other pharmaceutical opioids (called synthetic opioids) are also therefore technically designer drugs in the same way. So once again, making that designation for this specific compound, and not the others, makes very little sense.

San Francisco responds to isotonitazene

So far, what’s the damage with isotonitazene? A report earlier this month out of San Francisco expressed the thought that this new opioid on the streets of the California city, could greatly exacerbate the current opioid situation. Much like fentanyl, its being found as an addition to heroine and other opioid products, as a means to increase potency; and is used to make fake drugs.

There aren’t good overdose statistics specifically related to the drug yet, which is something authorities are keeping an eye on moving forward. As an opioid stronger than fentanyl, which would boast similar addiction rates, the unfortunate expectation is that deaths should increase proportionally to whatever increase in use it undergoes.

For a city like San Francisco, it’s making authorities nervous, as the city had in the neighborhood of 620 overdose deaths last year, with 72% of them attributed to fentanyl (and, I imagine, other synthetic opioids). This, of course, is representative of the overall growing fatalities related to these drugs in many places.

Said Matt Dorsey, District 6 Supervisor, “I just want to make sure that our city is set up to monitor it and to be testing for it.” He sent a letter to the medical examiner in regards to this, saying, “I just want to make sure that the Office of the Chief Medical Examiner has everything it needs to test for every potential drug that’s costing the lives of anyone in San Francisco.”

Where else is Isotonitazene causing problems?

Opioids might be known most for their damage in America, but the reality is that heroin and synthetic opioids cause problems in many countries, and isotonitazene is now a part of this. Though the article about San Francisco came out in February 2023, Isotonitazene has been causing problems elsewhere in the world already.

One of the interesting things about Isotonitazene is that while it was seen in several cases from 2019 – through 2020, it was replaced by other similar opioids upon the US putting the drug in Schedule I. Perhaps this is an indication that if the US wants to get rid of fentanyl, illegalizing it might help. Not to ignore that isotonitazene incidences were replaced by another similar drug metonitazene; but the situation does indicate that putting the effort into a formal illegalization, could help if there are support services to keep patients from picking up another opioid instead.

A 2021 study called Emerging characteristics of isotonitazene-involved overdose deaths: a case-control study investigated isotonitazene deaths from January 1, 2020 – July 31, 2020, in two locations: Cook County, Illinois and Milwaukee County, Wisconsin. It compared it to other synthetic opioids. In these counties, there were 40 overdose deaths from isotonitazene, and 981 from other synthetic opioids. The study noted that isotonitazene deaths usually occurred with other medications, more frequently than the other synthetic opioids; with particularly large concurrent use of the benzodiazepine flualprazolam.

Opioid overdose rates
Opioid overdose rates

Another report from UNODC in 2020 said that isotonitazene was only responsible for eight deaths in the US between June 2019 and December 2019. Either these numbers are lower than reality, the ones above are higher than reality, or the drug gained popularity greatly between 2019 and 2020.

The UK is another location where a little data does exist on deaths. According to the Advisory Council on the Misuse of Drugs, Isotonitazene was related to 24 deaths in 2021. In comparison, 2021 saw 2,219 opioid deaths in the UK (about 45% of all overdoses for the year).

A case report out of Switzerland in 2021 identified three different cases of deaths due to Isotonitazene, though in each case it was used with other drugs. In two cases this involved benzodiazepines among other drugs, and one included alcohol.

Right now, the stated cases are the only ones to give death statistics for the drug. Though it seemed to have its glory period between 2019 and 2021, the recent incidence of it in San Francisco signals that it either is coming back, or the article was more a hype piece about a drug that really isn’t seen often. Given the popularity of opioids, and the desire to get more and powerful versions, its not strange to think its making a reappearance.

The opioid epidemic

Opioids have become one of the bigger health concerns, with the largest issues still in the US, though countries like the UK and Canada certainly have their own issues. The choice by British Columbia in Canada to decriminalize all drugs is in direct relation to the growing opioid issue.

Even so, the US is where the meat of the problem is found. From 2019 to 2020 to 2021, overdose rates went from 73,000 to 93,000 to 107,622. And how many of these deaths did opioids account for? While we were never given an estimate for 2021 that I can find, its expected that over 68,000 of the 93,000 from 2020 were opioid-related, and over 48,000 of the 73,000 from 2019 were as well. Following the trajectory, it could be that close to 100,000 deaths in 2021 were from opioids.

It will be time before we have 2022 numbers, but nothing indicates a decrease, and everything indicates an increase. What did come out earlier this year, is New York City data from 2021 on opioid overdoses. 668 lost their lives that year to drug overdoses, and it was established that just fentanyl (minus other synthetic opioids) was responsible for 80% of these. Overdose numbers for 2021 were 78% higher than in 2019. This makes it the most common drug to show up in overdose scenarios, for five years straight.

The problem is so bad, and is so squarely put on the pharmaceutical companies involved, that in February 2022, Johnson & Johnson, AmerisourceBergen, Cardinal Health, and McKesson, offered Native American communities $590 to settle lawsuits against them for their drugs destroying so many communities. On a global level, the payout number was settled at $26 billion for the same companies.

Multi-billions to be paid by pharma companies over opioids
Multi-billions to be paid by pharma companies over opioids

And while they give the ridiculous line that these payouts don’t constitute guilt: Johnson & Johnson quote: “This settlement is not an admission of any liability or wrongdoing and the company will continue to defend against any litigation that the final agreement does not resolve,” the day I see a pharmaceutical company choose of their own volition to give up that much of their profits… well, you see where I’m going with this.

Those lawsuits aren’t even the end of it. That announcement about the $26 billion, came before another settlement with the entire state of Idaho. In this one, the same companies are paying yet another $119 million. And that’s just Idaho, imagine if the rest of the US states did the same. Maybe some are now.

It doesn’t even stop there. For their part in it, the pharmacy companies CVS, Walgreens, and Walmart were up against more than 300 lawsuits for their participation in the opioid game. And as of November 2022, they’re set to pay out $13 billion.

Perhaps the grossest issue of all? The US government, and any government that allows the drugs through regulation; is not only saying this is all okay (despite whatever lines they use to sound otherwise), they’re promoting the problem further. Hell, last year, it came up to lower guidelines for opioid prescriptions. I mean, is there a better way to say the government is complicit? And all this while ketamine has repeatedly shown comparable abilities for pain control, long lasting effects well beyond treatment, and no addiction or real overdose potential.

Conclusion

Do we have to worry about isotonitazene? With the current opioid issue, you better believe it. The one comforting fact, perhaps, is that at least with this one, the US government was smart enough to actually make it completely illegal.

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DEA Seizes Over 77 Million Fentanyl Pills in 2023

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Summary: The Drug Enforcement Administration (DEA) reported a significant seizure of fentanyl in the past year, amounting to over 77 million fentanyl pills and nearly 12,000 pounds of the substance. This quantity is alarming, as it is enough to potentially kill every American. The DEA’s findings revealed that seven out of ten pills tested contained a potentially lethal dose of fentanyl, with just 2 milligrams being enough to cause a fatal overdose. The seized fentanyl was sometimes disguised as other drugs. Currently, fentanyl is the leading cause of death among Americans aged 18 to 45.

DEA Record Fentanyl Pills Seizure Highlights Growing Opioid Crisis

In a staggering revelation, the DEA announced the seizure of more than 77 million fentanyl pills and nearly 12,000 pounds of fentanyl last year. This amount of fentanyl is sufficient to pose a lethal threat to the entire American population. The DEA’s testing showed that a significant portion of these pills, about 70%, contained a potentially deadly dose of fentanyl. The danger of fentanyl is highlighted by the fact that a mere 2 milligrams can be fatal.

The situation is further complicated by the fact that some of the seized fentanyl was marketed as other types of drugs, misleading users about the substance they were consuming. This deceptive practice significantly increases the risk of overdose and death. The impact of fentanyl is particularly pronounced among young adults, as it has become the leading cause of death for Americans between the ages of 18 and 45. This alarming statistic underscores the severity of the fentanyl crisis in the United States.

Why It Matters: The DEA’s report on fentanyl seizures is a stark reminder of the ongoing opioid crisis in the United States. The sheer volume of fentanyl seized indicates not only the widespread availability of this dangerous drug but also its potential to cause mass casualties. The fact that fentanyl is now the leading cause of death among young adults highlights the urgent need for effective strategies to combat the distribution and use of this lethal substance.

Potential Implications: The DEA’s findings could lead to increased efforts in drug enforcement and stricter regulations on pharmaceuticals. It may also prompt a reevaluation of strategies to address the opioid epidemic, including more robust public health initiatives and education campaigns about the dangers of fentanyl. Additionally, this situation could influence policy decisions regarding drug rehabilitation and treatment programs, emphasizing the need for more resources and support for individuals struggling with addiction.

Source: ABC7


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AI Disclaimer: This news update was created using a AI tools. PsychePen is an AI author who is constantly improving. We appreciate your kindness and understanding as PsychePen continues to learn and develop. Please note that the provided information is derived from various sources and should not be considered as legal, financial, or medical advice.



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Britain’s Cocaine Use: Higher Rates Than Mexico and Colombia

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Summary: A recent report reveals that Britain has the highest rate of cocaine use in Europe, with 2.7% of adults aged 15 to 64 using the drug annually. This equates to approximately 1.02 million people, or one in every 37 individuals. The report places the UK second globally in cocaine use among developed countries, only behind Australia.

Cocaine Use in the UK: A Growing Public Health Concern

According to a report by the OECD (Organisation for Economic Co-operation and Development), Britain has emerged as the largest consumer of cocaine in Europe. The statistics indicate that 2.7% of the population aged between 15 and 64 in England and Wales use cocaine each year, translating to about 1.02 million people or one in every 37 individuals. The usage rate is notably higher among men than women, with one in 26 men admitting to using cocaine compared to one in 63 women.

The UK’s cocaine usage ranks the highest in Europe and second out of 41 developed countries, surpassed only by Australia, which has a usage rate of 4.2%. Interestingly, the UK’s usage rate is higher than that in countries traditionally associated with cocaine production and trafficking, such as Mexico and Colombia.

Professor Ian Hamilton from the University of York attributes this high usage to the drug’s affordability and availability. He notes that in the UK, a small amount sufficient for a night out can be purchased for the price of a cocktail or a couple of pints. The drug’s increased availability and potency have also contributed to its widespread use.

Dr. Niall Campbell, a psychiatrist at the Priory rehab hospital, describes the current situation as an epidemic, noting that cocaine use is no longer confined to the wealthy classes but has become widespread across different social groups. He compares the ease of obtaining cocaine to ordering a pizza.

The widespread use of cocaine has significant health implications. Cocaine can damage the heart, cause irregular heartbeats, and even lead to cardiac arrest. It is also addictive and can adversely affect mental health, potentially causing depression, aggression, and paranoia. The drug’s supply is controlled by criminal gangs, leading to violence and exploitation in ‘county lines’ networks.

Recent figures from the Office for National Statistics show a sharp increase in cocaine-related deaths in England and Wales, with 872 deaths recorded in 2021, more than double the number in 2015. In response to the growing crisis, Switzerland is considering legalizing cocaine, acknowledging that the war on drugs has failed.

The UK Home Office has launched a 10-year drug strategy backed by a record £3 billion investment to tackle the supply of illicit drugs and build a world-class treatment system for drug abuse. This strategy aims to support individuals suffering from addiction and those exploited by criminal gangs.

Source: The Sun


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(More) Research Indicates CBD Can Bring Down Opioid Use

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With an growing opioid overdose issue, you’d think anything that can help, would be used immediately. Recent research (again) ties CBD use with a decrease in opioid prescriptions.

New study on CBD and opioid prescriptions

The study in question, called CBD as a cure-all? The impacts of state-level legalization of prescription cannabidiol (CBD) on opioid prescriptions, was recently published in the Southern Economic Journal. Study researchers for the project came from Wofford College in South Carolina and California State University Bakersfield.

The study examined if state legalization for CBD products, had any affect on opioid prescribing rates; as well as if access through legal dispensaries had any effect on prescription rates. The first measure was country-wide, while the second was a look at the situation by state. The first relied on states with laws for limited access to cannabis products (laws which generally only enable the use of CBD); and the second, on states with general recreational and medical legalization laws that provide access to CBD products via dispensaries.

When looking at the first part, concerning limited access laws, the researchers found no difference in opioid prescribing rates. However, when looking at states that provide access through dispensaries, they found a 6.6% – 8.1% reduction in prescriptions for opioids. A synthetic control model estimate, approximated that there is a reduction of 3.5% in opioid prescribing, two years after a legalization.

CBD vs opioid medications
CBD vs opioid medications

The study found something else interesting, which might apply to more than just CBD. Study results indicate that once users are required to show an ID to buy CBD, or join a patient registry; that the decrease is offset. This indicates a strong desire of patients to maintain privacy; and a reticence to purchase certain products, if it violates that privacy.

Researchers brought there investigation down to a few conclusions concerning how availability of CBD changes opioid use/prescribing. The first is that requiring prescriptions to obtain CBD, does not help reduce opioid prescriptions at all. The second, is that anything that gets in the way of a purchase, like even an ID check, is enough to dissuade many buyers, even if it means not getting the help they need. And third, that if there is really desire to combat the opioid crisis, that easy access to CBD products (dispensaries and/or interstate purchasing ability), is necessary.

The opioid epidemic and why this matters

This is not a study looking at whether people like CBD; it’s a study that aims to establish if CBD is helpful in what is a staggering problem in the US. And so to be clear, before saying anything more, CBD comes with no death toll. If you’ve seen stories about issues with vapes, or tainted products, this is a different concern. Dirty or corrupted products are everywhere, in every industry. The compound of CBD itself, however, does not cause death. In fact, the most it causes negatively, is an uncomfortable couch lock feel for some. But it is unquestionably (and this is important) a non-death toll compound.

Opioids, on the other hand, are completely death toll compounds; and have led to a massive increase in overdose deaths, since their main arrival through the drug OxyContin, in the 1990’s. The opioid issue actually extends to pretty much every other drug class, as opioids are often mixed with most anything; from coke, to meth, to heroin, to alcohol. This means, not only have direct opioid deaths gone up; but deaths in all drug categories have risen, due to mixing with opioids.

In terms of numbers; the 2022 preliminary overdose death numbers for the US, which were released in May, give the number 109,680. There was less of an increase from 2021’s 109,179, than seen in the preceding years; although 109,179 is the updated number, and the preliminary one, was 107,622. This indicates the 2022 preliminary number, could also rise by the time it becomes the official number.

Though still a smaller increase from the previous years, its still an increase; and that means the problem is not getting any smaller, only bigger. 2021’s number, was a 15% increase from 2020’s 93,000 overdose deaths. And that number, went up 30% from the year before. 2019 had about 70,630 fatal overdoses from drugs.

Opioids have skyrocketed overdose death toll in US
Opioids have skyrocketed overdose death toll in US

Between 2019-2022, the overdose number went up 40%. 2018 had 67,367, which was actually lower than 2017’s 70,237. This is the only time recently that we’ve seen the trajectory change. Considering how quickly numbers picked up after this dip; it implies access to opioids shot up, or that the 2018 number might be representative of bad data collection and reporting.

These numbers represent all overdose deaths from all drug classes; not just opioids. In terms of the 2022 number, its expected that approximately 2/3 are related to synthetic opioids. This means, not codeine or heroin; but drugs like oxycodone, fentanyl, and other synthetic compounds that don’t exist in the opium plant, and are considerably stronger than the offerings of previous decades, centuries, and millennia.

Heroin – what used to be the be-all-end-all of drug use, has had relatively consistent overdose death numbers for over 20 years, despite many reports that it spiked up around 2010. You can see from the attached graph, this notion was a bit of an overstatement; and probably just a means of shifting focus from the growing synthetic opioid epidemic, which was already taking off.

Is this the first time we’ve heard CBD can help with opioids?

No, not even close. This conversation has been going on even before CBD was legalized through the 2018 US Farm Bill. The reason is that CBD can reduce addiction anxiety, partly by deactivating opioid receptors. It can also decrease pain issues by working as an anti-inflammatory, and by blocking pain signals to the brain.

And its been bringing down opioid use numbers for many years. A 2014 study out of Johns Hopkins Bloomberg School of Public Health, in conjunction with the Philadelphia Veterans Affairs Medical Center, showed that medical cannabis states had prescription drug death rates 25% lower than in states with medical cannabis allowances. According to the study, states with medical cannabis laws, had approximately 1,700 less yearly deaths from opioids, as of 2010.

Both CBD, and cannabis in general, are cited for their ability to bring down opioid use. As cannabis as a whole (including THC) still has no direct death toll attached, we are once again automatically comparing something that kills no one, to drugs that kill close to 100,000 people a year in the US alone. This should always be remembered when there are fear campaigns in the US over cannabis.

CBD, cannabis, and ketamine are posited to bring down opioid use
CBD, cannabis, and ketamine are posited to bring down opioid use

In terms of cannabis as a whole, this 2022 study indicates the plant can bring down opioid use, and that its not just about CBD. This study, entitled Medical Cannabis Patients Report Improvements in Health Functioning and Reductions in Opiate Use, used a self-report method to evaluate how cannabis use affects opioid taking.

According to study results, a majority of 79% said they used less other pain medication, or stopped using all other pain medications completely, when using medical cannabis. Many (11.4%) said they had improved functionality in life. About 9% of the included participants only had a pain issue, while 49.92% reported pain along with a mental health issue.

Cannabis has been cited as a feasible answer to opioid addiction for so long; that its weird its not pushed by the federal government to deal with the opioid crisis, and that it gets pushback at all. If the idea is to really help people, shouldn’t they get helped? Even if it doesn’t work for a person, or if it only helps some people; the fact that it’s a safe option up against medicines understood to be taking lives by the tens of thousands, makes it silly that we have to make a case for it at all.

Any government lines of ‘concern,’ are shot to hell by the fact that these ‘concerns’ (over things like disproved smear-campaign theories that cannabis promotes psychosis); run alongside over 100,000 deaths a year from drug overdoses. Maybe those deaths should be the ‘concern,’ not a plant that has a chance of helping the problem.

And for that matter, what about ketamine?! CBD and cannabis, can probably help a lot of people. But the harsh reality, is that neither is likely enough for extreme pain issues. However, ketamine is; and much like weed, it offers an answer that comes without a death toll. Once again, any fear complaints about the drug, are gravely misplaced considering that any non-death toll drug (with minimal injury attached), is automatically a better option to a known killer. Yet despite this basic logic; nearly all information on ketamine for pain relief, is so badly suppressed that most people have no idea its an option at all.

Conclusion

The second there was an inkling that a compound like CBD could help with opioid addictions (or cannabis or ketamine); it should have been used immediately, to lower opioid use rates. That we still have to argue about non-lethal compounds while people die left and right; is not a good indication of what we can expect from governments or medical systems, in terms of taking real action. You’re best bet if you’re in the situation of dealing with pain, and don’t want opioids? Do the research, get the products (or sign up for the programs), and get yourself the help you need.

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