My first ever academic publication is out!

I'm very proud to share "Isotonitazene as a contaminant of concern in the illegal opioid supply: A practical synthesis and cost perspective".

We discuss a contaminant in the illegal opioid supply. (1/13) https://authors.elsevier.com/a/1bnXx3PEroSnB0

Isotonitazene has been found in the illegal opioid supply (what's sold as heroin) in recent months. It's an opioid as well, but from a different class - the benzimidazoles. Benzimidazoles are very versatile, and show up in proton pump inhibitors, cancer meds, and more. (2/13)

This makes it unrelated chemically to fentanyls, or morphinans like morphine and naloxone.

It was developed in the 1950s, but no drug company was interested, so it fell into obscurity and, crucially, we lack a lot of key data on it. Here's some of what we do know - (3/13)

1. It "behaves" similarly to fentanyl. Its potency and efficacy are similar, so it should feel like fentanyl.

2. Naloxone removes it from μ-opioid receptors. Let me repeat: naloxone works here. Iso is not naloxone-resistant.

3. It's not difficult or expensive to make. (4/13)

There are three main ways to make isotonitazene. The most likely route is a selective reduction that takes only 3 or 4 steps. It costs ~$20/g to produce, and heroin's average US price is ~$150/g. None of the chemicals or materials required to make it are regulated. (5/13)

There are at least two other synthetic pathways, both of which produce an undesired isomer. Isomers can have different effects on the body, but not always. We know nothing about what this isomer does. These pathways are also more difficult. (Regiochemistry headaches.) (6/13)

Unfortunately, fentanyl test strips don't detect isotonitazene. And remember - it hits and acts like fentanyl.

Non-immunoassay detection methods (like mass spec) will be able to detect it, but these modalities aren't commonly available in the US. (7/13)

This underlines how critical harm reduction is.

Isotonitazene has been showing up more and more. Other novel chems are popping up, too. This may be a new drug for most of us, but the solution is an old one. Harm reduction. Progressive policies. (8/13)

1. Don't use drugs alone.

2. Carry naloxone, and if you use drugs, make sure the people around you know how to use it and where it is.

3. We need to stop believing that scheduling and criminalization are going to fix anything. It's the balloon effect in full force. (9/13)

Everyone should carry naloxone. This isn't fringe, even Surgeon General @JeromeAdamsMD endorses this officially.

Find naloxone near you with this interactive map ( https://opioidepidemic.maps.arcgis.com/apps/webappviewer/index.html?id=153b0c32fefc432eae6a0e8439b9f56b),

or if you're in Texas, order it for free at http://morenarcanplease.com . (10/13)

Not using drugs alone is a tall order right now, but there are options. Try FaceTime so a friend can call for help if needed. There's also the Never Use Alone hotline - they only ask for your location in case you need EMS. Otherwise totally confidential. (800) 484-3731. (11/13)

Get involved. Progressive drug policy saves lives, but takes a lot of work to achieve. Support the decriminalization of harm reduction programming + tools. This is needed federally + locally - reach out to your local group + help them. Start here: https://harmreduction.org/resource-center/harm-reduction-near-you/ (12/13)

Thank you so much to my co-authors and friends, Dr. James Myslinski w the US Army CCDC Chemical Biological Center, + @HillPharmD, my supervisor here at @PhARMprogram. Thanks to the brilliant colleagues we cited - @alexkrotulski, @LeoBeletsky, @DrSarahWakeman, @pblancka. (13/13)