Mark Geary did not know what ISO was until his son overdosed on the stuff last year.
Now he keeps his offspring’s ashes in a small urn emblazoned with the Kansas City Chiefs logo. “They were Jeff’s favorite team,” Geary, a retiree in Northern California, told The Post. “He bought what he thought was hydrocodone from a so-called friend at work. But it actually had ISO in it and that is what killed him.”
The synthetic opioid ISO is said to be 20 times stronger than the already deadly fentanyl. Jeff, who was 42 when he died, crossed paths with it when he unknowingly bought counterfeit hydrocodone pills.
“I hate the guy who sold it to Jeff,” Geary said. “I never knew there was a black market where a pill looks like the real thing and is laced with this horrible stuff.”
ISO is being used more and more to make fake Valium and OxyContin pills. As is the case with fentanyl, counterfeiters use ISO because the ingredients of legitimate opiates are more expensive, difficult to obtain and tricky to combine.
Officially known as isotonitazene, the deadly drug is frighteningly easy to obtain in bulk. A Google search leads to a company based in China, with 24/7 customer service and 10 grams available for just $450.
It’s not always deadly, and a person’s tolerance and body size contribute to the likelihood of an overdose. The problem is, users have no way of knowing how much ISO a counterfeiter may have put into a pill.
According to the DEA, two milligrams of fentanyl can constitute a lethal dose. ISO’s toxicity can be considerably higher.
“It’s dangerous because people don’t know the dosage and [counterfeit pills] are illicitly made,” Bruce Goldberger, a professor at the University of Florida College of Medicine, told The Post.
The process for producing lookalike medication is stunningly simple. “You get raw [ISO] and use it as the active ingredient in counterfeit pills,” said Goldberger. “Somebody would put in filler [various inactive products]add ISO, put it into a pill press — which is cheap to buy — and press it into high-value pills.”
“These are not being made in labs,” Brandon del Pozo, former NYPD deputy inspector and current research fellow at the medical school of Brown University, told The Post. “They’re often being mixed in blenders and made on kitchen tables. Every pill and all the powders can be different in terms of exactly what they contain.”
ISO’s path to the black-market drug world has been jagged.
“It was developed in the 1950s as chemical research for treating pain,” said Cameron McNamee, director of policy and communication for the Ohio Board of Pharmacy, which is in charge of that’s state’s controlled substances act. “ISO got abandoned because there are more efficient drugs out there. Maybe [ISO] was too potent or there were too many adverse reactions.”
More recently, McNamee told The Post, it’s been revived after being redeveloped in Europe. “It came to our attention in 2020 when we saw deaths from ISO in the Midwest.”
In Florida, Attorney General Ashley Moody warned in March that ISO could be the culprit behind increasing numbers of drug overdoses. “Isotonitazene,” she said, “is so strong that it can kill just by coming in contact with someone’s skin or being accidentally inhaled.”
A 2020 study by American Society of Addiction Medicine found there to have been at least 40 deadly ODs in two counties (Cook County, Ill., and Milwaukee County, Wis.) from Jan 1 through July 31 of that year, due to the use of ISO.
That said, some experts believe there is severe under-reporting.
“The standards for toxicology vary widely,” said del Pozo. “So the more obscure fentanyl analogues, including ISO, can easily go unidentified.”
In fact, it took three months for Geary to find out the precise drug that led to his son’s death.
McNamee said that the ISO chemicals are produced in China and shipped to the US via Mexico’s drug cartels: “The cartels found a receptive audience in states hit by the opioid crisis.”
But it is not just opioid abusers who are being lured in by this chemical that is easier and cheaper to produce than heroin or morphine — reportedly at 60 times the latter’s strength — while mimicking the effects.
ISO is also being added to cocaine. While it would seem counterintuitive to spike a stimulant with an opiate that produces calming effects, the appeal of such a cocktail is decades old. A so-called speedball, which mixes heroin with cocaine, is what killed John Belushi back in 1982.
The effect has been described as euphoricand McNamee said “we’re seeing cocaine deaths increase because the drug is being adulterated with ISO or fentanyl” – often without the knowledge of users.
“Your typical cocaine users do not believe that opioids apply to them,” McNamee added. “Cocaine users are naïve about opiates.”
As to why underground drug operators would bother importing ISO when fentanyl already seems to be serving its fatal purpose, del Pozo told The Post that it comes down to the potency by volume of ISO.
“That can make it more profitable to produce and more compact to smuggle than other opioids, which is appealing to drug dealers,” I explained. “The problem is that when dealers divide ISO into doses or put it into counterfeit pills, it is hardly a precise process. … Ultimately, ISO makes good business sense for the dealers while being incredibly dangerous for drug users.”
This is precisely what worries Jacqui Berlinna co-founder of Mothers Against Drug Deaths and the mother of an opioid addicted are named Corey. “My son is an addict in San Francisco,” Berlinn told The Post. “Eighteen months ago, dealers begin putting fentanyl into heroin and now he can’t even get heroin at all. It’s all fentanyl; I never thought I’d hear myself saying that I prefer him doing heroin. The possibility that ISO will start popping up next is scary. If he goes back to his dealer and starts getting ISO, it could hit him harder than fentanyl and the dealer will not warn him. It could shut down his respiratory system from him.”
Concurring with del Pozo, Berlinn added, “If the producers can manipulate a drug to be stronger for a cheaper price, they will. It’s all about money, not about safety or anything. It is about making the drug cheaper and stronger. That is all anyone cares about. It’s apocalyptic.”