This week's NDEWS Hotspot Alerts report includes 34 counties with higher-than-expected drug-related 911 dispatch counts over the previous 7-day period. Read more here. Click here to read more about NDEWS Hotspot Alerts.

What is N-desethyl isotonitazene? N-desethyl isotonitazene is a highly potent synthetic opioid in the nitazene class, closely related to isotonitazene. It is reported to be approximately 20 times more potent than fentanyl, according to an in vitro study.

What was found? Analysis of online discussions indicates that N-desethyl isotonitazene emerged on Reddit in November 2022. A significant spike in interest and discussion occurred from October 2023 to January 2024. As of April 2024, another upward trend in discussions has begun to emerge.

How is it being discussed? Online discussions revolve around subjective effects preferable to other nitazenes, as well as particular mentions of a preference for N-desethyl isotonitazene over street fentanyl. Commenters describe finding the substance in pressed pills, and several commenters recommend volumetric dosing as opposed to ingesting the pills directly. Reddit users warn about the substance's extreme potency, strong addictive potential, and high risk of overdose.

Expert Insight: NDEWS Co-Investigator Dr. Bruce Goldberger provided the following information regarding N-desethyl isotonitazene: N-desethyl isotonitazene, also known as ISO, is a potent synthetic opioid (nitazene analogue) with the potential to cause profound depression of the central nervous system. N-desethyl isotonitazene is a metabolite of isotonitazene but also found as a drug on its own and is approximately 20-times more potent than fentanyl. It has been identified in non-fatal and fatal overdoses, most often in combination with other drugs including fentanyl. The analysis of body fluids and tissues for N-desethyl isotonitazene is challenging due to typically low concentration.

Drug Terms: N-desethyl isotonitazene, Norisotonitazene, N-des-iso

This week's MMWR analyzed data reported to the Toxicology Investigators Consortium (ToxIC) Core Registry from a single hospital operating in the U.S. Census Bureau Western Region from 2017 to 2022. The results showed that patients aged 15–34 years accounted for approximately two-thirds of 143 suspected exposures to counterfeit pills containing fentanyl evaluated at a U.S. hospital. Most patients with exposures were hospitalized, 69% of whom were admitted to an intensive care unit. Substances in addition to fentanyl were detected in approximately 90% of exposures. Similarly, the NDEWS Web Monitoring team reported on the sharp rise in Reddit online mentions of counterfeit M-30 pills in October 2021. Read the report here. Read NDEWS Web Monitoring M-30 Alert here.

A study recently published in Drug and Alcohol Dependence characterized xylazine awareness, desire, use, and exposure among people who use drugs (PWUD) in Rhode Island, US. The results showed that virtually all participants wanted to avoid xylazine exposure. Half of the participants knew what xylazine was, and a quarter suspected previous exposure. Xylazine was detected in 14.5% of samples using FTIR-S and in 21.4% of samples using a dual laboratory approach. Read the study here.

A postmortem forensic toxicology webinar presented by NMS Labs.

Date: Wednesday, July 31, 2024

Time: 1:00 p.m. ET

Register here.

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